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Borrell JA, Karumattu Manattu A, Copeland C, Fraser K, D'Ovidio A, Granatowicz Z, Delgado L, Zuniga JM. Prosthetic home intervention induces cortical plasticity in paediatrics with congenital limb reduction. Brain Commun 2024; 6:fcae044. [PMID: 38978721 PMCID: PMC11228431 DOI: 10.1093/braincomms/fcae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/08/2023] [Accepted: 06/26/2024] [Indexed: 07/10/2024] Open
Abstract
Paediatrics with congenital upper-limb reduction deficiency often face difficulties with normal development such as motor skills, needing assistance with daily activities such as self-care limitations with certain movements, sports, or activities. The purpose of this non-randomized longitudinal controlled trial was to assess, using intent-to-treat analysis, the effects of an 8-week home intervention of prosthetic use on the sensorimotor cortex in paediatrics with congenital upper-limb reduction deficiency. A paediatric population with congenital upper-limb reduction deficiency (n = 14) who were aged 6-18 years and who had a 20° or greater range of motion in the appropriate joint of the affected arm to move the body-powered prosthesis were enrolled. An age- and sex-matched control group (n = 14) was also enrolled. Participants were non-randomized and fitted with a custom low-cost 3D printed prosthesis and participated in 8 weeks of prosthetic use training at home. Control participants utilized a prosthetic simulator. The home intervention incorporated daily use training and exercises utilizing the prosthesis in direct use and assistive tasks explained by the researchers. After the home intervention, both groups displayed significant improvements in gross manual dexterity. During prosthetic use with the affected limb, significant increases in oxygenated hemodynamic responses were only displayed in the left premotor cortex of the upper-limb reduction deficiency group. The novel findings of this non-randomized longitudinal controlled trial suggest that the intervention may have improved the functional role of the left hemisphere which translated to the improvement of learning direction during adaptation to visuomotor control. The prosthetic home intervention was assumed to provide closed-loop training which could provide a direct benefit to the motor development of paediatrics with upper-limb reduction deficiency.
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Affiliation(s)
- Jordan A Borrell
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Center for Biomedical Rehabilitation and Manufacturing, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Department of Occupational Therapy Education, University of Kansas Medical Center, Kansas City, KS 66103, USA
| | | | - Christopher Copeland
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Kaitlin Fraser
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Andrew D'Ovidio
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Zach Granatowicz
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Liliana Delgado
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
| | - Jorge M Zuniga
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA
- Center for Biomedical Rehabilitation and Manufacturing, University of Nebraska at Omaha, Omaha, NE 68182, USA
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Kim T, Zhou R, Gassass S, Soberano T, Liu L, Philip BA. Healthy adults favor stable left/right hand choices over performance at an unconstrained reach-to-grasp task. Exp Brain Res 2024; 242:1349-1359. [PMID: 38563977 DOI: 10.1007/s00221-024-06828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
Reach-to-grasp actions are fundamental to the daily activities of human life, but few methods exist to assess individuals' reaching and grasping actions in unconstrained environments. The Block Building Task (BBT) provides an opportunity to directly observe and quantify these actions, including left/right hand choices. Here we sought to investigate the motor and non-motor causes of left/right hand choices, and optimize the design of the BBT, by manipulating motor and non-motor difficulty in the BBT's unconstrained reach-to-grasp task. We hypothesized that greater motor and non-motor (e.g. cognitive/perceptual) difficulty would drive increased usage of the dominant hand. To test this hypothesis, we modulated block size (large vs. small) to influence motor difficulty, and model complexity (10 vs. 5 blocks per model) to influence non-motor difficulty, in healthy adults (n = 57). Our data revealed that increased motor and non-motor difficulty led to lower task performance (slower task speed), but participants only increased use of their dominant hand only under the most difficult combination of conditions: in other words, participants allowed their performance to degrade before changing hand choices, even though participants were instructed only to optimize performance. These results demonstrate that hand choices during reach-to grasp actions are more stable than motor performance in healthy right-handed adults, but tasks with multifaceted difficulties can drive individuals to rely more on their dominant hand.
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Affiliation(s)
- Taewon Kim
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
- Department of Kinesiology, The Pennsylvania State University, University Park, PA, USA
- Department of Physical Medicine and Rehabilitation, Penn State College of Medicine, Hershey, PA, USA
| | - Ruiwen Zhou
- Department of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Samah Gassass
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Téa Soberano
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Lei Liu
- Department of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Benjamin A Philip
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.
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Kitchen NM, Dexheimer B, Yuk J, Maenza C, Ruelos PR, Kim T, Sainburg RL. The complementary dominance hypothesis: a model for remediating the 'good' hand in stroke survivors. J Physiol 2024. [PMID: 38733166 DOI: 10.1113/jp285561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
The complementary dominance hypothesis is a novel model of motor lateralization substantiated by decades of research examining interlimb differences in the control of upper extremity movements in neurotypical adults and hemisphere-specific motor deficits in stroke survivors. In contrast to earlier ideas that attribute handedness to the specialization of one hemisphere, our model proposes complementary motor control specializations in each hemisphere. The dominant hemisphere mediates optimal control of limb dynamics as required for smooth and efficient movements, whereas the non-dominant hemisphere mediates impedance control, important for countering unexpected mechanical conditions and achieving steady-state limb positions. Importantly, this model proposes that each hemisphere contributes its specialization to both arms (though with greater influence from either arm's contralateral hemisphere) and thus predicts that lesions to one hemisphere should produce hemisphere-specific motor deficits in not only the contralesional arm, but also the ipsilesional arm of stroke survivors - a powerful prediction now supported by a growing body of evidence. Such ipsilesional arm motor deficits vary with contralesional arm impairment, and thus individuals with little to no functional use of the contralesional arm experience both the greatest impairments in the ipsilesional arm, as well as the greatest reliance on it to serve as the main or sole manipulator for activities of daily living. Accordingly, we have proposed and tested a novel intervention that reduces hemisphere-specific ipsilesional arm deficits and thereby improves functional independence in stroke survivors with severe contralesional impairment.
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Affiliation(s)
- Nick M Kitchen
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Brooke Dexheimer
- Department of Occupational Therapy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jisung Yuk
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Candice Maenza
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Paul R Ruelos
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Taewon Kim
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
- Huck Institute of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Robert L Sainburg
- Department of Neurology, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
- Department of Kinesiology, Pennsylvania State University, University Park, Pennsylvania, USA
- Huck Institute of the Life Sciences, Pennsylvania State University, University Park, Pennsylvania, USA
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Yamada M, Jacob J, Hesling J, Johnson T, Wittenberg G, Kantak S. Goal conceptualization has distinct effects on spatial and temporal bimanual coordination after left- and right- hemisphere stroke. Hum Mov Sci 2024; 94:103196. [PMID: 38402657 PMCID: PMC10939720 DOI: 10.1016/j.humov.2024.103196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
Perception of task goal influences motor performance and coordination. In bimanual actions, it is unclear how one's perception of task goals influences bimanual coordination and performance in individuals with unilateral stroke. We characterized inter-limb coordination differences in individuals with chronic right- and left-hemisphere damaged (RCVA: n = 24, LCVA: n = 24) stroke and age-matched neurotypical controls (n = 24) as they completed bimanual reaching tasks under distinct goal conditions. In the dual-goal condition, participants reached to move two virtual bricks (cursors) assigned to each hand toward independent targets. In the common-goal condition, they moved a central common virtual brick representing both hands to a single, central target. Spatial and temporal coordination (cross-correlation coefficients of hand velocity and their time-lag), the redundant axis deviations (the hand deviations in the axis orthogonal to the axis along the cursor-target direction), and the contribution ratio of the paretic hand were measured. Compared to the dual-goal condition, reaching actions to the common-goal demonstrated better spatial bimanual coordination in all three participant groups. Temporal coordination was better during common-goal than dual-goal actions only for the LCVA group. Additionally, and novel to this field, sex, as a biological variable, differently influenced movement time and redundant axis deviation in participants with stroke under the common-goal condition. Specifically, female stroke survivors showed larger movements in the redundant axes and, consequently, longer movement times, which was more prominent in the LCVA group. Our results indicate that perception of task goals influences bimanual coordination, with common goal improving spatial coordination in neurotypical individuals and individuals with unilateral stroke and providing additional advantage for temporal coordination in those with LCVA. Sex influences bimanual performance in stroke survivors and needs to be considered in future investigations.
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Affiliation(s)
- Masahiro Yamada
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America; Department of Kinesiology, Whittier College, Science & Learning Center 304, Whittier, CA, United States of America
| | - Joshua Jacob
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America
| | - Jessica Hesling
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America
| | - Tessa Johnson
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America; Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, United States of America
| | - George Wittenberg
- Department of Neurology, Physical Medicine & Rehabilitation, and Bioengineering, University of Pittsburgh, Geriatrics Research, Education and Clinical Center, Human Engineering Research Laboratory, VA Pittsburgh Healthcare System, United States of America
| | - Shailesh Kantak
- Neuroplasticity and Motor Behavior Lab, Moss Rehabilitation Research Institute, Elkins Park, PA, United States of America; Department of Physical Therapy, Arcadia University, Glenside, PA, United States of America.
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Tomita Y, Mullick AA, Feldman AG, Levin MF. Altered Anticipatory Postural Adjustments During Whole-Body Reaching in Subjects With Stroke. Neurorehabil Neural Repair 2024; 38:176-186. [PMID: 38347695 DOI: 10.1177/15459683241231528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2024]
Abstract
BACKGROUND Coordination between arm movements and postural adjustments is crucial for reaching-while-stepping tasks involving both anticipatory postural adjustments (APAs) and compensatory movements to effectively propel the whole-body forward so that the hand can reach the target. Stroke impairs the ability to coordinate the action of multiple body segments but the underlying mechanisms are unclear. Objective. To determine the effects of stroke on reaching performance and APAs during whole-body reaching. METHODS We tested arm reaching in standing (stand-reach) and reaching-while-stepping (step-reach; 15 trials/condition) in individuals with chronic stroke (n = 18) and age-matched healthy subjects (n = 13). Whole-body kinematics and kinetic data were collected during the tasks. The primary outcome measure for step-reach was "gain" (g), defined as the extent to which the hip displacement contributing to hand motion was neutralized by appropriate changes in upper limb movements (g = 1 indicates complete compensation) and APAs measured as spatio-temporal profiles of the center-of-pressure shifts preceding stepping. RESULTS Individuals with stroke had lower gains and altered APAs compared to healthy controls. In addition, step onset was delayed, and the timing of endpoint, trunk, and foot movement offset was prolonged during step-reach compared to healthy controls. Those with milder sensorimotor impairment and better balance function had higher gains. Altered APAs were also related to reduced balance function. CONCLUSIONS Altered APAs and prolonged movement offset in stroke may lead to a greater reliance on compensatory arm movements. Altered APAs in individuals with stroke may be associated with a reduced shift of referent body configuration during the movement.
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Affiliation(s)
- Yosuke Tomita
- Department of Physical Therapy, Faculty of Health Care, Takasaki University of Health and Welfare, Gunma, Japan
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Aditi A Mullick
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
| | - Anatol G Feldman
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital Site, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC, Canada
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Dexheimer B, Sainburg R, Sharp S, Philip BA. Roles of Handedness and Hemispheric Lateralization: Implications for Rehabilitation of the Central and Peripheral Nervous Systems: A Rapid Review. Am J Occup Ther 2024; 78:7802180120. [PMID: 38305818 PMCID: PMC11017742 DOI: 10.5014/ajot.2024.050398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
IMPORTANCE Handedness and motor asymmetry are important features of occupational performance. With an increased understanding of the basic neural mechanisms surrounding handedness, clinicians will be better able to implement targeted, evidence-based neurorehabilitation interventions to promote functional independence. OBJECTIVE To review the basic neural mechanisms behind handedness and their implications for central and peripheral nervous system injury. DATA SOURCES Relevant published literature obtained via MEDLINE. FINDINGS Handedness, along with performance asymmetries observed between the dominant and nondominant hands, may be due to hemispheric specializations for motor control. These specializations contribute to predictable motor control deficits that are dependent on which hemisphere or limb has been affected. Clinical practice recommendations for occupational therapists and other rehabilitation specialists are presented. CONCLUSIONS AND RELEVANCE It is vital that occupational therapists and other rehabilitation specialists consider handedness and hemispheric lateralization during evaluation and treatment. With an increased understanding of the basic neural mechanisms surrounding handedness, clinicians will be better able to implement targeted, evidence-based neurorehabilitation interventions to promote functional independence. Plain-Language Summary: The goal of this narrative review is to increase clinicians' understanding of the basic neural mechanisms related to handedness (the tendency to select one hand over the other for specific tasks) and their implications for central and peripheral nervous system injury and rehabilitation. An enhanced understanding of these mechanisms may allow clinicians to better tailor neurorehabilitation interventions to address motor deficits and promote functional independence.
