1
|
Sadnicka A, Wiestler T, Butler K, Altenmuller E, Edwards MJ, Ejaz N, Diedrichsen J. Boundaries of task-specificity: bimanual finger dexterity is reduced in musician's dystonia. Sci Rep 2024; 14:15972. [PMID: 38987302 PMCID: PMC11237050 DOI: 10.1038/s41598-024-65888-3] [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: 04/19/2024] [Accepted: 06/25/2024] [Indexed: 07/12/2024] Open
Abstract
Task-specific dystonia leads to loss of sensorimotor control for a particular motor skill. Although focal in nature, it is hugely disabling and can terminate professional careers in musicians. Biomarkers for underlying mechanism and severity are much needed. In this study, we designed a keyboard device that measured the forces generated at all fingertips during individual finger presses. By reliably quantifying overflow to other fingers in the instructed (enslaving) and contralateral hand (mirroring) we explored whether this task could differentiate between musicians with and without dystonia. 20 right-handed professional musicians (11 with dystonia) generated isometric flexion forces with the instructed finger to match 25%, 50% or 75% of maximal voluntary contraction for that finger. Enslaving was estimated as a linear slope of the forces applied across all instructed/uninstructed finger combinations. Musicians with dystonia had a small but robust loss of finger dexterity. There was increased enslaving and mirroring, primarily during use of the symptomatic hand (enslaving p = 0.003; mirroring p = 0.016), and to a lesser extent with the asymptomatic hand (enslaving p = 0.052; mirroring p = 0.062). Increased enslaving and mirroring were seen across all combinations of finger pairs. In addition, enslaving was exaggerated across symptomatic fingers when more than one finger was clinically affected. Task-specific dystonia therefore appears to express along a gradient, most severe in the affected skill with subtle and general motor control dysfunction in the background. Recognition of this provides a more nuanced understanding of the sensorimotor control deficits at play and can inform therapeutic options for this highly disabling disorder.
Collapse
Affiliation(s)
- Anna Sadnicka
- Gatsby Computational Neuroscience Unit, University College London, 25 Howland Street, London, W1T 4JG, UK.
- Department of Clinical and Movement Neurosciences, University College London, London, UK.
- Neurosciences and Cell Biology Research Institute, St George's University of London, London, UK.
| | - Tobias Wiestler
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Katherine Butler
- Faculty of Health, School of Health Professions, University of Plymouth, Plymouth, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- London Hand Therapy, Mayo Clinic Healthcare, London, UK
| | | | - Mark J Edwards
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Naveed Ejaz
- Western Institute of Neuroscience, University of Western Ontario, London, Canada
| | - Jörn Diedrichsen
- Western Institute of Neuroscience, University of Western Ontario, London, Canada
| |
Collapse
|
2
|
Eilfort AM, Rasenack M, Zörner B, Curt A, Filli L. Evidence for reticulospinal plasticity underlying motor recovery in Brown-Séquard-plus Syndrome: a case report. Front Neurol 2024; 15:1335795. [PMID: 38895696 PMCID: PMC11183277 DOI: 10.3389/fneur.2024.1335795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/10/2024] [Indexed: 06/21/2024] Open
Abstract
Brown-Séquard Syndrome (BSS) is a rare neurological condition caused by a unilateral spinal cord injury (SCI). Upon initial ipsilesional hemiplegia, patients with BSS typically show substantial functional recovery over time. Preclinical studies on experimental BSS demonstrated that spontaneous neuroplasticity in descending motor systems is a key mechanism promoting functional recovery. The reticulospinal (RS) system is one of the main descending motor systems showing a remarkably high ability for neuroplastic adaptations after incomplete SCI. In humans, little is known about the contribution of RS plasticity to functional restoration after SCI. Here, we investigated RS motor drive to different muscles in a subject with Brown-Séquard-plus Syndrome (BSPS) five months post-injury using the StartReact paradigm. RS drive was compared between ipsi- and contralesional muscles, and associated with measures of functional recovery. Additionally, corticospinal (CS) drive was investigated using transcranial magnetic stimulation (TMS) in a subset of muscles. The biceps brachii showed a substantial enhancement of RS drive on the ipsi- vs. contralesional side, whereas no signs of CS plasticity were found ipsilesionally. This finding implies that motor recovery of ipsilesional elbow flexion is primarily driven by the RS system. Results were inversed for the ipsilesional tibialis anterior, where RS drive was not augmented, but motor-evoked potentials recovered over six months post-injury, suggesting that CS plasticity contributed to improvements in ankle dorsiflexion. Our findings indicate that the role of RS and CS plasticity in motor recovery differs between muscles, with CS plasticity being essential for the restoration of distal extremity motor function, and RS plasticity being important for the functional recovery of proximal flexor muscles after SCI in humans.
Collapse
Affiliation(s)
- Antonia Maria Eilfort
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
- Department of Health Science and Technology, ETH Zurich, Zurich, Switzerland
| | - Maria Rasenack
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Björn Zörner
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Swiss Paraplegic Center and Swiss Paraplegic Research, Nottwil, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
| | - Linard Filli
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich, Zurich, Switzerland
- Swiss Center for Movement Analysis, Balgrist Campus AG, Zurich, Switzerland
| |
Collapse
|
3
|
Shanks MJ, Byblow WD. Corticomotor pathway function and recovery after stroke: a look back and a way forward. J Physiol 2024. [PMID: 38814805 DOI: 10.1113/jp285562] [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: 12/26/2023] [Accepted: 05/15/2024] [Indexed: 06/01/2024] Open
Abstract
Stroke is a leading cause of adult disability that results in motor deficits and reduced independence. Regaining independence relies on motor recovery, particularly regaining function of the hand and arm. This review presents evidence from human studies that have used transcranial magnetic stimulation (TMS) to identify neurophysiological mechanisms underlying upper limb motor recovery early after stroke. TMS studies undertaken at the subacute stage after stroke have identified several neurophysiological factors that can drive motor impairment, including membrane excitability, the recruitment of corticomotor neurons, and glutamatergic and GABAergic neurotransmission. However, the inherent variability and subsequent poor reliability of measures derived from motor evoked potentials (MEPs) limit the use of TMS for prognosis at the individual patient level. Currently, prediction tools that provide the most accurate information about upper limb motor outcomes for individual patients early after stroke combine clinical measures with a simple neurophysiological biomarker based on MEP presence or absence, i.e. MEP status. Here, we propose a new compositional framework to examine MEPs across several upper limb muscles within a threshold matrix. The matrix can provide a more comprehensive view of corticomotor function and recovery after stroke by quantifying the evolution of subthreshold and suprathreshold MEPs through compositional analyses. Our contention is that subthreshold responses might be the most sensitive to reduced output of corticomotor neurons, desynchronized firing of the remaining neurons, and myelination processes that occur early after stroke. Quantifying subthreshold responses might provide new insights into post-stroke neurophysiology and improve the accuracy of prediction of upper limb motor outcomes.
Collapse
Affiliation(s)
- Maxine J Shanks
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Winston D Byblow
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| |
Collapse
|
4
|
Qi Y, Xu Y, Wang H, Wang Q, Li M, Han B, Liu H. Network Reorganization for Neurophysiological and Behavioral Recovery Following Stroke. Cent Nerv Syst Agents Med Chem 2024; 24:117-128. [PMID: 38299298 DOI: 10.2174/0118715249277597231226064144] [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: 09/18/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 02/02/2024]
Abstract
Stroke continues to be the main cause of motor disability worldwide. While rehabilitation has been promised to improve recovery after stroke, efficacy in clinical trials has been mixed. We need to understand the cortical recombination framework to understand how biomarkers for neurophysiological reorganized neurotechnologies alter network activity. Here, we summarize the principles of the movement network, including the current evidence of changes in the connections and function of encephalic regions, recovery from stroke and the therapeutic effects of rehabilitation. Overall, improvements or therapeutic effects in limb motor control following stroke are correlated with the effects of interhemispheric competition or compensatory models of the motor supplementary cortex. This review suggests that future research should focus on cross-regional communication and provide fundamental insights into further treatment and rehabilitation for post-stroke patients.
Collapse
Affiliation(s)
- Yuan Qi
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Yujie Xu
- Chengde Medical College Affiliated Hospital, Chengde, Hebei, CN, China
| | - Huailu Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Qiujia Wang
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Meijie Li
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Bo Han
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| | - Haijie Liu
- Department of Neurology, Xuanwu Hospital Capital Medical University, Beijing CN, China
| |
Collapse
|
5
|
Dietz V, Holliger NS, Christen A, Geissmann M, Filli L. Neural coordination of bilateral hand movements: evidence for an involvement of brainstem motor centres. J Physiol 2024; 602:397-412. [PMID: 38178603 DOI: 10.1113/jp285403] [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: 07/30/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
Bilateral hand movements are assumed to be coordinated by a neural coupling mechanism. Neural coupling is experimentally reflected in complex electromyographic (EMG) responses in the forearm muscles of both sides to unilateral electrical arm nerve stimulation (ES). The aim of this study was to examine a potential involvement of the reticulospinal system in neural coupling by the application of loud acoustic stimuli (LAS) known to activate neurons of this system. LAS, ES and combined LAS/ES were applied to healthy subjects during visually guided bilateral hand flexion-extension movements. Muscle responses to the different stimuli were evaluated by electrophysiological recordings. Unilateral electrical ulnar nerve stimulation resulted in neural coupling responses in the forearm extensors (FE) of both sides. Interestingly, LAS evoked bilateral EMG responses that were similar in their configuration to those induced by ES. The presence of startles was associated with a shift of the onset and enhanced amplitude of LAS-induced coupling-like responses. Upon combined LAS/ES application, ES facilitated ipsilateral startles and coupling-like responses. Modulation of coupling-like responses by startles, the similarity of the responses to ES and LAS, and their interaction following combined stimulation suggests that both responses are mediated by the reticulospinal system. Our findings provide novel indirect evidence that the reticulospinal system is involved in the neural coupling of hand movements. This becomes clinically relevant in subjects with a damaged corticospinal system where a dominant reticulospinal system leads to involuntary limb coupling, referred to as associated movements. KEY POINTS: Automatic coordination of hand movements is assumed to be mediated by a neural coupling mechanism reflected by bilateral reflex responses in forearm muscles to unilateral electrical arm nerve stimulation (ES). Loud acoustic stimuli (LAS) were applied to assess a potential involvement of the reticulospinal system in the neural coupling mechanism. LAS evoked a bilateral reflex response in the forearm extensors that was similar to the neural coupling response to ES, and which could be separated from the acoustic startle response. Combined application of LAS and ES resulted in a facilitation of startle and coupling-like responses ipsilateral to ES, thus indicating an interaction of afferences from both stimuli. These novel findings provide indirect evidence that the reticulospinal system is a key motor structure for the coupling of bilateral hand movements.
Collapse
Affiliation(s)
- Volker Dietz
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Nicole Sarah Holliger
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrin Christen
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marina Geissmann
- Swiss Center for Movement Analysis (SCMA), Balgrist Campus AG, Zurich, Switzerland
| | - Linard Filli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Swiss Center for Movement Analysis (SCMA), Balgrist Campus AG, Zurich, Switzerland
| |
Collapse
|
6
|
Abstract
Neurological insults, such as congenital blindness, deafness, amputation, and stroke, often result in surprising and impressive behavioural changes. Cortical reorganisation, which refers to preserved brain tissue taking on a new functional role, is often invoked to account for these behavioural changes. Here, we revisit many of the classical animal and patient cortical remapping studies that spawned this notion of reorganisation. We highlight empirical, methodological, and conceptual problems that call this notion into doubt. We argue that appeal to the idea of reorganisation is attributable in part to the way that cortical maps are empirically derived. Specifically, cortical maps are often defined based on oversimplified assumptions of 'winner-takes-all', which in turn leads to an erroneous interpretation of what it means when these maps appear to change. Conceptually, remapping is interpreted as a circuit receiving novel input and processing it in a way unrelated to its original function. This implies that neurons are either pluripotent enough to change what they are tuned to or that a circuit can change what it computes. Instead of reorganisation, we argue that remapping is more likely to occur due to potentiation of pre-existing architecture that already has the requisite representational and computational capacity pre-injury. This architecture can be facilitated via Hebbian and homeostatic plasticity mechanisms. Crucially, our revised framework proposes that opportunities for functional change are constrained throughout the lifespan by the underlying structural 'blueprint'. At no period, including early in development, does the cortex offer structural opportunities for functional pluripotency. We conclude that reorganisation as a distinct form of cortical plasticity, ubiquitously evoked with words such as 'take-over'' and 'rewiring', does not exist.