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Affiliation(s)
- Brooke Dexheimer
- Brooke Dexheimer, PhD, OTD, OTR/L, is Assistant Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond;
| | - Robert Sainburg
- Robert Sainburg, PhD, OTR, is Professor and Huck Institutes Distinguished Chair, Department of Kinesiology, Pennsylvania State University, University Park, and Department of Neurology, Pennsylvania State College of Medicine, Hershey
| | - Sydney Sharp
- Sydney Sharp, is Occupational Therapy Doctoral Student, Department of Occupational Therapy, Virginia Commonwealth University, Richmond
| | - Benjamin A Philip
- Benjamin A. Philip, PhD, is Assistant Professor, Program in Occupational Therapy, Department of Neurology and Department of Surgery, Washington University School of Medicine, St. Louis, MO
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Kim T, Lohse KR, Mackinnon SE, Philip BA. Patient Outcomes After Peripheral Nerve Injury Depend on Bimanual Dexterity and Preserved Use of the Affected Hand. Neurorehabil Neural Repair 2024; 38:134-147. [PMID: 38268466 PMCID: PMC10922924 DOI: 10.1177/15459683241227222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Little is known about how peripheral nerve injury affects human performance, behavior, and life. Hand use choices are important for rehabilitation after unilateral impairment, but rarely measured, and are not changed by the normal course of rehabilitation and daily life. OBJECTIVE To identify the relationship between hand use (L/R choices), motor performance, and patient-centered outcomes. METHODS Participants (n = 48) with unilateral peripheral nerve injury were assessed for hand use via Block Building Task, Motor Activity Log, and Edinburgh Handedness Inventory; dexterity (separately for each hand) via Nine-Hole Peg Test, Jebsen Taylor Hand Function Test, and a precision drawing task; patient-centered outcomes via surveys of disability, activity participation, and health-related quality of life; and injury-related factors including injury cause and affected nerve. Factor Analysis of Mixed Data was used to explore relationships between these variables. The data were analyzed under 2 approaches: comparing dominant hand (DH) versus non-dominant hand (NH), or affected versus unaffected hand. RESULTS The data were best explained by 5 dimensions. Good patient outcomes were associated with NH performance, DH performance (separately and secondarily to NH performance), and preserved function and use of the affected hand; whereas poor patient outcomes were associated with preserved but unused function of the affected hand. CONCLUSION After unilateral peripheral nerve injury, hand function, hand usage, and patient life arise from a complex interaction of many factors. To optimize rehabilitation after unilateral impairment, new rehabilitation methods are needed to promote performance and use with the NH, as well as the injured hand.
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Affiliation(s)
- Taewon Kim
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Keith R Lohse
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, United States
| | - Susan E. Mackinnon
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO, United States
| | - Benjamin A. Philip
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, United States
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Shih PC, Steele CJ, Hoepfel D, Muffel T, Villringer A, Sehm B. The impact of lesion side on bilateral upper limb coordination after stroke. J Neuroeng Rehabil 2023; 20:166. [PMID: 38093308 PMCID: PMC10717693 DOI: 10.1186/s12984-023-01288-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND A stroke frequently results in impaired performance of activities of daily life. Many of these are highly dependent on effective coordination between the two arms. In the context of bimanual movements, cyclic rhythmical bilateral arm coordination patterns can be classified into two fundamental modes: in-phase (bilateral homologous muscles contract simultaneously) and anti-phase (bilateral muscles contract alternately) movements. We aimed to investigate how patients with left (LHS) and right (RHS) hemispheric stroke are differentially affected in both individual-limb control and inter-limb coordination during bilateral movements. METHODS We used kinematic measurements to assess bilateral coordination abilities of 18 chronic hemiparetic stroke patients (9 LHS; 9 RHS) and 18 age- and sex-matched controls. Using KINARM upper-limb exoskeleton system, we examined individual-limb control by quantifying trajectory variability in each hand and inter-limb coordination by computing the phase synchronization between hands during anti- and in-phase movements. RESULTS RHS patients exhibited greater impairment in individual- and inter-limb control during anti-phase movements, whilst LHS patients showed greater impairment in individual-limb control during in-phase movements alone. However, LHS patients further showed a swap in hand dominance during in-phase movements. CONCLUSIONS The current study used individual-limb and inter-limb kinematic profiles and showed that bilateral movements are differently impaired in patients with left vs. right hemispheric strokes. Our results demonstrate that both fundamental bilateral coordination modes are differently controlled in both hemispheres using a lesion model approach. From a clinical perspective, we suggest that lesion side should be taken into account for more individually targeted bilateral coordination training strategies. TRIAL REGISTRATION the current experiment is not a health care intervention study.
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Affiliation(s)
- Pei-Cheng Shih
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Sony Computer Science Laboratories, Inc, Tokyo, Japan
| | - Christopher J Steele
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Dennis Hoepfel
- Clinic and Polyclinic for Psychiatry and Psychotherapy, Leipzig, Germany
| | - Toni Muffel
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Arno Villringer
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Bernhard Sehm
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
- Department of Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany.
- Department of Neurology, University Hospital Halle (Saale), Halle, Germany.
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Kanade-Mehta P, Bengtson M, Stoeckmann T, McGuire J, Ghez C, Scheidt RA. Spatial mapping of posture-dependent resistance to passive displacement of the hypertonic arm post-stroke. J Neuroeng Rehabil 2023; 20:163. [PMID: 38041164 PMCID: PMC10693118 DOI: 10.1186/s12984-023-01285-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/18/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Muscles in the post-stroke arm commonly demonstrate abnormal reflexes that result in increased position- and velocity-dependent resistance to movement. We sought to develop a reliable way to quantify mechanical consequences of abnormal neuromuscular mechanisms throughout the reachable workspace in the hemiparetic arm post-stroke. METHODS Survivors of hemiparetic stroke (HS) and neurologically intact (NI) control subjects were instructed to relax as a robotic device repositioned the hand of their hemiparetic arm between several testing locations that sampled the arm's passive range of motion. During transitions, the robot induced motions at either the shoulder or elbow joint at three speeds: very slow (6°/s), medium (30°/s), and fast (90°/s). The robot held the hand at the testing location for at least 20 s after each transition. We recorded and analyzed hand force and electromyographic activations from selected muscles spanning the shoulder and elbow joints during and after transitions. RESULTS Hand forces and electromyographic activations were invariantly small at all speeds and all sample times in NI control subjects but varied systematically by transport speed during and shortly after movement in the HS subjects. Velocity-dependent resistance to stretch diminished within 2 s after movement ceased in the hemiparetic arms. Hand forces and EMGs changed very little from 2 s after the movement ended onward, exhibiting dependence on limb posture but no systematic dependence on movement speed or direction. Although each HS subject displayed a unique field of hand forces and EMG responses across the workspace after movement ceased, the magnitude of steady-state hand forces was generally greater near the outer boundaries of the workspace than in the center of the workspace for the HS group but not the NI group. CONCLUSIONS In the HS group, electromyographic activations exhibited abnormalities consistent with stroke-related decreases in the stretch reflex thresholds. These observations were consistent across repeated testing days. We expect that the approach described here will enable future studies to elucidate stroke's impact on the interaction between the neural mechanisms mediating control of upper extremity posture and movement during goal-directed actions such as reaching and pointing with the arm and hand.
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Affiliation(s)
- Priyanka Kanade-Mehta
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Engineering Hall, Rm 342, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Maria Bengtson
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Engineering Hall, Rm 342, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA
| | - Tina Stoeckmann
- Department of Physical Therapy, Marquette University, Milwaukee, USA
| | - John McGuire
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, USA
| | - Claude Ghez
- Department of Neuroscience, Neurology, and Physiology, Columbia University Medical Center, New York, USA
| | - Robert A Scheidt
- Joint Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Engineering Hall, Rm 342, P.O. Box 1881, Milwaukee, WI, 53201-1881, USA.
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Studnicki A, Seidler RD, Ferris DP. A table tennis serve versus rally hit elicits differential hemispheric electrocortical power fluctuations. J Neurophysiol 2023; 130:1444-1456. [PMID: 37964746 PMCID: PMC10994643 DOI: 10.1152/jn.00091.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 10/10/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023] Open
Abstract
Human visuomotor control requires coordinated interhemispheric interactions to exploit the brain's functional lateralization. In right-handed individuals, the left hemisphere (right arm) is better for dynamic control and the right hemisphere (left arm) is better for impedance control. Table tennis is a game that requires precise movements of the paddle, whole body coordination, and cognitive engagement, providing an ecologically valid way to study visuomotor integration. The sport has many different types of strokes (e.g., serve, return, and rally shots), which should provide unique cortical dynamics given differences in the sensorimotor demands. The goal of this study was to determine the hemispheric specialization of table tennis serving - a sequential, self-paced, bimanual maneuver. We used time-frequency analysis, event-related potentials, and functional connectivity measures of source-localized electrocortical clusters and compared serves with other types of shots, which varied in the types of movement required, attentional focus, and other task demands. We found greater alpha (8-12 Hz) and beta (13-30 Hz) power in the right sensorimotor cortex than in the left sensorimotor cortex, and we found a greater magnitude of spectral power fluctuations in the right sensorimotor cortex for serve hits than return or rally hits, in all right-handed participants. Surprisingly, we did not find a difference in interhemispheric functional connectivity between a table tennis serve and return or rally hits, even though a serve could arguably be a more complex maneuver. Studying real-world brain dynamics of table tennis provides insight into bilateral sensorimotor integration.NEW & NOTEWORTHY We found different spectral power fluctuations in the left and right sensorimotor cortices during table tennis serves, returns, and rallies. Our findings contribute to the basic science understanding of hemispheric specialization in a real-world context.
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Affiliation(s)
- Amanda Studnicki
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States
| | - Rachael D Seidler
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, Florida, United States
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, United States
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Noguchi N, Akiyama R, Kondo K, Vo DQ, Sato L, Yanai A, Ino M, Lee B. Kinematic alteration in three-dimensional reaching movement in C3-4 level cervical myelopathy. PLoS One 2023; 18:e0295156. [PMID: 38032987 PMCID: PMC10688652 DOI: 10.1371/journal.pone.0295156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/15/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECT This study aimed to compare the reaching movement between two different spinal cord compression level groups in cervical myelopathy (CM) patients. METHODS Nine CM patients with maximal cord compression at the C3-4 level (C3-4 group) and 15 CM patients with maximal cord compression at the C4-7 level (C4-7 group) participated in the study. We monitored three-dimensional (3D) reaching movement using an electronic-mechanical whack-a-mole-type task pre-and post-operatively. Movement time (MT) and 3D movement distance (MD) during the task were recorded. An analysis of variance for split-plot factorial design was performed to investigate the effects of compression level or surgery on MT and MD. Moreover, we investigated the relationship between these kinematic reaching parameters and conventional clinical tests. RESULTS The 3D reaching trajectories of the C3-4 group was unstable with higher variability. The C3-4 group showed longer MT (p < 0.05) and MD (p < 0.01) compared with the C4-7 group both before and after surgery. Moreover, MT was negatively correlated with the Japanese Orthopedic Association score only in the C3-4 group (r = - 0.48). CONCLUSION We found that spinal cord compression at the C3-4 level had a negative effect on 3D reaching movement and the kinematic alteration influenced the upper extremity performance. This new knowledge may increase our understanding of kinematic alteration in patients with CM.
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Affiliation(s)
- Naoto Noguchi
- Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Ryoto Akiyama
- Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
| | - Ken Kondo
- Department of Occupational Therapy Faculty of Rehabilitation, Gunma Paz University, Takasaki, Gunma, Japan
| | - Duy Quoc Vo
- Gunma University Graduate School of Health Sciences Doctoral Program, Maebashi, Gunma, Japan
| | - Lisa Sato
- Department of Rehabilitation, Harunaso Hospital, Takasaki, Gunma, Japan
| | - Akihito Yanai
- Non-Profit Organization Sonrisa, Maebashi, Gunma, Japan
| | - Masatake Ino
- Gunma Spine Center, Harunaso Hospital, Takasaki, Gunma, Japan
| | - Bumsuk Lee
- Gunma University Graduate School of Health Sciences, Maebashi, Gunma, Japan
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12
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Kim T, Zhou R, Gassass S, Liu L, Philip BA. Healthy adults favor stable left/right hand choices over performance at an unconstrained reach-to-grasp task. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.11.561912. [PMID: 37904957 PMCID: PMC10614726 DOI: 10.1101/2023.10.11.561912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Reach-to-grasp actions are fundamental to the daily activities of human life, but few methods exist to assess individuals' reaching and grasping actions in unconstrained environments. The Block Building Task (BBT) provides an opportunity to directly observe and quantify these actions, including left/right hand choices. Here we sought to investigate the motor and non-motor causes of left/right hand choices, and optimize the design of the BBT, by manipulating motor and non-motor difficulty in the BBT's unconstrained reach-to-grasp task We hypothesized that greater motor and non-motor (e.g. cognitive/perceptual) difficulty would drive increased usage of the dominant hand. To test this hypothesis, we modulated block size (large vs. small) to influence motor difficulty, and model complexity (10 vs. 5 blocks per model) to influence non-motor difficulty, in healthy adults (n=57). We hypothesized that healthy adults with high non-dominant hand performance in a precision drawing task should be more likely to use their non-dominant hand in the BBT. Our data revealed that increased motor and non-motor difficulty led to lower task performance (slower speed), but participants only increased use of their dominant hand only under the most difficult combination of conditions: in other words, participants allowed their performance to degrade before changing hand choices, even though participants were instructed only to optimize performance. These results demonstrate that hand choices during reach-to grasp actions are more stable than motor performance in healthy right-handed adults, but tasks with multifaceted difficulties can drive individuals to rely more on their dominant hand. Statements and Declarations Dr. Philip and Washington University in St. Louis have a licensing agreement with PlatformSTL to commercialize the iPad app used in this study.