Collapse
Affiliation(s)
- Tamar R Makin
- MRC Cognition and Brain Sciences Unit, University of CambridgeCambridgeUnited Kingdom
| | - John W Krakauer
- Department of Neuroscience, Johns Hopkins University School of MedicineBaltimoreUnited States
- Department of Neurology, Johns Hopkins University School of MedicineBaltimoreUnited States
- The Santa Fe InstituteSanta FeUnited States
| |
Collapse
|
7
|
Cleland BT, Giffhorn M, Jayaraman A, Madhavan S. Understanding corticomotor mechanisms for activation of non-target muscles during unilateral isometric contractions of leg muscles after stroke. Int J Neurosci 2023:1-10. [PMID: 37750212 PMCID: PMC10963339 DOI: 10.1080/00207454.2023.2263817] [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: 06/23/2023] [Accepted: 09/22/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Muscle activation often occurs in muscles ipsilateral to a voluntarily activated muscle and to a greater extent after stroke. In this study, we measured muscle activation in non-target, ipsilateral leg muscles and used transcranial magnetic stimulation (TMS) to provide insight into whether corticomotor pathways contribute to involuntary activation. MATERIALS AND METHODS Individuals with stroke performed unilateral isometric ankle dorsiflexion, ankle plantarflexion, knee extension, and knee flexion. To quantify involuntary muscle activation in non-target muscles, muscle activation was measured during contractions from the ipsilateral tibialis anterior (TA), medial gastrocnemius (MG), rectus femoris (RF), and biceps femoris (BF) and normalized to resting muscle activity. To provide insight into mechanisms of involuntary non-target muscle activation, TMS was applied to the contralateral hemisphere, and motor evoked potentials (MEPs) were recorded. RESULTS We found significant muscle activation in nearly every non-target muscle during isometric unilateral contractions. MEPs were frequently observed in non-target muscles, but greater non-target MEP amplitude was not associated with greater non-target muscle activation. CONCLUSIONS Our results suggest that non-target muscle activation occurs frequently in individuals with chronic stroke. The lack of association between non-target TMS responses and non-target muscle activation suggests that non-target muscle activation may have a subcortical or spinal origin. Non-target muscle activation has important clinical implications because it may impair torque production, out-of-synergy movement, and muscle activation timing.
Collapse
Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
| | - Matt Giffhorn
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Arun Jayaraman
- Max Nader Center for Rehabilitation Technologies & Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois Chicago, Chicago, IL, USA
| |
Collapse
|
8
|
Quattrone A, Latorre A, Magrinelli F, Mulroy E, Rajan R, Neo RJ, Quattrone A, Rothwell JC, Bhatia KP. A Reflection on Motor Overflow, Mirror Phenomena, Synkinesia and Entrainment. Mov Disord Clin Pract 2023; 10:1243-1252. [PMID: 37772299 PMCID: PMC10525069 DOI: 10.1002/mdc3.13798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/08/2023] [Accepted: 05/08/2023] [Indexed: 09/30/2023] Open
Abstract
In patients with movement disorders, voluntary movements can sometimes be accompanied by unintentional muscle contractions in other body regions. In this review, we discuss clinical and pathophysiological aspects of several motor phenomena including mirror movements, dystonic overflow, synkinesia, entrainment and mirror dystonia, focusing on their similarities and differences. These phenomena share some common clinical and pathophysiological features, which often leads to confusion in their definition. However, they differ in several aspects, such as the body part showing the undesired movement, the type of this movement (identical or not to the intentional movement), the underlying neurological condition, and the role of primary motor areas, descending pathways and inhibitory circuits involved, suggesting that these are distinct phenomena. We summarize the main features of these fascinating clinical signs aiming to improve the clinical recognition and standardize the terminology in research studies. We also suggest that the term "mirror dystonia" may be not appropriate to describe this peculiar phenomenon which may be closer to dystonic overflow rather than to the classical mirror movements.
Collapse
Affiliation(s)
- Andrea Quattrone
- Institute of NeurologyUniversity “Magna Graecia”CatanzaroItaly
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Francesca Magrinelli
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Roopa Rajan
- Department of NeurologyAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
| | - Ray Jen Neo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
- Department of NeurologyHospital Kuala LumpurKuala LumpurMalaysia
| | - Aldo Quattrone
- Neuroscience Research Center, Department of Medical and Surgical SciencesUniversity “Magna Graecia”CatanzaroItaly
| | - John C. Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Kailash P. Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| |
Collapse
|
9
|
Xu J, Ma T, Kumar S, Olds K, Brown J, Carducci J, Forrence A, Krakauer J. Loss of finger control complexity and intrusion of flexor biases are dissociable in finger individuation impairment after stroke. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.29.555444. [PMID: 37693573 PMCID: PMC10491249 DOI: 10.1101/2023.08.29.555444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
The ability to control each finger independently is an essential component of human hand dexterity. A common observation of hand function impairment after stroke is the loss of this finger individuation ability, often referred to as enslavement, i.e., the unwanted coactivation of non-intended fingers in individuated finger movements. In the previous literature, this impairment has been attributed to several factors, such as the loss of corticospinal drive, an intrusion of flexor synergy due to upregulations of the subcortical pathways, and/or biomechanical constraints. These factors may or may not be mutually exclusive and are often difficult to tease apart. It has also been suggested, based on a prevailing impression, that the intrusion of flexor synergy appears to be an exaggerated pattern of the involuntary coactivations of task-irrelevant fingers seen in a healthy hand, often referred to as a flexor bias. Most previous studies, however, were based on assessments of enslavement in a single dimension (i.e., finger flexion/extension) that coincide with the flexor bias, making it difficult to tease apart the other aforementioned factors. Here, we set out to closely examine the nature of individuated finger control and finger coactivation patterns in all dimensions. Using a novel measurement device and a 3D finger-individuation paradigm, we aim to tease apart the contributions of lower biomechanical, subcortical constraints, and top-down cortical control to these patterns in both healthy and stroke hands. For the first time, we assessed all five fingers' full capacity for individuation. Our results show that these patterns in the healthy and paretic hands present distinctly different shapes and magnitudes that are not influenced by biomechanical constraints. Those in the healthy hand presented larger angular distances that were dependent on top-down task goals, whereas those in the paretic hand presented larger Euclidean distances that arise from two dissociable factors: a loss of complexity in finger control and the dominance of an intrusion of flexor bias. These results suggest that finger individuation impairment after stroke is due to two dissociable factors: the loss of finger control complexity present in the healthy hand reflecting a top-down neural control strategy and an intrusion of flexor bias likely due to an upregulation of subcortical pathways. Our device and paradigm are demonstrated to be a promising tool to assess all aspects of the dexterous capacity of the hand.
Collapse
Affiliation(s)
- Jing Xu
- Department of Kinesiology, University of Georgia, Athens, GA, USA
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
| | - Timothy Ma
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
- Center for Neural Science, New York University, New York, NY, USA
| | - Sapna Kumar
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Kevin Olds
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Jeremy Brown
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Jacob Carducci
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Alex Forrence
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Department of Psychology, Yale University, New Haven, NJ, USA
| | - John Krakauer
- The Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
10
|
Mirdamadi JL, Xu J, Arevalo-Alas KM, Kam LK, Borich MR. State-dependent interhemispheric inhibition reveals individual differences in motor behavior in chronic stroke. Clin Neurophysiol 2023; 149:157-167. [PMID: 36965468 PMCID: PMC10101934 DOI: 10.1016/j.clinph.2023.02.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/05/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To investigate state-dependent interhemispheric inhibition (IHI) in chronic stroke survivors compared to neurotypical older adult controls, and test whether abnormal IHI modulation was associated with upper extremity motor behavior. METHODS Dual-coil transcranial magnetic stimulation (TMS) measured IHI bi-directionally, between non-lesioned and lesioned motor cortex (M1) in two activity states: (1) at rest and (2) during contralateral isometric hand muscle contraction. IHI was tested by delivering a conditioning stimulus 8-msec or 50-msec prior to a test stimulus over contralateral M1. Paretic motor behavior was assessed by clinical measures of impairment, strength, and dexterity, and mirroring activity in the non-paretic hand. RESULTS Stroke survivors demonstrated reduced IHI at rest, and less IHI modulation (active - rest) compared to controls. Individual differences in IHI modulation were related to motor behavior differences where greater IHI modulation was associated with greater motor impairment and more mirroring. In contrast, there were no relationships between IHI at rest and motor behavior. CONCLUSIONS Abnormal state-dependent interhemispheric circuit activity may be more sensitive to post-stroke motor deficits than when assessed in a single motor state. SIGNIFICANCE Characterizing state-dependent changes in neural circuitry may enhance models of stroke recovery and inform rehabilitation interventions.
Collapse
Affiliation(s)
- Jasmine L Mirdamadi
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jing Xu
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Karla M Arevalo-Alas
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Liana K Kam
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael R Borich
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| |
Collapse
|
11
|
Van Malderen S, Hehl M, Verstraelen S, Swinnen SP, Cuypers K. Dual-site TMS as a tool to probe effective interactions within the motor network: a review. Rev Neurosci 2023; 34:129-221. [PMID: 36065080 DOI: 10.1515/revneuro-2022-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/02/2022] [Indexed: 02/07/2023]
Abstract
Dual-site transcranial magnetic stimulation (ds-TMS) is well suited to investigate the causal effect of distant brain regions on the primary motor cortex, both at rest and during motor performance and learning. However, given the broad set of stimulation parameters, clarity about which parameters are most effective for identifying particular interactions is lacking. Here, evidence describing inter- and intra-hemispheric interactions during rest and in the context of motor tasks is reviewed. Our aims are threefold: (1) provide a detailed overview of ds-TMS literature regarding inter- and intra-hemispheric connectivity; (2) describe the applicability and contributions of these interactions to motor control, and; (3) discuss the practical implications and future directions. Of the 3659 studies screened, 109 were included and discussed. Overall, there is remarkable variability in the experimental context for assessing ds-TMS interactions, as well as in the use and reporting of stimulation parameters, hindering a quantitative comparison of results across studies. Further studies examining ds-TMS interactions in a systematic manner, and in which all critical parameters are carefully reported, are needed.
Collapse
Affiliation(s)
- Shanti Van Malderen
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Melina Hehl
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Stefanie Verstraelen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Stephan P Swinnen
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Koen Cuypers
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| |
Collapse
|
12
|
Pichiorri F, Toppi J, de Seta V, Colamarino E, Masciullo M, Tamburella F, Lorusso M, Cincotti F, Mattia D. Exploring high-density corticomuscular networks after stroke to enable a hybrid Brain-Computer Interface for hand motor rehabilitation. J Neuroeng Rehabil 2023; 20:5. [PMID: 36639665 PMCID: PMC9840279 DOI: 10.1186/s12984-023-01127-6] [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: 08/02/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Brain-Computer Interfaces (BCI) promote upper limb recovery in stroke patients reinforcing motor related brain activity (from electroencephalogaphy, EEG). Hybrid BCIs which include peripheral signals (electromyography, EMG) as control features could be employed to monitor post-stroke motor abnormalities. To ground the use of corticomuscular coherence (CMC) as a hybrid feature for a rehabilitative BCI, we analyzed high-density CMC networks (derived from multiple EEG and EMG channels) and their relation with upper limb motor deficit by comparing data from stroke patients with healthy participants during simple hand tasks. METHODS EEG (61 sensors) and EMG (8 muscles per arm) were simultaneously recorded from 12 stroke (EXP) and 12 healthy participants (CTRL) during simple hand movements performed with right/left (CTRL) and unaffected/affected hand (EXP, UH/AH). CMC networks were estimated for each movement and their properties were analyzed by means of indices derived ad-hoc from graph theory and compared among groups. RESULTS Between-group analysis showed that CMC weight of the whole brain network was significantly reduced in patients during AH movements. The network density was increased especially for those connections entailing bilateral non-target muscles. Such reduced muscle-specificity observed in patients was confirmed by muscle degree index (connections per muscle) which indicated a connections' distribution among non-target and contralateral muscles and revealed a higher involvement of proximal muscles in patients. CMC network properties correlated with upper-limb motor impairment as assessed by Fugl-Meyer Assessment and Manual Muscle Test in patients. CONCLUSIONS High-density CMC networks can capture motor abnormalities in stroke patients during simple hand movements. Correlations with upper limb motor impairment support their use in a BCI-based rehabilitative approach.