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Nguyen H, Phan T, Shadmehr R, Lee SW. Impact of unilateral and bilateral impairments on bimanual force production following stroke. J Neurophysiol 2023; 130:608-618. [PMID: 37529847 DOI: 10.1152/jn.00125.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/03/2023] Open
Abstract
Large bilateral asymmetry and task deficits are typically observed during bimanual actions of stroke survivors. Do these abnormalities originate from unilateral impairments affecting their more-impaired limb, such as weakness and abnormal synergy, or from bilateral impairments such as incoordination of two limbs? To answer this question, 23 subjects including 10 chronic stroke survivors and 13 neurologically intact subjects participated in an experiment where they produced bimanual forces at different hand locations. The force magnitude and directional deviation of the more-impaired arm were measured for unilateral impairments and bimanual coordination across locations for bilateral impairments. Force asymmetry and task error were used to define task performance. Significant unilateral impairments were observed in subjects with stroke; the maximal force capacity of their more-impaired arm was significantly lower than that of their less-impaired arm, with a higher degree of force deviation. However, its force contribution during submaximal tasks was greater than its relative force capacity. Significant bilateral impairments were also observed, as stroke survivors modulated two forces to a larger degree across hand locations but in a less coordinated manner than control subjects did. But only unilateral, not bilateral, impairments explained a significant amount of between-subject variability in force asymmetry across subjects with stroke. Task error, in contrast, was correlated with neither unilateral nor bilateral impairments. Our results suggest that unilateral impairments of the more-impaired arm of stroke survivors mainly contribute to its reduced recruitment, but that the degree of its participation in bimanual task may be greater than their capacity as they attempt to achieve symmetry.NEW & NOTEWORTHY We studied how unilateral and bilateral impairments in stroke survivors affect their bimanual task performance. Unilateral impairments of the more-impaired limb, both weakness and loss of directional control, mainly contribute to bimanual asymmetry, but stroke survivors generally produce higher force with their more-impaired limb than their relative capacity. Bilateral force coordination was significantly impaired in stroke survivors, but its degree of impairment was not related to their unilateral impairments.
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Affiliation(s)
- Hien Nguyen
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
| | - Thanh Phan
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
| | - Reza Shadmehr
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
| | - Sang Wook Lee
- Department of Biomedical Engineering, Catholic University of America, Washington, District of Columbia, United States
- Center for Applied Biomechanics and Rehabilitation Research, MedStar National Rehabilitation Hospital, Washington, District of Columbia, United States
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
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14
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Beyaz O, Eyraud V, Demirhan G, Akpinar S, Przybyla A. Effects of Short-Term Novice Archery Training on Reaching Movement Performance and Interlimb Asymmetries. J Mot Behav 2023; 56:78-90. [PMID: 37586703 DOI: 10.1080/00222895.2023.2245352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
Previous studies showed numerous evidence for the interlimb asymmetries in motor performance during arm reaching movements. Furthermore, these interlimb asymmetries have been shown to associate with spatial patterns of hand selection behavior. Importantly, these interlimb asymmetries can be modified systematically by occlusion of visual feedback, or a long-term sports training. In this study, we asked about the effects of a short-term training on interlimb asymmetries. Eighteen healthy young participants underwent a 12-week novice traditional archery training (TAT). Their unimanual dominant and nondominant arm reaching movement performance was assessed before and after TAT. We found that movement accuracy, movement precision, and movement efficiency in the experimental group have all improved significantly as a result of TAT. These improvements were comparable across both arms, thus the interlimb differences in movement performance were not affected by the short-term TAT and remained similar. These results suggest that while short-term training may contribute positively to reaching performance, it is unlikely to have a significant impact on the differences observed between the dominant and nondominant arms. This unique characteristics of dominant and nondominant arm should be taken into consideration when developing targeted sports and rehabilitation programs for athletes or individuals with acute or chronic motor deficits.
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Affiliation(s)
- Ozkan Beyaz
- Department of Physical Education and Sports, Faculty of Sport Science, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
| | - Virginie Eyraud
- Department of Physical Therapy, University of North Georgia, Dahlonega, Georgia, USA
| | - Gıyasettin Demirhan
- Department of Physical Education and Sports, Faculty of Sport Science, Hacettepe University, Ankara, Turkey
| | - Selcuk Akpinar
- Department of Physical Education and Sports, Faculty of Sport Science, Nevşehir Hacı Bektaş Veli University, Nevşehir, Turkey
| | - Andrzej Przybyla
- Department of Physical Therapy, University of North Georgia, Dahlonega, Georgia, USA
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15
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Lin DJ, Hardstone R, DiCarlo JA, Mckiernan S, Snider SB, Jacobs H, Erler KS, Rishe K, Boyne P, Goldsmith J, Ranford J, Finklestein SP, Schwamm LH, Hochberg LR, Cramer SC. Distinguishing Distinct Neural Systems for Proximal vs Distal Upper Extremity Motor Control After Acute Stroke. Neurology 2023; 101:e347-e357. [PMID: 37268437 PMCID: PMC10435065 DOI: 10.1212/wnl.0000000000207417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 03/31/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The classic and singular pattern of distal greater than proximal upper extremity motor deficits after acute stroke does not account for the distinct structural and functional organization of circuits for proximal and distal motor control in the healthy CNS. We hypothesized that separate proximal and distal upper extremity clinical syndromes after acute stroke could be distinguished and that patterns of neuroanatomical injury leading to these 2 syndromes would reflect their distinct organization in the intact CNS. METHODS Proximal and distal components of motor impairment (upper extremity Fugl-Meyer score) and strength (Shoulder Abduction Finger Extension score) were assessed in consecutively recruited patients within 7 days of acute stroke. Partial correlation analysis was used to assess the relationship between proximal and distal motor scores. Functional outcomes including the Box and Blocks Test (BBT), Barthel Index (BI), and modified Rankin scale (mRS) were examined in relation to proximal vs distal motor patterns of deficit. Voxel-based lesion-symptom mapping was used to identify regions of injury associated with proximal vs distal upper extremity motor deficits. RESULTS A total of 141 consecutive patients (49% female) were assessed 4.0 ± 1.6 (mean ± SD) days after stroke onset. Separate proximal and distal upper extremity motor components were distinguishable after acute stroke (p = 0.002). A pattern of proximal more than distal injury (i.e., relatively preserved distal motor control) was not rare, observed in 23% of acute stroke patients. Patients with relatively preserved distal motor control, even after controlling for total extent of deficit, had better outcomes in the first week and at 90 days poststroke (BBT, ρ = 0.51, p < 0.001; BI, ρ = 0.41, p < 0.001; mRS, ρ = 0.38, p < 0.001). Deficits in proximal motor control were associated with widespread injury to subcortical white and gray matter, while deficits in distal motor control were associated with injury restricted to the posterior aspect of the precentral gyrus, consistent with the organization of proximal vs distal neural circuits in the healthy CNS. DISCUSSION These results highlight that proximal and distal upper extremity motor systems can be selectively injured by acute stroke, with dissociable deficits and functional consequences. Our findings emphasize how disruption of distinct motor systems can contribute to separable components of poststroke upper extremity hemiparesis.
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Affiliation(s)
- David J Lin
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital.
| | - Richard Hardstone
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Julie A DiCarlo
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Sydney Mckiernan
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Samuel B Snider
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Hannah Jacobs
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Kimberly S Erler
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Kelly Rishe
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Pierce Boyne
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Jeff Goldsmith
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Jessica Ranford
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Seth P Finklestein
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Lee H Schwamm
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Leigh R Hochberg
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
| | - Steven C Cramer
- From the Center for Neurotechnology and Neurorecovery (D.J.L., R.H., J.A.D., S.M., H.J., K.S.E., K.R., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology; Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School; Department of Occupational Therapy (H.J., K.S.E.), MGH Institute of Health Professions, Boston, MA; Department of Rehabilitation (P.B.), Exercise and Nutrition Sciences, University of Cincinnati College of Allied Health Sciences, OH; Department of Biostatistics (J.G.), Columbia University Mailman School of Public Health, New York, NY; Department of Occupational Therapy (J.R.), Massachusetts General Hospital, Boston; School of Engineering (L.R.H.), Brown University, Providence, RI; and Department of Neurology (S.C.C.), University of California, Los Angeles, California Rehabilitation Hospital
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16
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Neuroplasticity Following Stroke from a Functional Laterality Perspective: A fNIRS Study. Brain Topogr 2023; 36:283-293. [PMID: 36856917 DOI: 10.1007/s10548-023-00946-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/14/2023] [Indexed: 03/02/2023]
Abstract
To explore alterations of resting-state functional connectivity (rsFC) in sensorimotor cortex following strokes with left or right hemiplegia considering the lateralization and neuroplasticity. Seventy-three resting-state functional near-infrared spectroscopy (fNIRS) files were selected, including 26 from left hemiplegia (LH), 21 from right hemiplegia (RH) and 26 from normal controls (NC) group. Whole-brain analyses matching the Pearson correlation were used for rsFC calculations. For right-handed normal controls, rsFC of motor components (M1 and M2) in the left hemisphere displayed a prominent intensity in comparison with the right hemisphere (p < 0.05), while for stroke groups, this asymmetry has disappeared. Additionally, RH rather than LH showed stronger rsFC between left S1 and left M1 in contrast to normal controls (p < 0.05), which correlated inversely with motor function (r = - 0.53, p < 0.05). Regarding M1, rsFC within ipsi-lesioned M1 has a negative correlation with motor function of the affected limb (r = - 0.60 for the RH group and - 0.43 for the LH group, p < 0.05). The rsFC within contra-lesioned M1 that innervates the normal side was weakened compared with that of normal controls (p < 0.05). Stronger rsFC of motor components in left hemisphere was confirmed by rs-fNIRS as the "secret of dominance" for the first time, while post-stroke hemiplegia broke this cortical asymmetry. Meanwhile, a statistically strengthened rsFC between left S1 and M1 only in right-hemiplegia group may act as a compensation for the impairment of the dominant side. This research has implications for brain-computer interfaces synchronizing sensory feedback with motor performance and transcranial magnetic regulation for cortical excitability to induce cortical plasticity.
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Restoring After Central Nervous System Injuries: Neural Mechanisms and Translational Applications of Motor Recovery. Neurosci Bull 2022; 38:1569-1587. [DOI: 10.1007/s12264-022-00959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022] Open
Abstract
AbstractCentral nervous system (CNS) injuries, including stroke, traumatic brain injury, and spinal cord injury, are leading causes of long-term disability. It is estimated that more than half of the survivors of severe unilateral injury are unable to use the denervated limb. Previous studies have focused on neuroprotective interventions in the affected hemisphere to limit brain lesions and neurorepair measures to promote recovery. However, the ability to increase plasticity in the injured brain is restricted and difficult to improve. Therefore, over several decades, researchers have been prompted to enhance the compensation by the unaffected hemisphere. Animal experiments have revealed that regrowth of ipsilateral descending fibers from the unaffected hemisphere to denervated motor neurons plays a significant role in the restoration of motor function. In addition, several clinical treatments have been designed to restore ipsilateral motor control, including brain stimulation, nerve transfer surgery, and brain–computer interface systems. Here, we comprehensively review the neural mechanisms as well as translational applications of ipsilateral motor control upon rehabilitation after CNS injuries.
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18
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Dexheimer B, Przybyla A, Murphy TE, Akpinar S, Sainburg R. Reaction time asymmetries provide insight into mechanisms underlying dominant and non-dominant hand selection. Exp Brain Res 2022; 240:2791-2802. [PMID: 36066589 PMCID: PMC10130955 DOI: 10.1007/s00221-022-06451-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022]
Abstract
Handedness is often thought of as a hand "preference" for specific tasks or components of bimanual tasks. Nevertheless, hand selection decisions depend on many factors beyond hand dominance. While these decisions are likely influenced by which hand might show performance advantages for the particular task and conditions, there also appears to be a bias toward the dominant hand, regardless of performance advantage. This study examined the impact of hand selection decisions and workspace location on reaction time and movement quality. Twenty-six neurologically intact participants performed targeted reaching across the horizontal workspace in a 2D virtual reality environment, and we compared reaction time across two groups: those selecting which hand to use on a trial-by-trial basis (termed the choice group) and those performing the task with a preassigned hand (the no-choice group). Along with reaction time, we also compared reach performance for each group across two ipsilateral workspaces: medial and lateral. We observed a significant difference in reaction time between the hands in the choice group, regardless of workspace. In contrast, both hands showed shorter but similar reaction times and differences between the lateral and medial workspaces in the no-choice group. We conclude that the shorter reaction times of the dominant hand under choice conditions may be due to dominant hand bias in the selection process that is not dependent upon interlimb performance differences.