Collapse
Affiliation(s)
- Floriana Pichiorri
- Neuroelectrical Imaging and Brain Computer Interface Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina, 306, 00179, Rome, Italy.
| | - Jlenia Toppi
- grid.417778.a0000 0001 0692 3437Neuroelectrical Imaging and Brain Computer Interface Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina, 306, 00179 Rome, Italy ,grid.7841.aDept. of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Valeria de Seta
- grid.417778.a0000 0001 0692 3437Neuroelectrical Imaging and Brain Computer Interface Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina, 306, 00179 Rome, Italy ,grid.7841.aDept. of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Emma Colamarino
- grid.417778.a0000 0001 0692 3437Neuroelectrical Imaging and Brain Computer Interface Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina, 306, 00179 Rome, Italy ,grid.7841.aDept. of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Marcella Masciullo
- grid.414396.d0000 0004 1760 8127Neurology and Neurovascular Treatment Unit, Belcolle Hospital, Viterbo, Italy
| | - Federica Tamburella
- grid.417778.a0000 0001 0692 3437Laboratory of Robotic Neurorehabilitation (NeuroRobot Lab), Neurorehabilitation 1 Department, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Matteo Lorusso
- grid.417778.a0000 0001 0692 3437Laboratory of Robotic Neurorehabilitation (NeuroRobot Lab), Neurorehabilitation 1 Department, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Febo Cincotti
- grid.417778.a0000 0001 0692 3437Neuroelectrical Imaging and Brain Computer Interface Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina, 306, 00179 Rome, Italy ,grid.7841.aDept. of Computer, Control and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Donatella Mattia
- grid.417778.a0000 0001 0692 3437Neuroelectrical Imaging and Brain Computer Interface Lab, IRCCS Fondazione Santa Lucia, Via Ardeatina, 306, 00179 Rome, Italy
| |
Collapse
|
13
|
Dai J, Wu F, Li J, Yu M, Liao C, Shou Y. Surface electromyography analysis of mirror movements under unilateral movement in stroke patients: A retrospective study. Front Hum Neurosci 2022; 16:1079596. [PMID: 36606247 PMCID: PMC9807621 DOI: 10.3389/fnhum.2022.1079596] [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: 10/25/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Mirror movements (MMs) are common abnormal motor performance in patients with poststroke hemiparesis. The study aimed to utilize the Electromyography (EMG) characterization of MMs in stroke patients and explore the relationship between MMs and the motor function of affected limbs. Methods Sixty patients with stroke who had used to undergo clinical assessment and surface Electromyography (sEMG) were selected in this study. We investigated the standardized net excitation (SNE) and overflow percentage (OF) as a measure of mirror activities on bilateral muscles of stroke patients. Results In stroke patients, mirror activities occurred in both affected and unaffected muscles during maximal contractions. We found that OF at unilateral contraction on the affected side (UCA) was significantly greater than that at unilateral contraction on the unaffected side (UCU). Additionally, a negative correlation between OF at UCA and Brunnstrom stages on admission and discharge. However, there were no significant correlations between OF and disease duration, Barthel Index, or the degree of improvement in all clinical evaluations. We still found a positive correlation between SNE at UCA and the improvement of the Brunnstrom stage of the hand. But we could not find any significant correlation between SNE and other clinical evaluation scores. Conclusion In conclusion, the study found mirror activities in both affected and unaffected muscles, confirming an asymmetry between them. Although the mechanisms are still unclear, we confirmed a significant correlation between MMs at UCA and the motor function of the affected upper extremity, which might provide further evidences for understanding MMs in stroke patients and a new research direction on evaluation for motor function and outcomes of stroke patients.
Collapse
Affiliation(s)
- Jie Dai
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fangchao Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianhua Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mengjie Yu
- Department of Rehabilitation Medicine, Hospital of Zhejiang Chinese Armed Police Force, Hangzhou, Zhejiang, China
| | - Chen Liao
- Department of Rehabilitation Medicine, The Third Hospital of Quzhou, Quzhou, Zhejiang, China
| | - Yiqun Shou
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,*Correspondence: Yiqun Shou,
| |
Collapse
|
14
|
Suzuki H, Yamamoto S, Wakatabi M, Ohtsuka H. Post Stroke Mirror Movements Preventing Performance of Bilateral Movements and Activities of Daily Living. Case Rep Neurol 2022; 14:389-396. [PMID: 36824575 PMCID: PMC9941781 DOI: 10.1159/000525907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/03/2022] [Indexed: 11/19/2022] Open
Abstract
Mirror movements (MMs) are involuntary synchronous movements of one limb during voluntary movements of the contralateral limb. Generally, MMs after stroke are observed in the unaffected hand during voluntary movements of the affected hand; MMs in the affected hand are comparatively rare. In previous studies, evaluation of MMs in the affected hand was performed using simple unilateral movement tasks, such as tapping or forceful repeated hand closure. However, the impact of MMs of the affected hand on functional tasks, such as activities of daily living (ADLs), has not been reported. We report the rare case of a patient with MMs of the affected hand due to atherothrombotic cerebral infarction of the right postcentral and precentral gyri. An 85-year-old Japanese man presented with left-sided hemiplegia and sensory impairment. MMs were observed in the left (affected) hand during many ADLs and could not be suppressed by the patient's will even when the examiner verbally instructed the patient to move only the unaffected hand. The patient was aware that his hand moved on its own, but he could not control it. The patient was trained on various types of bilateral coordinated motor exercises for 114 days after the MMs were first identified. However, this did not affect MM occurrence, and the MMs remained at the time of discharge. Future research is necessary to plan long-term interventions for MMs of the affected hand.
Collapse
Affiliation(s)
- Hokuto Suzuki
- aDepartment of Rehabilitation, Zama General Hospital, Zama, Japan
| | - Satoshi Yamamoto
- bDepartment of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Masahiro Wakatabi
- bDepartment of Physical Therapy, Ibaraki Prefectural University of Health Sciences Hospital, Ibaraki, Japan
| | - Hiroyuki Ohtsuka
- cDepartment of Physical Therapy, Showa University School of Nursing and Rehabilitation Sciences, Kanagawa, Japan
| |
Collapse
|
15
|
Cleland BT, Madhavan S. Motor overflow in the lower limb after stroke: insights into mechanisms. Eur J Neurosci 2022; 56:4455-4468. [PMID: 35775788 PMCID: PMC9380181 DOI: 10.1111/ejn.15753] [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: 01/19/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Motor overflow (involuntary muscle activation) is common after stroke, particularly in the non-paretic upper limb. Two potential cortical mechanisms are: 1) the contralesional hemisphere controls both limbs, and 2) inhibition from the ipsilesional to the contralesional hemisphere is diminished. Few studies have differentiated between these hypotheses or investigated motor overflow in the lower limb after stroke. To investigate these potential mechanisms, individuals with chronic stroke performed unilateral isometric and dynamic dorsiflexion. Motor overflow was quantified in the contralateral, resting (non-target) ankle. Transcranial magnetic stimulation was applied, and responses were measured in both legs. Relations between motor overflow, excitability of ipsilateral motor pathways, and interhemispheric inhibition were assessed. Non-target muscle activity (motor overflow) was greater during isometric and dynamic conditions than rest in both legs (p≤0.001) and was higher in the non-paretic than the paretic leg (p=0.03). Some participants (25%) had motor overflow >4SD above the group mean in the non-paretic leg. Greater motor overflow in the non-paretic leg was associated with lesser inhibition from the ipsilesional to the contralesional hemisphere (p=0.04). In both legs, non-target TMS responses were greater during the isometric and dynamic than the rest condition (p≤0.01), but not when normalized to background muscle activity. Overall, motor overflow occurred in both legs after stroke, suggesting a common bilateral mechanism. Our correlational results suggest that alterations in interhemispheric inhibition may contribute to motor overflow. Furthermore, the lack of differences in non-target MEPs between rest, isometric, and dynamic conditions, suggests that subcortical and/or spinal pathways may contribute to motor overflow.
Collapse
Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
16
|
Saes M, Mohamed Refai MI, van Beijnum BJF, Bussmann JBJ, Jansma EP, Veltink PH, Buurke JH, van Wegen EEH, Meskers CGM, Krakauer JW, Kwakkel G. Quantifying Quality of Reaching Movements Longitudinally Post-Stroke: A Systematic Review. Neurorehabil Neural Repair 2022; 36:183-207. [PMID: 35100897 PMCID: PMC8902693 DOI: 10.1177/15459683211062890] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Disambiguation of behavioral restitution from compensation is important to better understand recovery of upper limb motor control post-stroke and subsequently design better interventions. Measuring quality of movement (QoM) during standardized performance assays and functional tasks using kinematic and kinetic metrics potentially allows for this disambiguation. Objectives To identify longitudinal studies that used kinematic and/or kinetic metrics to investigate post-stroke recovery of reaching and assess whether these studies distinguish behavioral restitution from compensation. Methods A systematic literature search was conducted using the databases PubMed, Embase, Scopus, and Wiley/Cochrane Library up to July 1st, 2020. Studies were identified if they performed longitudinal kinematic and/or kinetic measurements during reaching, starting within the first 6 months post-stroke. Results Thirty-two longitudinal studies were identified, which reported a total of forty-six different kinematic metrics. Although the majority investigated improvements in kinetics or kinematics to quantify recovery of QoM, none of these studies explicitly addressed the distinction between behavioral restitution and compensation. One study obtained kinematic metrics for both performance assays and a functional task. Conclusions Despite the growing number of kinematic and kinetic studies on post-stroke recovery, longitudinal studies that explicitly seek to delineate between behavioral restitution and compensation are still lacking in the literature. To rectify this situation, future studies should measure kinematics and/or kinetics during performance assays to isolate restitution and during a standardized functional task to determine the contributions of restitution and compensation.
Collapse
Affiliation(s)
- M Saes
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - M I Mohamed Refai
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - B J F van Beijnum
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - J B J Bussmann
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - E P Jansma
- Medical Library, 1190Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location VUmcAmsterdam, The Netherlands
| | - P H Veltink
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands
| | - J H Buurke
- Department of Biomedical Signals & Systems, Technical Medical Centre, 214825University of Twente, Enschede, Netherlands.,Rehabilitation Technology, Roessingh Research and Development, Enschede, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA
| | - E E H van Wegen
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - C G M Meskers
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA
| | - J W Krakauer
- Departments of Neurology, Neuroscience and Physical Medicine and Rehabilitation, 1500Johns Hopkins University, Baltimore, MD, United States
| | - G Kwakkel
- Department of Rehabilitation Medicine, 1209Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, Netherlands.,Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, 12244Northwestern University, Chicago, Il, USA.,Department of Neurorehabilitation, 522567Amsterdam Rehabilitation Research Centre, Amsterdam, Netherlands
| |
Collapse
|
17
|
Tisseyre J, Cremoux S, Amarantini D, Tallet J. Increased intensity of unintended mirror muscle contractions after cervical spinal cord injury is associated with changes in interhemispheric and corticomuscular coherences. Behav Brain Res 2022; 417:113563. [PMID: 34499938 DOI: 10.1016/j.bbr.2021.113563] [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: 10/22/2020] [Revised: 08/02/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
Mirror contractions refer to unintended contractions of the contralateral homologous muscles during voluntary unilateral contractions or movements. Exaggerated mirror contractions have been found in several neurological diseases and indicate dysfunction or lesion of the cortico-spinal pathway. The present study investigates mirror contractions and the associated interhemispheric and corticomuscular interactions in adults with spinal cord injury (SCI) - who present a lesion of the cortico-spinal tract - compared to able-bodied participants (AB). Eight right-handed adults with chronic cervical SCI and ten age-matched right-handed able-bodied volunteers performed sets of right elbow extensions at 20% of maximal voluntary contraction. Electromyographic activity (EMG) of the right and left elbow extensors, interhemispheric coherence over cerebral sensorimotor regions evaluated by electroencephalography (EEG) and corticomuscular coherence between signals over the cerebral sensorimotor regions and each extensor were quantified. Overall, results revealed that participants with SCI exhibited (1) increased EMG activity of both active and unintended active limbs, suggesting more mirror contractions, (2) reduced corticomuscular coherence between signals over the left sensorimotor region and the right active limb and increased corticomuscular coherence between the right sensorimotor region and the left unintended active limb, (3) decreased interhemispheric coherence between signals over the two sensorimotor regions. The increased corticomuscular communication and decreased interhemispheric communication may reflect a reduced inhibition leading to increased communication with the unintended active limb, possibly resulting to exacerbated mirror contractions in SCI. Finally, mirror contractions could represent changes of neural and neuromuscular communication after SCI.
Collapse
Affiliation(s)
- Joseph Tisseyre
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France.
| | - Sylvain Cremoux
- CerCo, CNRS, UMR5549, Université de Toulouse, 31052 Toulouse, France
| | - David Amarantini
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Jessica Tallet
- Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| |
Collapse
|
18
|
Ariani G, Pruszynski JA, Diedrichsen J. Motor planning brings human primary somatosensory cortex into action-specific preparatory states. eLife 2022; 11:69517. [PMID: 35018886 PMCID: PMC8786310 DOI: 10.7554/elife.69517] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022] Open
Abstract
Motor planning plays a critical role in producing fast and accurate movement. Yet, the neural processes that occur in human primary motor and somatosensory cortex during planning, and how they relate to those during movement execution, remain poorly understood. Here, we used 7T functional magnetic resonance imaging and a delayed movement paradigm to study single finger movement planning and execution. The inclusion of no-go trials and variable delays allowed us to separate what are typically overlapping planning and execution brain responses. Although our univariate results show widespread deactivation during finger planning, multivariate pattern analysis revealed finger-specific activity patterns in contralateral primary somatosensory cortex (S1), which predicted the planned finger action. Surprisingly, these activity patterns were as informative as those found in contralateral primary motor cortex (M1). Control analyses ruled out the possibility that the detected information was an artifact of subthreshold movements during the preparatory delay. Furthermore, we observed that finger-specific activity patterns during planning were highly correlated to those during execution. These findings reveal that motor planning activates the specific S1 and M1 circuits that are engaged during the execution of a finger press, while activity in both regions is overall suppressed. We propose that preparatory states in S1 may improve movement control through changes in sensory processing or via direct influence of spinal motor neurons.