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Affiliation(s)
- Brooke Dexheimer
- Department of Kinesiology, The Pennsylvania State University, PA, 16802, University Park, USA.
| | - Andrzej Przybyla
- Department of Physical Therapy, University of North Georgia, Dahlonega, GA, USA
| | - Terrence E Murphy
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Selcuk Akpinar
- Department of Physical Education and Sport, Nevsehir Bektas Veli University, Nevsehir, Turkey
| | - Robert Sainburg
- Department of Kinesiology, The Pennsylvania State University, PA, 16802, University Park, USA.,Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, USA
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19
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Johnson T, Ridgeway G, Luchmee D, Jacob J, Kantak S. Bimanual coordination during reach-to-grasp actions is sensitive to task goal with distinctions between left- and right-hemispheric stroke. Exp Brain Res 2022; 240:2359-2373. [PMID: 35869986 PMCID: PMC10077867 DOI: 10.1007/s00221-022-06419-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/06/2022] [Indexed: 11/30/2022]
Abstract
The perceptual feature of a task such as how a task goal is perceived influences performance and coordination of bimanual actions in neurotypical adults. To assess how bimanual task goal modifies paretic and non-paretic arm performance and bimanual coordination in individuals with stroke affecting left and right hemispheres, 30 participants with hemispheric stroke (15 right-hemisphere damage-RHD); 15 left-hemisphere damage-LHD) and 10 age-matched controls performed reach-to-grasp and pick-up actions under bimanual common-goal (i.e., two physically coupled dowels), bimanual independent-goal (two physically uncoupled dowels), and unimanual conditions. Reach-to-grasp time and peak grasp aperture indexed motor performance, while time lags between peak reach velocities, peak grasp apertures, and peak pick-up velocities of the two hands characterized reach, grasp, and pick-up coordination, respectively. Compared to unimanual actions, bimanual actions significantly slowed non-paretic arm speed to match paretic arm speed, thus affording no benefit to paretic arm performance. Detriments in non-paretic arm performance during bimanual actions was more pronounced in the RHD group. Under common-goal conditions, movements were faster with smaller peak grasp apertures compared to independent-goal conditions for all groups. Compared to controls, individuals with stroke demonstrated poor grasp and pick-up coordination. Of the patient groups, patients with LHD showed more pronounced deficits in grasp coordination between hands. Finally, grasp coordination deficits related to paretic arm motor deficits (upper extremity Fugl-Meyer score) for LHD group, and to Trail-Making Test performance for RHD group. Findings suggest that task goal and distinct clinical deficits influence bimanual performance and coordination in patients with left- and right-hemispheric stroke.
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Affiliation(s)
- Tessa Johnson
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Gordon Ridgeway
- College of Medicine, Drexel University, Philadelphia, PA, USA
| | - Dustin Luchmee
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
| | - Joshua Jacob
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA
| | - Shailesh Kantak
- Neuroplasticity and Motor Behavior Laboratory, Moss Rehabilitation Research Institute, Elkins Park, PA, 19027, USA.
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA.
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20
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Li X, Fang F, Li R, Zhang Y. Functional Brain Controllability Alterations in Stroke. Front Bioeng Biotechnol 2022; 10:925970. [PMID: 35832411 PMCID: PMC9271898 DOI: 10.3389/fbioe.2022.925970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Motor control deficits are very common in stroke survivors and often lead to disability. Current clinical measures for profiling motor control impairments are largely subjective and lack precise interpretation in a “control” perspective. This study aims to provide an accurate interpretation and assessment of the underlying “motor control” deficits caused by stroke, using a recently developed novel technique, i.e., the functional brain controllability analysis. The electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) were simultaneously recorded from 16 stroke patients and 11 healthy subjects during a hand-clenching task. A high spatiotemporal resolution fNIRS-informed EEG source imaging approach was then employed to estimate the cortical activity and construct the functional brain network. Subsequently, network control theory was applied to evaluate the modal controllability of some key motor regions, including primary motor cortex (M1), premotor cortex (PMC), and supplementary motor cortex (SMA), and also the executive control network (ECN). Results indicated that the modal controllability of ECN in stroke patients was significantly lower than healthy subjects (p = 0.03). Besides, the modal controllability of SMA in stroke patients was also significant smaller than healthy subjects (p = 0.02). Finally, the baseline modal controllability of M1 was found to be significantly correlated with the baseline FM-UL clinical scores (r = 0.58, p = 0.01). In conclusion, our results provide a new perspective to better understand the motor control deficits caused by stroke. We expect such an analytical methodology can be extended to investigate the other neurological or psychiatric diseases caused by cognitive control or motor control impairment.
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Affiliation(s)
- Xuhong Li
- Department of Rehabilitation Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Feng Fang
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
- *Correspondence: Feng Fang, , Yingchun Zhang,
| | - Rihui Li
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
- *Correspondence: Feng Fang, , Yingchun Zhang,
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21
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Brain Asymmetry and Its Effects on Gait Strategies in Hemiplegic Patients: New Rehabilitative Conceptions. Brain Sci 2022; 12:brainsci12060798. [PMID: 35741683 PMCID: PMC9220897 DOI: 10.3390/brainsci12060798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/08/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Brain asymmetry is connected with motor performance, suggesting that hemiparetic patients have different gait patterns depending on the side of the lesion. This retrospective cohort study aims to further investigate the difference between right and left hemiplegia in order to assess whether the injured side can influence the patient’s clinical characteristics concerning gait, thus providing insights for new personalized rehabilitation strategies. The data from 33 stroke patients (17 with left and 16 with right hemiplegia) were retrospectively compared with each other and with a control group composed of 20 unaffected age-matched individuals. The 3D gait analysis was used to assess kinematic data and spatio-temporal parameters. Compared to left hemiplegic patients, right hemiplegic patients showed worse spatio-temporal parameters (p < 0.05) and better kinematic parameters (p < 0.05). Both pathological groups were characterized by abnormal gait parameters in comparison with the control group (p < 0.05). These findings show an association between the side of the lesion—right or left—and the different stroke patients’ gait patterns: left hemiplegic patients show better spatio-temporal parameters, whereas right hemiplegic patients show better segmentary motor performances. Therefore, further studies may develop and assess new personalized rehabilitation strategies considering the injured hemisphere and brain asymmetry.
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22
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Demers M, Varghese R, Winstein C. Retrospective Analysis of Task-Specific Effects on Brain Activity After Stroke: A Pilot Study. Front Hum Neurosci 2022; 16:871239. [PMID: 35721357 PMCID: PMC9201099 DOI: 10.3389/fnhum.2022.871239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEvidence supports cortical reorganization in sensorimotor areas induced by constraint-induced movement therapy (CIMT). However, only a few studies examined the neural plastic changes as a function of task specificity. This retrospective analysis aims to evaluate the functional brain activation changes during a precision and a power grasp task in chronic stroke survivors who received 2-weeks of CIMT compared to a no-treatment control group.MethodsFourteen chronic stroke survivors, randomized to CIMT (n = 8) or non-CIMT (n = 6), underwent functional MRI (fMRI) before and after a 2-week period. Two behavioral measures, the 6-item Wolf Motor Function Test (WMFT-6) and the Motor Activity Log (MAL), and fMRI brain scans were collected before and after a 2-week period. During scan runs, participants performed two different grasp tasks (precision, power). Pre to post changes in laterality index (LI) were compared by group and task for two predetermined motor regions of interest: dorsal premotor cortex (PMd) and primary motor cortex (MI).ResultsIn contrast to the control group, the CIMT group showed significant improvements in the WMFT-6. For the MAL, both groups showed a trend toward greater improvements from baseline. Two weeks of CIMT resulted in a relative increase in activity in a key region of the motor network, PMd of the lesioned hemisphere, under precision grasp task conditions compared to the non-treatment control group. No changes in LI were observed in MI for either task or group.ConclusionThese findings provide preliminary evidence for task-specific effects of CIMT in the promotion of recovery-supportive cortical reorganization in chronic stroke survivors.
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Affiliation(s)
- Marika Demers
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Rini Varghese
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Carolee Winstein
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Carolee Winstein,
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23
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Maenza C, Sainburg RL, Varghese R, Dexheimer B, Demers M, Bishop L, Jayasinghe SAL, Wagstaff DA, Winstein C. Ipsilesional arm training in severe stroke to improve functional independence (IPSI): phase II protocol. BMC Neurol 2022; 22:141. [PMID: 35413856 PMCID: PMC9002228 DOI: 10.1186/s12883-022-02643-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We previously characterized hemisphere-specific motor control deficits in the ipsilesional, less-impaired arm of unilaterally lesioned stroke survivors. Our preliminary data indicate these deficits are substantial and functionally limiting in patients with severe paresis. METHODS We have designed an intervention ("IPSI") to remediate the hemisphere-specific deficits in the ipsilesional arm, using a virtual-reality platform, followed by manipulation training with a variety of real objects, designed to facilitate generalization and transfer to functional behaviors encountered in the natural environment. This is a 2-site (primary site - Penn State College of Medicine, secondary site - University of Southern California), two-group randomized intervention with an experimental group, which receives unilateral training of the ipsilesional arm throughout 3 one-hour sessions per week for 5 weeks, through our Virtual Reality and Manipulation Training (VRMT) protocol. Our control group receives a conventional intervention on the contralesional arm, 3 one-hour sessions per week for 5 weeks, guided by recently released practice guidelines for upper limb rehabilitation in adult stroke. The study aims to include a total of 120 stroke survivors (60 per group) whose stroke was in the territory of the middle cerebral artery (MCA) resulting in severe upper-extremity motor impairments. Outcome measures (Primary: Jebsen-Taylor Hand Function Test, Fugl-Meyer Assessment, Abilhand, Barthel Index) are assessed at five evaluation points: Baseline 1, Baseline 2, immediate post-intervention (primary endpoint), and 3-weeks (short-term retention) and 6-months post-intervention (long-term retention). We hypothesize that both groups will improve performance of the targeted arm, but that the ipsilesional arm remediation group will show greater improvements in functional independence. DISCUSSION The results of this study are expected to inform upper limb evaluation and treatment to consider ipsilesional arm function, as part of a comprehensive physical rehabilitation strategy that includes evaluation and remediation of both arms. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov (Registration ID: NCT03634397 ; date of registration: 08/16/2018).
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Affiliation(s)
- Candice Maenza
- Department of Neurology, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA. .,Department of Kinesiology, Pennsylvania State University, 27 Rec Hall, University Park, PA, 16802, USA.
| | - Robert L Sainburg
- Department of Neurology, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA.,Department of Kinesiology, Pennsylvania State University, 27 Rec Hall, University Park, PA, 16802, USA
| | - Rini Varghese
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Brooke Dexheimer
- Department of Kinesiology, Pennsylvania State University, 27 Rec Hall, University Park, PA, 16802, USA
| | - Marika Demers
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Lauri Bishop
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Shanie A L Jayasinghe
- Department of Neurology, Pennsylvania State University College of Medicine, 500 University Drive, Hershey, PA, 17033, USA
| | - David A Wagstaff
- Department of Human Development and Family Studies, Pennsylvania State University, 102 HHD Building, University Park, PA, 16802, USA
| | - Carolee Winstein
- Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.,Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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24
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Jayasinghe SAL, Scheidt RA, Sainburg RL. Neural Control of Stopping and Stabilizing the Arm. Front Integr Neurosci 2022; 16:835852. [PMID: 35264934 PMCID: PMC8899537 DOI: 10.3389/fnint.2022.835852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/17/2022] [Indexed: 11/27/2022] Open
Abstract
Stopping is a crucial yet under-studied action for planning and producing meaningful and efficient movements. In this review, we discuss classical human psychophysics studies as well as those using engineered systems that aim to develop models of motor control of the upper limb. We present evidence for a hybrid model of motor control, which has an evolutionary advantage due to division of labor between cerebral hemispheres. Stopping is a fundamental aspect of movement that deserves more attention in research than it currently receives. Such research may provide a basis for understanding arm stabilization deficits that can occur following central nervous system (CNS) damage.
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Affiliation(s)
- Shanie A. L. Jayasinghe
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Robert A. Scheidt
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, United States
| | - Robert L. Sainburg
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States
- Department of Kinesiology, Pennsylvania State University, State College, PA, United States
- Huck Institutes of the Life Sciences, Pennsylvania State University, State College, PA, United States
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25
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Kim S, Han CE, Kim B, Winstein CJ, Schweighofer N. Effort, success, and side of lesion determine arm choice in individuals with chronic stroke. J Neurophysiol 2022; 127:255-266. [PMID: 34879206 PMCID: PMC8782657 DOI: 10.1152/jn.00532.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
In neurotypical individuals, arm choice in reaching movements depends on expected biomechanical effort, expected success, and a handedness bias. Following a stroke, does arm choice change to account for the decreased motor performance, or does it follow a preinjury habitual preference pattern? Participants with mild-to-moderate chronic stroke who were right-handed before stroke performed reaching movements in both spontaneous and forced-choice blocks, under no-time, medium-time, and fast-time constraint conditions designed to modulate reaching success. Mixed-effects logistic regression models of arm choice revealed that expected effort predicted choices. However, expected success only strongly predicted choice in left-hemiparetic individuals. In addition, reaction times decreased in left-hemiparetic individuals between the no-time and the fast-time constraint conditions but showed no changes in right-hemiparetic individuals. Finally, arm choice in the no-time constraint condition correlated with a clinical measure of spontaneous arm use for right-, but not for left-hemiparetic individuals. Our results are consistent with the view that right-hemiparetic individuals show a habitual pattern of arm choice for reaching movements relatively independent of failures. In contrast, left-hemiparetic individuals appear to choose their paretic left arm more optimally: that is, if a movement with the paretic arm is predicted to be not successful in the upcoming movement, the nonparetic right arm is chosen instead.NEW & NOTEWORTHY Although we are seldom aware of it, we constantly make decisions to use one arm or the other in daily activities. Here, we studied whether these decisions change following stroke. Our results show that effort, success, and side of lesion determine arm choice in a reaching task: whereas left-paretic individuals modified their arm choice in response to failures in reaching the target, right-paretic individuals showed a pattern of choice independent of failures.