Collapse
Affiliation(s)
- Giacomo Ariani
- The Brain and Mind Institute, Western University, London, Canada
| | - J Andrew Pruszynski
- Department of Physiology and Pharmacology, Western University, London, Canada
| | - Jörn Diedrichsen
- The Brain and Mind Institute, Western University, London, Canada
| |
Collapse
|
19
|
Branscheidt M, Ejaz N, Xu J, Widmer M, Harran MD, Cortés JC, Kitago T, Celnik PA, Hernandez-Castillo C, Diedrichsen J, Luft AR, Krakauer JW. No evidence for motor recovery-related cortical connectivity changes after stroke using resting-state fMRI. J Neurophysiol 2021; 127:637-650. [PMID: 34965743 PMCID: PMC8896990 DOI: 10.1152/jn.00148.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
It has been proposed that a form of cortical reorganization (changes in functional connectivity between brain areas) can be assessed with resting-state (rs) fMRI. Here we report a longitudinal data-set collected from 19 patients with subcortical stroke and 11 controls. Patients were imaged up to five times over one year. We found no evidence, using rs-fMRI, for post-stroke cortical connectivity changes despite substantial behavioral recovery. These results could be construed as questioning the value of resting-state imaging. Here we argue instead that they are consistent with other emerging reasons to challenge the idea of motor recovery-related cortical reorganization post-stroke when conceived of as changes in connectivity between cortical areas.
Collapse
Affiliation(s)
- Meret Branscheidt
- Brain Physiology and Stimulation Laboratory, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States.,Department of Neurology, University Hospital Zurich, Zürich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Naveed Ejaz
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Jing Xu
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States.,Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, United States
| | - Mario Widmer
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland
| | - Michelle D Harran
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States
| | - Juan Camilo Cortés
- Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| | - Tomoko Kitago
- Burke Neurological Institute and Weill Cornell Medicine, White Plains, NY, United States
| | - Pablo A Celnik
- Brain Physiology and Stimulation Laboratory, Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | | | - Jörn Diedrichsen
- Brain and Mind Institute, Western University, London, Ontario, Canada
| | - Andreas R Luft
- Department of Neurology, University Hospital Zurich, Zürich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - John W Krakauer
- Department of Neuroscience, Johns Hopkins University, Baltimore, MD, United States.,Malone Center for Engineering in Healthcare, Johns Hopkins University, Baltimore, MD, United States.,Department of Neurology, Johns Hopkins University, Baltimore, MD, United States
| |
Collapse
|
20
|
Vinehout K, Tynes K, Sotelo MR, Hyngstrom AS, McGuire JR, Schmit BD. Changes in Cortical Activity in Stroke Survivors Undergoing Botulinum Neurotoxin Therapy for Treatment of Focal Spasticity. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:735819. [PMID: 36188774 PMCID: PMC9397708 DOI: 10.3389/fresc.2021.735819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Background: Botulinum NeuroToxin-A (BoNT-A) relieves muscle spasticity and increases range of motion necessary for stroke rehabilitation. Determining the effects of BoNT-A therapy on brain neuroplasticity could help physicians customize its use and predict its outcome. Objective: The purpose of this study was to investigate the effects of Botulinum Toxin-A therapy for treatment of focal spasticity on brain activation and functional connectivity. Design: We used functional Magnetic Resonance Imaging (fMRI) to track changes in blood oxygen-level dependent (BOLD) activation and functional connectivity associated with BoNT-A therapy in nine chronic stroke participants, and eight age-matched controls. Scans were acquired before BoNT-A injections (W0) and 6 weeks after the injections (W6). The task fMRI scan consisted of a block design of alternating mass finger flexion and extension. The voxel-level changes in BOLD activation, and pairwise changes in functional connectivity were analyzed for BoNT-A treatment (stroke W0 vs. W6). Results: BoNT-A injection therapy resulted in significant increases in brain activation in the contralesional premotor cortex, cingulate gyrus, thalamus, superior cerebellum, and in the ipsilesional sensory integration area. Lastly, cerebellar connectivity correlated with the Fugl-Meyer assessment of motor impairment before injection, while premotor connectivity correlated with the Fugl-Meyer score after injection. Conclusion: BoNT-A therapy for treatment of focal spasticity resulted in increased brain activation in areas associated with motor control, and cerebellar connectivity correlated with motor impairment before injection. These results suggest that neuroplastic effects might take place in response to improvements in focal spasticity.
Collapse
Affiliation(s)
- Kaleb Vinehout
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kelsey Tynes
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Miguel R. Sotelo
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Allison S. Hyngstrom
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - John R. McGuire
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Brian D. Schmit
| |
Collapse
|
21
|
Liu P, Yuan Y, Zhang N, Liu X, Yu L, Luo B. Mirror Movements in Acquired Neurological Disorders: A Mini-Review. Front Neurol 2021; 12:736115. [PMID: 34616356 PMCID: PMC8488104 DOI: 10.3389/fneur.2021.736115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/17/2021] [Indexed: 11/13/2022] Open
Abstract
Mirror movements (MMs) are specifically defined as involuntary movements occurring on one side of homologous muscles when performing unilateral movements with the contralateral limb. MMs have been considered a kind of soft neurological signs, and the persistence or reappearance of MMs in adults is usually pathologic. In addition to some congenital syndrome, MMs have been also described in age-related neurological diseases including pyramidal system diseases (e.g., stroke, amyotrophic lateral sclerosis) and extrapyramidal disorders (e.g., Parkinson's disease, essential tremor). With the advances in instrumentation and detection means, subtle or subclinical MMs have been deeply studied. Furthermore, the underlying mechanism is also being further elucidated. In this mini-review, we firstly discuss the MM examination means, and then review the literature regarding MMs in individuals with acquired neurological disorders, in order to further understand the pathogenesis of MMs.