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Affiliation(s)
- Sujin Kim
- 1Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California,2Department of Physical Therapy, Jeonju University, Jeonju, Republic of Korea
| | - Cheol E. Han
- 3Department of Electronics and Information Engineering, Korea University, Sejong, Republic of Korea
| | - Bokkyu Kim
- 1Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California,4Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, New York
| | - Carolee J. Winstein
- 1Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Nicolas Schweighofer
- 1Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
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26
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Chilvers MJ, Hawe RL, Scott SH, Dukelow SP. Investigating the neuroanatomy underlying proprioception using a stroke model. J Neurol Sci 2021; 430:120029. [PMID: 34695704 DOI: 10.1016/j.jns.2021.120029] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/08/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022]
Abstract
Neuroanatomical investigations have associated cortical areas, beyond Primary Somatosensory Cortex (S1), with impaired proprioception. Cortical regions have included temporoparietal (TP) regions (supramarginal gyrus, superior temporal gyrus, Heschl's gyrus) and insula. Previous approaches have struggled to account for concurrent damage across multiple brain regions. Here, we used a targeted lesion analysis approach to examine the impact of specific combinations of cortical and sub-cortical lesions and quantified the prevalence of proprioceptive impairments when different regions are damaged or spared. Seventy-seven individuals with stroke (49 male; 28 female) were identified meeting prespecified lesion criteria based on MRI/CT imaging: 1) TP lesions without S1, 2) TP lesions with S1, 3) isolated S1 lesions, 4) isolated insula lesions, and 5) lesions not impacting these regions (other regions group). Initially, participants meeting these criteria (1-4) were grouped together into right or left lesion groups and compared to each other, and the other regions group (5), on a robotic Arm Position Matching (APM) task and a Kinesthesia (KIN) task. We then examined the behaviour of individuals that met each specific criteria (groups 1-5). Proprioceptive impairments were more prevalent following right hemisphere lesions than left hemisphere lesions. The extent of damage to TP regions correlated with performance on both robotic tasks. Even without concurrent S1 lesions, TP and insular lesions were associated with impairments on the APM and KIN tasks. Finally, lesions not impacting these regions were much less likely to result in impairments. This study highlights the critical importance of TP and insular regions for accurate proprioception. SIGNIFICANCE STATEMENT: This work advances our understanding of the neuroanatomy of human proprioception. We validate the importance of regions, beyond the dorsal column medial lemniscal pathway and S1, for proprioception. Further, we provide additional evidence of the importance of the right hemisphere for human proprioception. Improved knowledge on the neuroanatomy of proprioception is crucial for advancing therapeutic approaches which target individuals with proprioceptive impairments following neurological injury or with neurological disorders.
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Affiliation(s)
- Matthew J Chilvers
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
| | - Rachel L Hawe
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; School of Kinesiology, University of Minnesota, 1900 University Ave SE, Minneapolis, MN 55455, United States
| | - Stephen H Scott
- Department of Biomedical and Molecular Sciences, Centre for Neuroscience Studies, Queens University, Kingston, ON K7L 3N6, Canada
| | - Sean P Dukelow
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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Feingold-Polak R, Yelkin A, Edelman S, Shapiro A, Levy-Tzedek S. The effects of an object's height and weight on force calibration and kinematics when post-stroke and healthy individuals reach and grasp. Sci Rep 2021; 11:20559. [PMID: 34663848 PMCID: PMC8523696 DOI: 10.1038/s41598-021-00036-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
Impairment in force regulation and motor control impedes the independence of individuals with stroke by limiting their ability to perform daily activities. There is, at present, incomplete information about how individuals with stroke regulate the application of force and control their movement when reaching, grasping, and lifting objects of different weights, located at different heights. In this study, we assess force regulation and kinematics when reaching, grasping, and lifting a cup of two different weights (empty and full), located at three different heights, in a total of 46 participants: 30 sub-acute stroke participants, and 16 healthy individuals. We found that the height of the reached target affects both force calibration and kinematics, while its weight affects only the force calibration when post-stroke and healthy individuals perform a reach-to-grasp task. There was no difference between the two groups in the mean and peak force values. The individuals with stroke had slower, jerkier, less efficient, and more variable movements compared to the control group. This difference was more pronounced with increasing stroke severity. With increasing stroke severity, post-stroke individuals demonstrated altered anticipation and preparation for lifting, which was evident for either cortical lesion side.
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Affiliation(s)
- Ronit Feingold-Polak
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Ben-Gurion Blvd, Beer-Sheva, Israel
| | - Anna Yelkin
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Ben-Gurion Blvd, Beer-Sheva, Israel
- Beit Hadar Rehabilitation Center, Ashdod, Israel
| | - Shmil Edelman
- Department of Mechanical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amir Shapiro
- Department of Mechanical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shelly Levy-Tzedek
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Ben-Gurion Blvd, Beer-Sheva, Israel.
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany.
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de Souza Costa Garbus RB, Nardini AG, Alouche SR, de Freitas SMSF. Ipsilesional arm reaching movements are not affected by the postural configuration adopted by individuals with stroke. Hum Mov Sci 2021; 80:102865. [PMID: 34537625 DOI: 10.1016/j.humov.2021.102865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 07/16/2021] [Accepted: 08/31/2021] [Indexed: 01/12/2023]
Abstract
Individuals with stroke present several impairments in the ipsilesional arm reaching movements that can limit the execution of daily living activities. These impairments depend on the side of the brain lesion. The present study aimed to compare the arm reaching movements performed in sitting and standing positions and to examine whether the effects of the adopted posture configuration depend on the side of the brain lesion. Twenty right-handed individuals with stroke (half with right hemiparesis and a half with left hemiparesis) and twenty healthy adults (half used the left arm) reached toward a target displayed on a monitor screen placed in one of three heights (i.e., upper, central, or lower targets). Participants performed the reaches in sitting and standing positions under conditions where the target location was either well-known in advance (certainty condition) or unknown until the movement onset (uncertainty condition). The values of movement onset time, movement time, and constant error were compared across conditions (posture configuration and uncertainty) and groups for each target height. Individuals with stroke were slower and spent more time to start to move than healthy participants, mainly when they reached the superior target in the upright position and under the uncertainty condition. Individuals who have suffered a right stroke were more affected by the task conditions and those who suffered a left stroke showed less accurate reaches. Overall, these results were observed regardless of the adopted posture. The current findings suggested that ipsilesional arm reaching movements are not affected by the postural configuration adopted by individuals with stroke. The central nervous system modulates the reaching movements according to the target position, adopted posture, and the uncertainty in the final target position to be reached.
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Affiliation(s)
- Rafaela Barroso de Souza Costa Garbus
- Graduate Program in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno, 448/475, Tatuapé, 03071-000 São Paulo, SP, Brazil; Physical Education Program, Federal University of São Paulo, Santos, SP, Brazil
| | - Alethéa Gomes Nardini
- Graduate Program in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno, 448/475, Tatuapé, 03071-000 São Paulo, SP, Brazil; Undergraduate Program in Physical Therapy, Universidade Paulista, Rua Dr. Bacelar, 1212, Vila Clementino, 04026-002 São Paulo, SP, Brazil
| | - Sandra Regina Alouche
- Graduate Program in Physical Therapy, Universidade Cidade de São Paulo, Rua Cesário Galeno, 448/475, Tatuapé, 03071-000 São Paulo, SP, Brazil
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Maurus P, Kurtzer I, Antonawich R, Cluff T. Similar stretch reflexes and behavioral patterns are expressed by the dominant and nondominant arms during postural control. J Neurophysiol 2021; 126:743-762. [PMID: 34320868 DOI: 10.1152/jn.00152.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Limb dominance is evident in many daily activities, leading to the prominent idea that each hemisphere of the brain specializes in controlling different aspects of movement. Past studies suggest that the dominant arm is primarily controlled via an internal model of limb dynamics that enables the nervous system to produce efficient movements. In contrast, the nondominant arm may be primarily controlled via impedance mechanisms that rely on the strong modulation of sensory feedback from individual joints to control limb posture. We tested whether such differences are evident in behavioral responses and stretch reflexes following sudden displacement of the arm during posture control. Experiment 1 applied specific combinations of elbow-shoulder torque perturbations (the same for all participants). Peak joint displacements, return times, end point accuracy, and the directional tuning and amplitude of stretch reflexes in nearly all muscles were not statistically different between the two arms. Experiment 2 induced specific combinations of joint motion (the same for all participants). Again, peak joint displacements, return times, end point accuracy, and the directional tuning and amplitude of stretch reflexes in nearly all muscles did not differ statistically when countering the imposed loads with each arm. Moderate to strong correlations were found between stretch reflexes and behavioral responses to the perturbations with the two arms across both experiments. Collectively, the results do not support the idea that the dominant arm specializes in exploiting internal models and the nondominant arm in impedance control by increasing reflex gains to counter sudden loads imposed on the arms during posture control.NEW & NOTEWORTHY A prominent hypothesis is that the nervous system controls the dominant arm through predictive internal models and the nondominant arm through impedance mechanisms. We tested whether stretch reflexes of muscles in the two arms also display such specialization during posture control. Nearly all behavioral responses and stretch reflexes did not differ statistically but were strongly correlated between the arms. The results indicate individual signatures of feedback control that are common for the two arms.
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Affiliation(s)
- Philipp Maurus
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Isaac Kurtzer
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Ryan Antonawich
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, New York
| | - Tyler Cluff
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Bobrova EV, Reshetnikova VV, Vershinina EA, Grishin AA, Bobrov PD, Frolov AA, Gerasimenko YP. Success of Hand Movement Imagination Depends on Personality Traits, Brain Asymmetry, and Degree of Handedness. Brain Sci 2021; 11:853. [PMID: 34202413 PMCID: PMC8301954 DOI: 10.3390/brainsci11070853] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/23/2021] [Accepted: 06/23/2021] [Indexed: 12/05/2022] Open
Abstract
Brain-computer interfaces (BCIs), based on motor imagery, are increasingly used in neurorehabilitation. However, some people cannot control BCI, predictors of this are the features of brain activity and personality traits. It is not known whether the success of BCI control is related to interhemispheric asymmetry. The study was conducted on 44 BCI-naive subjects and included one BCI session, EEG-analysis, 16PF Cattell Questionnaire, estimation of latent left-handedness, and of subjective complexity of real and imagery movements. The success of brain states recognition during imagination of left hand (LH) movement compared to the rest is higher in reserved, practical, skeptical, and not very sociable individuals. Extraversion, liveliness, and dominance are significant for the imagination of right hand (RH) movements in "pure" right-handers, and sensitivity in latent left-handers. Subjective complexity of real LH and of imagery RH movements correlates with the success of brain states recognition in the imagination of movement of LH compared to RH and depends on the level of handedness. Thus, the level of handedness is the factor influencing the success of BCI control. The data are supposed to be connected with hemispheric differences in motor control, lateralization of dopamine, and may be important for rehabilitation of patients after a stroke.
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Affiliation(s)
- Elena V. Bobrova
- Pavlov Institute of Physiology of the Russian Academy of Sciences, 199034 Saint-Petersburg, Russia; (V.V.R.); (E.A.V.); (A.A.G.); (Y.P.G.)
| | - Varvara V. Reshetnikova
- Pavlov Institute of Physiology of the Russian Academy of Sciences, 199034 Saint-Petersburg, Russia; (V.V.R.); (E.A.V.); (A.A.G.); (Y.P.G.)
| | - Elena A. Vershinina
- Pavlov Institute of Physiology of the Russian Academy of Sciences, 199034 Saint-Petersburg, Russia; (V.V.R.); (E.A.V.); (A.A.G.); (Y.P.G.)
| | - Alexander A. Grishin
- Pavlov Institute of Physiology of the Russian Academy of Sciences, 199034 Saint-Petersburg, Russia; (V.V.R.); (E.A.V.); (A.A.G.); (Y.P.G.)
| | - Pavel D. Bobrov
- Institute of Translational Medicine of Pirogov of Russian National Research Medical University, 117997 Moscow, Russia; (P.D.B.); (A.A.F.)
- Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, 117485 Moscow, Russia
| | - Alexander A. Frolov
- Institute of Translational Medicine of Pirogov of Russian National Research Medical University, 117997 Moscow, Russia; (P.D.B.); (A.A.F.)
- Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Sciences, 117485 Moscow, Russia
| | - Yury P. Gerasimenko
- Pavlov Institute of Physiology of the Russian Academy of Sciences, 199034 Saint-Petersburg, Russia; (V.V.R.); (E.A.V.); (A.A.G.); (Y.P.G.)
- Department of Physiology and Biophysics, University of Louisville, Louisville, KY 40292, USA
- Kentucky Spinal Cord Injury Research Center, Frazier Rehab Institute, University of Louisville, UofL Health, Louisville, KY 40202, USA
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Aerobic Exercise After Left-Sided Stroke Improves Gait Speed and Endurance: A Prospective Cohort Study. Am J Phys Med Rehabil 2021; 100:576-583. [PMID: 32932358 DOI: 10.1097/phm.0000000000001596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the effects of aerobic exercise on individuals who have had a stroke and showed baseline scores lower than the standard scores for the 6-min and 10-meter walk tests. DESIGN Individuals were assigned to groups according to gait performance, defined by the standard values in the 6-min and 10-meter walk tests (standard baseline score and lower baseline score), and brain injury side. Aerobic exercise, 30 mins per day, 2 times a week, for a total of 12 wks. The 6-min and 10-meter walk tests in five assessments: initial, after 4, 8, 12 wks, and 4 wks of follow-up, analyzed by multivariate analysis, with P value of less than 0.05. RESULTS The 6-min walk test data showed an increase in endurance for lower baseline score and left-brain injury, during assessments 4, and follow-up, compared with standard baseline score (F4,84 = 14.64). Lower baseline score showed endurance increase for assessments 2, 3, 4, and follow-up compared with assessment 1 (F4,84 = 7.70). The 10-meter walk test data showed an increase in speed for lower baseline score and left-brain injury, during assessments 3, 4, and follow-up, compared with assessment 1, 4, and follow-up, compared with assessment 2 (F4,84 = 5.33). CONCLUSIONS Aerobic exercise increases gait endurance and speed in individuals who have had a stroke, with left-brain injury, and lower baseline score in the 6-min and 10-meter walk tests.
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Unilateral traumatic brain injury of the left and right hemisphere produces the left hindlimb response in rats. Exp Brain Res 2021; 239:2221-2232. [PMID: 34021800 PMCID: PMC8282563 DOI: 10.1007/s00221-021-06118-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
Traumatic brain injury and stroke result in hemiplegia, hemiparesis, and asymmetry in posture. The effects are mostly contralateral; however, ipsilesional deficits may also develop. We here examined whether ablation brain injury and controlled cortical impact (CCI), a rat model of clinical focal traumatic brain injury, both centered over the left or right sensorimotor cortex, induced hindlimb postural asymmetry (HL-PA) with contralesional or ipsilesional limb flexion. The contralesional hindlimb was flexed after left or right side ablation injury. In contrast, both the left and right CCI unexpectedly produced HL-PA with flexion on left side. The flexion persisted after complete spinal cord transection suggesting that CCI triggered neuroplastic processes in lumbar neural circuits enabling asymmetric muscle contraction. Left limb flexion was exhibited under pentobarbital anesthesia. However, under ketamine anesthesia, the body of the left and right CCI rats bent laterally in the coronal plane to the ipsilesional side suggesting that the left and right injury engaged mirror-symmetrical motor pathways. Thus, the effects of the left and right CCI on HL-PA were not mirror-symmetrical in contrast to those of the ablation brain injury, and to the left and right CCI produced body bending. Ipsilateral effects of the left CCI on HL-PA may be mediated by a lateralized motor pathway that is not affected by the left ablation injury. Alternatively, the left-side-specific neurohormonal mechanism that signals from injured brain to spinal cord may be activated by both the left and right CCI but not by ablation injury.
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Philip BA, McAvoy MP, Frey SH. Interhemispheric Parietal-Frontal Connectivity Predicts the Ability to Acquire a Nondominant Hand Skill. Brain Connect 2021; 11:308-318. [PMID: 33403906 PMCID: PMC8112712 DOI: 10.1089/brain.2020.0916] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: After chronic impairment of the right dominant hand, some individuals are able to compensate with increased performance with the intact left nondominant hand. This process may depend on the nondominant (right) hemisphere's ability to access dominant (left) hemisphere mechanisms. To predict or modulate patients' ability to compensate with the left hand, we must understand the neural mechanisms and connections that underpin this process. Methods: We studied 17 right-handed healthy adults who underwent resting-state functional connectivity (FC) magnetic resonance imaging scans before 10 days of training on a left-hand precision drawing task. We sought to identify right-hemisphere areas where FC from left-hemisphere seeds (primary motor cortex, intraparietal sulcus [IPS], inferior parietal lobule) would predict left-hand skill learning or magnitude. Results: Left-hand skill learning was predicted by convergent FC from left primary motor cortex and left IPS onto the same small region (0.31 cm3) in the right superior parietal lobule (SPL). Discussion: For patients who must compensate with the left hand, the right SPL may play a key role in integrating left-hemisphere mechanisms that typically control the right hand. Our study provides the first model of how interhemispheric functional connections in the human brain may support compensation after chronic injury to the right hand.
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Affiliation(s)
- Benjamin A. Philip
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Mark P. McAvoy
- Department of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Scott H. Frey
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
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Effects of Hemispheric Stroke Localization on the Reorganization of Arm Movements within Different Mechanical Environments. Life (Basel) 2021; 11:life11050383. [PMID: 33922668 PMCID: PMC8145329 DOI: 10.3390/life11050383] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 01/24/2023] Open
Abstract
This study investigated how stroke’s hemispheric localization affects motor performance, spinal maps and muscle synergies while performing planar reaching with and without assistive or resistive forces. A lesion of the right hemisphere affected performance, reducing average speed and smoothness and augmenting lateral deviation in both arms. Instead, a lesion of the left hemisphere affected the aiming error, impairing the feedforward control of the ipsilesional arm. The structure of the muscle synergies had alterations dependent on the lesion side in both arms. The applied force fields reduced the differences in performance and in muscle activations between arms and among populations. These results support the hypotheses of hemispheric specialization in movement control and identify potential significant biomarkers for the design of more effective and personalized rehabilitation protocols.
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Lin DJ, Erler KS, Snider SB, Bonkhoff AK, DiCarlo JA, Lam N, Ranford J, Parlman K, Cohen A, Freeburn J, Finklestein SP, Schwamm LH, Hochberg LR, Cramer SC. Cognitive Demands Influence Upper Extremity Motor Performance During Recovery From Acute Stroke. Neurology 2021; 96:e2576-e2586. [PMID: 33858997 DOI: 10.1212/wnl.0000000000011992] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that cognitive demands influence motor performance during recovery from acute stroke, we tested patients with acute stroke on 2 motor tasks with different cognitive demands and related task performance to cognitive impairment and neuroanatomic injury. METHODS We assessed the contralesional and ipsilesional upper extremities of a cohort of 50 patients with weakness after unilateral acute ischemic stroke at 3 time points with 2 tasks: the Box & Blocks Test, a task with greater cognitive demand, and Grip Strength, a simple and ballistic motor task. We compared performance on the 2 tasks, related motor performance to cognitive dysfunction, and used voxel-based lesion symptom mapping to determine neuroanatomic sites associated with motor performance. RESULTS Consistent across contralesional and ipsilesional upper extremities and most pronounced immediately after stroke, Box & Blocks scores were significantly more impaired than Grip Strength scores. The presence of cognitive dysfunction significantly explained up to 33% of variance in Box & Blocks performance but was not associated with Grip Strength performance. While Grip Strength performance was associated with injury largely restricted to sensorimotor regions, Box & Blocks performance was associated with broad injury outside sensorimotor structures, particularly the dorsal anterior insula, a region known to be important for complex cognitive function. CONCLUSIONS Together, these results suggest that cognitive demands influence upper extremity motor performance during recovery from acute stroke. Our findings emphasize the integrated nature of motor and cognitive systems and suggest that it is critical to consider cognitive demands during motor testing and neurorehabilitation after stroke.
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Affiliation(s)
- David J Lin
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles.
| | - Kimberly S Erler
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Samuel B Snider
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Anna K Bonkhoff
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Julie A DiCarlo
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Nicole Lam
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Jessica Ranford
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Kristin Parlman
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Audrey Cohen
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Jennifer Freeburn
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Seth P Finklestein
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Lee H Schwamm
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Leigh R Hochberg
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
| | - Steven C Cramer
- From the Center for Neurotechnology and Neurorecovery (D.J.L., J.A.D., N.L., J.R., K.P., A.C., J.F., L.R.H.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston; Division of Neurocritical Care (D.J.L., L.R.H.), Department of Neurology, Stroke Service (D.J.L., S.P.F., L.H.S., L.R.H.), Department of Neurology, J. Philip Kistler Stroke Research Center (A.K.B.), Department of Neurology, Department of Occupational Therapy (J.R.), Department of Physical Therapy (K.P.), and Department of Speech, Language, and Swallowing Disorders (A.C., J.F.), Massachusetts General Hospital, Boston; VA RR&D Center for Neurorestoration and Neurotechnology (D.J.L., L.R.H.), Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Department of Occupational Therapy (K.S.E., N.L.), MGH Institute of Health Professions, Boston, MA; Division of Neurocritical Care (S.B.S.), Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; School of Engineering (L.R.H.), Brown University, Providence, RI; Department of Neurology (S.C.C.), University of California, Los Angeles; and California Rehabilitation Hospital (S.C.C.), Los Angeles
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36
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Fernandes ABGS, de Melo JCP, de Oliveira DC, Cavalcanti FADC, Postolache OA, Passos PJM, Campos TF. Is motor learning of stroke patients in non-immersive virtual environment influenced by laterality of injury? A preliminary study. J Bodyw Mov Ther 2021; 25:53-60. [PMID: 33714511 DOI: 10.1016/j.jbmt.2020.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 09/23/2020] [Accepted: 10/15/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stroke is the leading cause of long-term disability in adults, causing residual sensorimotor deficits in many survivors. Patients may have different impairments according to laterality of injury, as well as different responses to some therapies. OBJECTIVE This preliminary study sought to investigate motor learning in rehabilitation of stroke patients with non-immersive virtual environment by process (electroencephalography) and product (performance) measures in stroke patients with left and right cerebral hemispheres damage. METHODS The study included 10 chronic stroke patients; 5 with left brain injury (LI), mean age 48.8 years (±4.76), and 5 with right brain injury (RI), mean age 52 years (±10.93). Patients were evaluated for electroencephalographic activity (alpha and beta frequencies) and performance (absolute error) in a darts game on XBOX Kinect (Microsoft®). Then they underwent a virtual darts game training task, 12 sessions for 4 weeks (acquisition stage). After training, they were revaluated (long-term retention). RESULTS RI group increased alpha power and decreased beta in ipsilesional areas, increased activation on left hemisphere and decreased the absolute error of performance; LI group increased right hemisphere activation and did not decrease the absolute error. CONCLUSIONS Patients with right brain injury reduce neural effort and errors after virtual darts training, which did not happen to patients with left brain injury. Therefore, the laterality of lesion should be considered in studies that use virtual reality for stroke rehabilitation.
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Affiliation(s)
| | | | | | | | | | | | - Tania Fernandes Campos
- Federal University of Rio Grande Do Norte, Department of Physiotherapy, Natal, RN, Brazil
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37
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Maenza C, Wagstaff DA, Varghese R, Winstein C, Good DC, Sainburg RL. Remedial Training of the Less-Impaired Arm in Chronic Stroke Survivors With Moderate to Severe Upper-Extremity Paresis Improves Functional Independence: A Pilot Study. Front Hum Neurosci 2021; 15:645714. [PMID: 33776672 PMCID: PMC7994265 DOI: 10.3389/fnhum.2021.645714] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/23/2021] [Indexed: 01/22/2023] Open
Abstract
The ipsilesional arm of stroke patients often has functionally limiting deficits in motor control and dexterity that depend on the side of the brain that is lesioned and that increase with the severity of paretic arm impairment. However, remediation of the ipsilesional arm has yet to be integrated into the usual standard of care for upper limb rehabilitation in stroke, largely due to a lack of translational research examining the effects of ipsilesional-arm intervention. We now ask whether ipsilesional-arm training, tailored to the hemisphere-specific nature of ipsilesional-arm motor deficits in participants with moderate to severe contralesional paresis, improves ipsilesional arm performance and generalizes to improve functional independence. We assessed the effects of this intervention on ipsilesional arm unilateral performance [Jebsen–Taylor Hand Function Test (JHFT)], ipsilesional grip strength, contralesional arm impairment level [Fugl–Meyer Assessment (FM)], and functional independence [Functional independence measure (FIM)] (N = 13). Intervention occurred over a 3 week period for 1.5 h/session, three times each week. All sessions included virtual reality tasks that targeted the specific motor control deficits associated with either left or right hemisphere damage, followed by graded dexterity training in real-world tasks. We also exposed participants to 3 weeks of sham training to control for the non-specific effects of therapy visits and interactions. We conducted five test-sessions: two pre-tests and three post-tests. Our results indicate substantial improvements in the less-impaired arm performance, without detriment to the paretic arm that transferred to improved functional independence in all three posttests, indicating durability of training effects for at least 3 weeks. We provide evidence for establishing the basis of a rehabilitation approach that includes evaluation and remediation of the ipsilesional arm in moderately to severely impaired stroke survivors. This study was originally a crossover design; however, we were unable to complete the second arm of the study due to the COVID-19 pandemic. We report the results from the first arm of the planned design as a longitudinal study.
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Affiliation(s)
- Candice Maenza
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States.,Department of Kinesiology, Pennsylvania State University, State College, PA, United States
| | - David A Wagstaff
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, United States
| | - Rini Varghese
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Carolee Winstein
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - David C Good
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - Robert L Sainburg
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States.,Department of Kinesiology, Pennsylvania State University, State College, PA, United States
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38
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Frenkel-Toledo S, Ofir-Geva S, Mansano L, Granot O, Soroker N. Stroke Lesion Impact on Lower Limb Function. Front Hum Neurosci 2021; 15:592975. [PMID: 33597852 PMCID: PMC7882502 DOI: 10.3389/fnhum.2021.592975] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
The impact of stroke on motor functioning is analyzed at different levels. ‘Impairment’ denotes the loss of basic characteristics of voluntary movement. ‘Activity limitation’ denotes the loss of normal capacity for independent execution of daily activities. Recovery from impairment is accomplished by ‘restitution’ and recovery from activity limitation is accomplished by the combined effect of ‘restitution’ and ‘compensation.’ We aimed to unravel the long-term effects of variation in lesion topography on motor impairment of the hemiparetic lower limb (HLL), and gait capacity as a measure of related activity limitation. Gait was assessed by the 3 m walk test (3MWT) in 67 first-event chronic stroke patients, at their homes. Enduring impairment of the HLL was assessed by the Fugl–Meyer Lower Extremity (FMA-LE) test. The impact of variation in lesion topography on HLL impairment and on walking was analyzed separately for left and right hemispheric damage (LHD, RHD) by voxel-based lesion-symptom mapping (VLSM). In the LHD group, HLL impairment tended to be affected by damage to the posterior limb of the internal capsule (PLIC). Walking capacity tended to be affected by a larger array of structures: PLIC and corona radiata, external capsule and caudate nucleus. In the RHD group, both HLL impairment and walking capacity were sensitive to damage in a much larger number of brain voxels. HLL impairment was affected by damage to the corona radiata, superior longitudinal fasciculus and insula. Walking was affected by damage to the same areas, plus the internal and external capsules, putamen, thalamus and parts of the perisylvian cortex. In both groups, voxel clusters have been found where damage affected FMA-LE and also 3MWT, along with voxels where damage affected only one of the measures (mainly 3MWT). In stroke, enduring ‘activity limitation’ is affected by damage to a much larger array of brain structures and voxels within specific structures, compared to enduring ‘impairment.’ Differences between the effects of left and right hemisphere damage are likely to reflect variation in motor-network organization and post-stroke re-organization related to hemispheric dominance. Further studies with larger sample size are required for the validation of these results.
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Affiliation(s)
- Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Shay Ofir-Geva
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lihi Mansano
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Granot
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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39
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Jayasinghe SAL, Good D, Wagstaff DA, Winstein C, Sainburg RL. Motor Deficits in the Ipsilesional Arm of Severely Paretic Stroke Survivors Correlate With Functional Independence in Left, but Not Right Hemisphere Damage. Front Hum Neurosci 2020; 14:599220. [PMID: 33362495 PMCID: PMC7756120 DOI: 10.3389/fnhum.2020.599220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Chronic stroke survivors with severe contralesional arm paresis face numerous challenges to performing activities of daily living, which largely rely on the use of the less-affected ipsilesional arm. While use of the ipsilesional arm is often encouraged as a compensatory strategy in rehabilitation, substantial evidence indicates that motor control deficits in this arm can be functionally limiting, suggesting a role for remediation of this arm. Previous research has indicated that the nature of ipsilesional motor control deficits vary with hemisphere of damage and with the severity of contralesional paresis. Thus, in order to design rehabilitation that accounts for these deficits in promoting function, it is critical to understand the relative contributions of both ipsilesional and contralesional arm motor deficits to functional independence in stroke survivors with severe contralesional paresis. We now examine motor deficits in each arm of severely paretic chronic stroke survivors with unilateral damage (10 left-, 10 right-hemisphere damaged individuals) to determine whether hemisphere-dependent deficits are correlated with functional independence. Clinical evaluation of contralesional, paretic arm impairment was conducted with the upper extremity portion of the Fugl-Meyer assessment (UEFM). Ipsilesional arm motor performance was evaluated using the Jebsen-Taylor Hand Function Test (JTHFT), grip strength, and ipsilesional high-resolution kinematic analysis during a visually targeted reaching task. Functional independence was measured with the Barthel Index. Functional independence was better correlated with ipsilesional than contralesional arm motor performance in the left hemisphere damage group [JTHFT: [r (10) = -0.73, p = 0.017]; grip strength: [r (10) = 0.64, p = 0.047]], and by contralesional arm impairment in the right hemisphere damage group [UEFM: [r (10) = 0.66, p = 0.040]]. Ipsilesional arm kinematics were correlated with functional independence in the left hemisphere damage group only. Examination of hemisphere-dependent motor correlates of functional independence showed that ipsilesional arm deficits were important in determining functional outcomes in individuals with left hemisphere damage only, suggesting that functional independence in right hemisphere damaged participants was affected by other factors.
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Affiliation(s)
- Shanie A L Jayasinghe
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - David Good
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States
| | - David A Wagstaff
- Department of Human Development and Family Studies, Pennsylvania State University, State College, PA, United States
| | - Carolee Winstein
- Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Robert L Sainburg
- Department of Neurology, Pennsylvania State University College of Medicine, Hershey, PA, United States.,Department of Kinesiology, Pennsylvania State University, State College, PA, United States
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40
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Schaffer JE, Maenza C, Good DC, Przybyla A, Sainburg RL. Left hemisphere damage produces deficits in predictive control of bilateral coordination. Exp Brain Res 2020; 238:2733-2744. [PMID: 32970199 PMCID: PMC10704921 DOI: 10.1007/s00221-020-05928-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/24/2020] [Indexed: 10/23/2022]
Abstract
Previous research has demonstrated hemisphere-specific motor deficits in ipsilesional and contralesional unimanual movements in patients with hemiparetic stroke due to MCA infarct. Due to the importance of bilateral motor actions on activities of daily living, we now examine how bilateral coordination may be differentially affected by right or left hemisphere stroke. To avoid the caveat of simply adding unimanual deficits in assessing bimanual coordination, we designed a unique task that requires spatiotemporal coordination features that do not exist in unimanual movements. Participants with unilateral left (LHD) or right hemisphere damage (RHD) and age-matched controls moved a virtual rectangle (bar) from a midline start position to a midline target. Movement along the long axis of the bar was redundant to the task, such that the bar remained in the center of and parallel to an imaginary line connecting each hand. Thus, to maintain midline position of the bar, movements of one hand closer to or further away from the bar midline required simultaneous, but oppositely directed displacements with the other hand. Our findings indicate that left (LHD), but not right (RHD) hemisphere-damaged patients showed poor interlimb coordination, reflected by significantly lower correlations between displacements of each hand along the bar axis. These left hemisphere-specific deficits were only apparent prior to peak velocity, likely reflecting predictive control of interlimb coordination. In contrast, the RHD group bilateral coordination was not significantly different than that of the control group. We conclude that predictive mechanisms that govern bilateral coordination are dependent on left hemisphere mechanisms. These findings indicate that assessment and training in cooperative bimanual tasks should be considered as part of an intervention framework for post-stroke physical rehabilitation.
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Affiliation(s)
- Jacob E Schaffer
- Department of Kinesiology, The Pennsylvania State University, 27 Recreation Building, University Park, PA, 16802, USA.
| | - Candice Maenza
- Department of Neurology, Penn State Milton S. Hershey College of Medicine, Hershey, USA
| | - David C Good
- Department of Neurology, Penn State Milton S. Hershey College of Medicine, Hershey, USA
| | - Andrzej Przybyla
- Department of Physical Therapy, University of North Georgia, Dahlonega, USA
| | - Robert L Sainburg
- Department of Kinesiology, The Pennsylvania State University, 27 Recreation Building, University Park, PA, 16802, USA
- Department of Neurology, Penn State Milton S. Hershey College of Medicine, Hershey, USA
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41
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Burns MK, Stika J, Patel V, Pei D, Nataraj R, Vinjamuri R. Lateralization and Model Transference in a Bilateral Cursor Task .. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:3240-3243. [PMID: 33018695 DOI: 10.1109/embc44109.2020.9176496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Post-stroke rehabilitation, occupational and physical therapy, and training for use of assistive prosthetics leverages our current understanding of bilateral motor control to better train individuals. In this study, we examine upper limb lateralization and model transference using a bimanual joystick cursor task with orthogonal controls. Two groups of healthy subjects are recruited into a 2-session study spaced seven days apart. One group uses their left and right hands to control cursor position and rotation respectively, while the other uses their right and left hands. The groups switch control methods in the second session, and a rotational perturbation is applied to the positional controls in the latter half of each session. We find agreement with current lateralization theories when comparing robustness to feedforward perturbations in feedback and feedforward measures. We find no evidence of a transferable model after seven days, and evidence that the brain does not synchronize task completion between the hands.
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Brain Connectivity Modulation After Exoskeleton-Assisted Gait in Chronic Hemiplegic Stroke Survivors: A Pilot Study. Am J Phys Med Rehabil 2020; 99:694-700. [PMID: 32084035 DOI: 10.1097/phm.0000000000001395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate electroencephalographic (EEG) connectivity short-term changes, quantified by node strength and betweenness centrality, induced by a single trial of exoskeleton-assisted gait in chronic stroke survivors. DESIGN Study design was randomized crossover. Electroencephalographic data (64-channel system) were recorded before gait (baseline) and after unassisted overground walking and overground exoskeleton-assisted walking. Coherence was estimated for alpha1, alpha2, and beta frequency ranges. Graph analysis assessed network model properties: node strength and betweenness centrality. RESULTS Nine participants were included in the final analysis. In the group (four participants) with a left-hemisphere stroke lesion (dominant hemisphere), over the vertex, node strength increased in alpha1, alpha2, and beta bands, and betweenness centrality decreased in alpha2 both after unassisted overground walking and exoskeleton-assisted walking. In the group (five participants) with a right-hemisphere lesion (nondominant hemisphere), node strength increased in alpha1 and alpha2 over the contralesional sensorimotor area and ipsilesional prefrontal area after overground exoskeleton-assisted walking, compared with baseline and unassisted overground walking. CONCLUSION A single session of exoskeleton training provides short-term neuroplastic modulation in chronic stroke. In participants with a nondominant hemisphere lesion, exoskeleton training induces activations similar to those observed in able-bodied participants, suggesting a role of lesion lateralization in networks' reorganization.
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Sequeira E, Pierce ML, Akasheh D, Sellers S, Gerwick WH, Baden DG, Murray TF. Epicortical Brevetoxin Treatment Promotes Neural Repair and Functional Recovery after Ischemic Stroke. Mar Drugs 2020; 18:md18070374. [PMID: 32708077 PMCID: PMC7404386 DOI: 10.3390/md18070374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 02/01/2023] Open
Abstract
Emerging literature suggests that after a stroke, the peri-infarct region exhibits dynamic changes in excitability. In rodent stroke models, treatments that enhance excitability in the peri-infarct cerebral cortex promote motor recovery. This increase in cortical excitability and plasticity is opposed by increases in tonic GABAergic inhibition in the peri-infarct zone beginning three days after a stroke in a mouse model. Maintenance of a favorable excitatory-inhibitory balance promoting cerebrocortical excitability could potentially improve recovery. Brevetoxin-2 (PbTx-2) is a voltage-gated sodium channel (VGSC) gating modifier that increases intracellular sodium ([Na+]i), upregulates N-methyl-D-aspartate receptor (NMDAR) channel activity and engages downstream calcium (Ca2+) signaling pathways. In immature cerebrocortical neurons, PbTx-2 promoted neuronal structural plasticity by increasing neurite outgrowth, dendritogenesis and synaptogenesis. We hypothesized that PbTx-2 may promote excitability and structural remodeling in the peri-infarct region, leading to improved functional outcomes following a stroke. We tested this hypothesis using epicortical application of PbTx-2 after a photothrombotic stroke in mice. We show that PbTx-2 enhanced the dendritic arborization and synapse density of cortical layer V pyramidal neurons in the peri-infarct cortex. PbTx-2 also produced a robust improvement of motor recovery. These results suggest a novel pharmacologic approach to mimic activity-dependent recovery from stroke.
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Affiliation(s)
- Erica Sequeira
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE 68123, USA; (E.S.); (M.L.P.); (D.A.); (S.S.)
| | - Marsha L. Pierce
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE 68123, USA; (E.S.); (M.L.P.); (D.A.); (S.S.)
| | - Dina Akasheh
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE 68123, USA; (E.S.); (M.L.P.); (D.A.); (S.S.)
| | - Stacey Sellers
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE 68123, USA; (E.S.); (M.L.P.); (D.A.); (S.S.)
| | - William H. Gerwick
- Center for Marine Biotechnology & Biomedicine, Scripps Institution of Oceanography, San Diego, La Jolla, CA 92093, USA;
| | - Daniel G. Baden
- Center for Marine Science University of North Carolina Wilmington, Wilmington, NC 28409, USA;
| | - Thomas F. Murray
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE 68123, USA; (E.S.); (M.L.P.); (D.A.); (S.S.)
- Correspondence:
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Frenkel-Toledo S, Ofir-Geva S, Soroker N. Lesion Topography Impact on Shoulder Abduction and Finger Extension Following Left and Right Hemispheric Stroke. Front Hum Neurosci 2020; 14:282. [PMID: 32765245 PMCID: PMC7379861 DOI: 10.3389/fnhum.2020.00282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
The existence of shoulder abduction and finger extension movement capacity shortly after stroke onset is an important prognostic factor, indicating favorable functional outcomes for the hemiparetic upper limb (HUL). Here, we asked whether variation in lesion topography affects these two movements similarly or distinctly and whether lesion impact is similar or distinct for left and right hemisphere damage. Shoulder abduction and finger extension movements were examined in 77 chronic post-stroke patients using relevant items of the Fugl-Meyer test. Lesion effects were analyzed separately for left and right hemispheric damage patient groups, using voxel-based lesion-symptom mapping. In the left hemispheric damage group, shoulder abduction and finger extension were affected only by damage to the corticospinal tract in its passage through the corona radiata. In contrast, following the right hemispheric damage, these two movements were affected not only by corticospinal tract damage but also by damage to white matter association tracts, the putamen, and the insular cortex. In both groups, voxel clusters have been found where damage affected shoulder abduction and also finger extension, along with voxels where damage affected only one of the two movements. The capacity to execute shoulder abduction and finger extension movements following stroke is affected significantly by damage to shared and distinct voxels in the corticospinal tract in left-hemispheric damage patients and by damage to shared and distinct voxels in a larger array of cortical and subcortical regions in right hemispheric damage patients.
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Affiliation(s)
- Silvi Frenkel-Toledo
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Shay Ofir-Geva
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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45
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Srinivasan GA, Embar T, Sainburg R. Interlimb differences in coordination of rapid wrist/forearm movements. Exp Brain Res 2020; 238:713-725. [PMID: 32060564 DOI: 10.1007/s00221-020-05743-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
We have previously proposed a model of motor lateralization that attributes specialization for predictive control of intersegmental coordination to the dominant hemisphere/limb system, and control of limb impedance to the non-dominant system. This hypothesis was developed based on visually targeted discrete reaching movement made predominantly with the shoulder and elbow joints. The purpose of this experiment was to determine whether dominant arm advantages for multi-degree of freedom coordination also occur during continuous distal movements of the wrist that do not involve visual guidance. In other words, are the advantages of the dominant arm restricted to controlling intersegmental coordination during discrete visually targeted reaching movements, or are they more generally related to coordination of multiple degrees of freedom at other joints, regardless of whether the movements are discrete or invoke visual guidance? Eight right-handed participants were instructed to perform alternating wrist ulnar/radial deviation movements at two instructed speeds, slow and fast, with the dominant or the non-dominant arm, and were instructed not to rotate the forearm (pronation/supination) or move the wrist up and down (flexion/extension). This was explained by slowly and passively moving the wrist in each plane during the instructions. Because all the muscles that cross the wrist have moment arms with respect to more than one axis of rotation, intermuscular coordination is required to prevent motion about non-instructed axes of rotation. We included two conditions, a very slow condition, as a control condition, to demonstrate understanding of the task, and an as-fast-as-possible condition to challenge predictive aspect of control, which we hypothesize are specialized to the dominant controller. Our results indicated that during as-fast-as-possible conditions the non-dominant arm incorporated significantly more non-instructed motion, which resulted in greater circumduction at the non-dominant than the dominant wrist. These findings extend the dynamic dominance hypothesis, indicating that the dominant hemisphere-arm system is specialized for predictive control of multiple degrees of freedom, even in movements of the distal arm and made in the absence of visual guidance.
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Affiliation(s)
- Gautum A Srinivasan
- Department of Kinesiology, Pennsylvania State University, Rec Hall 27, Burrowes Rd., University Park, PA, 16802, USA.
| | - Tarika Embar
- Department of Kinesiology, Pennsylvania State University, Rec Hall 27, Burrowes Rd., University Park, PA, 16802, USA
| | - Robert Sainburg
- Department of Kinesiology, Pennsylvania State University, Rec Hall 27, Burrowes Rd., University Park, PA, 16802, USA.,Department of Neurology, Penn State College of Medicine, Hershey, USA
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Brain regions associated with periodic leg movements during sleep in restless legs syndrome. Sci Rep 2020; 10:1615. [PMID: 32005856 PMCID: PMC6994717 DOI: 10.1038/s41598-020-58365-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
The neural substrates related to periodic leg movements during sleep (PLMS) remain uncertain, and the specific brain regions involved in PLMS have not been evaluated. We investigated the brain regions associated with PLMS and their severity using the electroencephalographic (EEG) source localization method. Polysomnographic data, including electromyographic, electrocardiographic, and 19-channel EEG signals, of 15 patients with restless legs syndrome were analyzed. We first identified the source locations of delta-band (2–4 Hz) spectral power prior to the onset of PLMS using a standardized low-resolution brain electromagnetic tomography method. Next, correlation analysis was conducted between current densities and PLMS index. Delta power initially and most prominently increased before leg movement (LM) onset in the PLMS series. Sources of delta power at −4~−3 seconds were located in the right pericentral, bilateral dorsolateral prefrontal, and cingulate regions. PLMS index was correlated with current densities at the right inferior parietal, temporoparietal junction, and middle frontal regions. In conclusion, our results suggest that the brain regions activated before periodic LM onset or associated with their severity are the large-scale motor network and provide insight into the cortical contribution of PLMS pathomechanism.
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Raghavan P, Bilaloglu S, Ali SZ, Jin X, Aluru V, Buckley MC, Tang A, Yousefi A, Stone J, Agrawal SK, Lu Y. The Role of Robotic Path Assistance and Weight Support in Facilitating 3D Movements in Individuals With Poststroke Hemiparesis. Neurorehabil Neural Repair 2020; 34:134-147. [PMID: 31959040 DOI: 10.1177/1545968319887685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background. High-intensity repetitive training is challenging to provide poststroke. Robotic approaches can facilitate such training by unweighting the limb and/or by improving trajectory control, but the extent to which these types of assistance are necessary is not known. Objective. The purpose of this study was to examine the extent to which robotic path assistance and/or weight support facilitate repetitive 3D movements in high functioning and low functioning subjects with poststroke arm motor impairment relative to healthy controls. Methods. Seven healthy controls and 18 subjects with chronic poststroke right-sided hemiparesis performed 300 repetitions of a 3D circle-drawing task using a 3D Cable-driven Arm Exoskeleton (CAREX) robot. Subjects performed 100 repetitions each with path assistance alone, weight support alone, and path assistance plus weight support in a random order over a single session. Kinematic data from the task were used to compute the normalized error and speed as well as the speed-error relationship. Results. Low functioning stroke subjects (Fugl-Meyer Scale score = 16.6 ± 6.5) showed the lowest error with path assistance plus weight support, whereas high functioning stroke subjects (Fugl-Meyer Scale score = 59.6 ± 6.8) moved faster with path assistance alone. When both speed and error were considered together, low functioning subjects significantly reduced their error and increased their speed but showed no difference across the robotic conditions. Conclusions. Robotic assistance can facilitate repetitive task performance in individuals with severe arm motor impairment, but path assistance provides little advantage over weight support alone. Future studies focusing on antigravity arm movement control are warranted poststroke.
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Affiliation(s)
- Preeti Raghavan
- New York University, New York, NY, USA.,Johns Hopkins University, Baltimore, MD, USA
| | | | - Syed Zain Ali
- New York University, New York, NY, USA.,NYIT College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Xin Jin
- Columbia University, New York, NY, USA
| | | | - Megan C Buckley
- New York University, New York, NY, USA.,NYIT College of Osteopathic Medicine, Old Westbury, NY, USA
| | | | | | | | | | - Ying Lu
- New York University, New York, NY, USA
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Varghese R, Winstein CJ. Relationship Between Motor Capacity of the Contralesional and Ipsilesional Hand Depends on the Side of Stroke in Chronic Stroke Survivors With Mild-to-Moderate Impairment. Front Neurol 2020; 10:1340. [PMID: 31998211 PMCID: PMC6961702 DOI: 10.3389/fneur.2019.01340] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/04/2019] [Indexed: 01/13/2023] Open
Abstract
There is growing evidence that after a stroke, sensorimotor deficits in the ipsilesional hand are related to the degree of impairment in the contralesional upper extremity. Here, we asked if the relationship between the motor capacities of the two hands differs based on the side of stroke. Forty-two pre-morbidly right-handed chronic stroke survivors (left hemisphere damage, LHD = 21) with mild-to-moderate paresis performed distal items of the Wolf Motor Function Test (dWMFT). We found that compared to RHD, the relationship between contralesional arm impairment (Upper Extremity Fugl-Meyer, UEFM) and ipsilesional hand motor capacity was stronger (R L H D 2 = 0.42;R R H D 2 < 0.01; z = 2.12; p = 0.03) and the slope was steeper (t = -2.03; p = 0.04) in LHD. Similarly, the relationship between contralesional dWMFT and ipsilesional hand motor capacity was stronger (R L H D 2 = 0.65;R R H D 2 = 0.09; z = 2.45; p = 0.01) and the slope was steeper (t = 2.03; p = 0.04) in LHD compared to RHD. Multiple regression analysis confirmed the presence of an interaction between contralesional UEFM and side of stroke (β3 = 0.66 ± 0.30; p = 0.024) and between contralesional dWMFT and side of stroke (β3 = -0.51 ± 0.34; p = 0.05). Our findings suggest that the relationship between contra- and ipsi-lesional motor capacity depends on the side of stroke in chronic stroke survivors with mild-to-moderate impairment. When contralesional impairment is more severe, the ipsilesional hand is proportionally slower in those with LHD compared to those with RHD.
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Affiliation(s)
- Rini Varghese
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Carolee J. Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Swanson CW, Fling BW. Associations between Turning Characteristics and Corticospinal Inhibition in Young and Older Adults. Neuroscience 2019; 425:59-67. [PMID: 31765624 DOI: 10.1016/j.neuroscience.2019.10.051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/23/2019] [Accepted: 10/30/2019] [Indexed: 01/12/2023]
Abstract
The effects of aging are multifaceted including deleterious changes to the structure and function of the nervous system which often results in reduced mobility and quality of life. Turning while walking (dynamic) and in-place (stable) are ubiquitous aspects of mobility and have substantial consequences if performed poorly. Further, turning is thought to require higher cortical control compared to bouts of straight-ahead walking. This study sought to understand how relative amounts of corticospinal inhibition as measured by transcranial magnetic stimulation and the cortical silent period within the primary motor cortices are associated with various turning characteristics in neurotypical young (YA) and older adults (OA). In the current study, OA had reduced peak turn velocity and increased turn duration for both dynamic and stable turns. Further, OA demonstrated significantly reduced corticospinal inhibition within the right motor cortex. Finally, all associations between corticospinal inhibition and turning performance were specific to the right hemisphere, reflecting that those OA who maintained high levels of inhibition performed turning similar to their younger counterparts. These results compliment the right hemisphere model of aging and lateralization specification of cortically regulated temporal measures of dynamic movement. While additional investigations are required, these pilot findings provide an additional understanding as to the neural control of dynamic movements.
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Affiliation(s)
- Clayton W Swanson
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA
| | - Brett W Fling
- Department of Health & Exercise Science, Colorado State University, Fort Collins, CO, USA; Molecular, Cellular, and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO, USA.
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50
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Bundy DT, Leuthardt EC. The Cortical Physiology of Ipsilateral Limb Movements. Trends Neurosci 2019; 42:825-839. [PMID: 31514976 PMCID: PMC6825896 DOI: 10.1016/j.tins.2019.08.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/25/2019] [Accepted: 08/16/2019] [Indexed: 12/19/2022]
Abstract
Whereas voluntary movements have long been understood to derive primarily from the cortical hemisphere contralateral to a moving limb, substantial cortical activations also occur in the same-sided, or ipsilateral, cortical hemisphere. These ipsilateral motor activations have recently been shown to be useful to decode specific movement features. Furthermore, in contrast to the classical understanding that unilateral limb movements are solely driven by the contralateral hemisphere, it appears that the ipsilateral hemisphere plays an active and specific role in the planning and execution of voluntary movements. Here we review the movement-related activations observed in the ipsilateral cortical hemisphere, interpret this evidence in light of the potential roles of the ipsilateral hemisphere in the planning and execution of movements, and describe the implications for clinical populations.
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Affiliation(s)
- David T Bundy
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA; Department of Biomedical Engineering, Washington University, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Biomedical Engineering, Washington University, St. Louis, MO, USA; Department of Neurological Surgery, Washington University, St. Louis, MO, USA; Center of Innovation in Neuroscience and Technology, Washington University, St. Louis, MO, USA.
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