Collapse
Affiliation(s)
- Ping Liu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuan Yuan
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ning Zhang
- Department of Neurology, Pujiang People's Hospital, Jinhua, China
| | - Xiaoyan Liu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lihua Yu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Benyan Luo
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
22
|
Colamarino E, de Seta V, Masciullo M, Cincotti F, Mattia D, Pichiorri F, Toppi J. Corticomuscular and Intermuscular Coupling in Simple Hand Movements to Enable a Hybrid Brain-Computer Interface. Int J Neural Syst 2021; 31:2150052. [PMID: 34590990 DOI: 10.1142/s0129065721500520] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hybrid Brain-Computer Interfaces (BCIs) for upper limb rehabilitation after stroke should enable the reinforcement of "more normal" brain and muscular activity. Here, we propose the combination of corticomuscular coherence (CMC) and intermuscular coherence (IMC) as control features for a novel hybrid BCI for rehabilitation purposes. Multiple electroencephalographic (EEG) signals and surface electromyography (EMG) from 5 muscles per side were collected in 20 healthy participants performing finger extension (Ext) and grasping (Grasp) with both dominant and non-dominant hand. Grand average of CMC and IMC patterns showed a bilateral sensorimotor area as well as multiple muscles involvement. CMC and IMC values were used as features to classify each task versus rest and Ext versus Grasp. We demonstrated that a combination of CMC and IMC features allows for classification of both movements versus rest with better performance (Area Under the receiver operating characteristic Curve, AUC) for the Ext movement (0.97) with respect to Grasp (0.88). Classification of Ext versus Grasp also showed high performances (0.99). All in all, these preliminary findings indicate that the combination of CMC and IMC could provide for a comprehensive framework for simple hand movements to eventually be employed in a hybrid BCI system for post-stroke rehabilitation.
Collapse
Affiliation(s)
- Emma Colamarino
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Via Ariosto 25, Rome 00185, Italy.,Fondazione Santa Lucia IRCCS, Via Ardeatina 306-354, Rome 00179, Italy
| | - Valeria de Seta
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Via Ariosto 25, Rome 00185, Italy.,Fondazione Santa Lucia IRCCS, Via Ardeatina 306-354, Rome 00179, Italy
| | | | - Febo Cincotti
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Via Ariosto 25, Rome 00185, Italy.,Fondazione Santa Lucia IRCCS, Via Ardeatina 306-354, Rome 00179, Italy
| | - Donatella Mattia
- Fondazione Santa Lucia IRCCS, Via Ardeatina 306-354, Rome 00179, Italy
| | | | - Jlenia Toppi
- Department of Computer, Control and Management Engineering, Sapienza University of Rome, Via Ariosto 25, Rome 00185, Italy.,Fondazione Santa Lucia IRCCS, Via Ardeatina 306-354, Rome 00179, Italy
| |
Collapse
|
23
|
Hill NM, Sukal-Moulton T, Dewald JPA. Between Limb Muscle Co-activation Patterns in the Paretic Arm During Non-paretic Arm Tasks in Hemiparetic Cerebral Palsy. Front Neurosci 2021; 15:666697. [PMID: 34393702 PMCID: PMC8358604 DOI: 10.3389/fnins.2021.666697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 07/07/2021] [Indexed: 11/16/2022] Open
Abstract
Tasks of daily life require the independent use of the arms and hands. Individuals with hemiparetic cerebral palsy (HCP) often experience difficulty with fine motor tasks demonstrating mirrored movements between the arms. In this study, bilateral muscle activations were quantified during single arm isometric maximum efforts and submaximal reaching tasks. The magnitude and direction of mirrored activation was examined in 14 individuals with HCP and 9 age-matched controls. Participants generated maximum voluntary torques (MVTs) in five different directions and completed ballistic reaches while producing up to 80% of shoulder abduction MVT. Electromyography (EMG) signals were recorded from six upper extremity muscles bilaterally. Participants with HCP demonstrated more mirrored activation when volitionally contracting the non-paretic (NP) arm than the paretic arm (F = 83.543, p < 0.001) in isometric efforts. Increased EMG activation during reach acceleration resulted in a larger increase in rest arm co-activation when reaching with the NP arm compared to the paretic arm in the HCP group (t = 8.425, p < 0.001). Mirrored activation is more pronounced when driving the NP arm and scales with effort level. This directionality of mirroring is indicative of the use of ipsilaterally terminating projections of the corticospinal tract (CST) originating in the non-lesioned hemisphere. Peripheral measures of muscle activation provide insight into the descending pathways available for control of the upper extremity after early unilateral brain injury.
Collapse
Affiliation(s)
- Nayo M Hill
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University, Chicago, IL, United States
| | - Julius P A Dewald
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States.,Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States
| |
Collapse
|
24
|
Hammerbeck U, Tyson SF, Samraj P, Hollands K, Krakauer JW, Rothwell J. The Strength of the Corticospinal Tract Not the Reticulospinal Tract Determines Upper-Limb Impairment Level and Capacity for Skill-Acquisition in the Sub-Acute Post-Stroke Period. Neurorehabil Neural Repair 2021; 35:812-822. [PMID: 34219510 PMCID: PMC8414832 DOI: 10.1177/15459683211028243] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Upper-limb impairment in patients with
chronic stroke appears to be partly attributable to an
upregulated reticulospinal tract (RST). Here, we assessed whether the impact of
corticospinal (CST) and RST connectivity on motor impairment and
skill-acquisition differs in sub-acute stroke, using
transcranial magnetic stimulation (TMS)–based proxy measures.
Methods. Thirty-eight stroke survivors were randomized to
either reach training 3-6 weeks post-stroke (plus usual care) or usual care
only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and
contralesional cortical connectivity (surrogates for CST and RST connectivity,
respectively) to weak pre-activated triceps and deltoid muscles with single
pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity
Index) and synergies (Fugl-Meyer upper-limb score). Results.
Strength and presence of synergies were associated with ipsilesional (CST)
connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar
reaching skill beyond that expected from spontaneous recovery and occurred for
both weak and strong ipsilesional tract integrity. Reaching ability, presence of
synergies, skill-acquisition and strength were not affected by either the
presence or absence of contralesional (RST) connectivity.
Conclusion. The degree of ipsilesional CST connectivity is
the main determinant of proximal dexterity, upper-limb strength and synergy
expression in sub-acute stroke. In contrast, there is no evidence for enhanced
contralesional RST connectivity contributing to any of these components of
impairment. In the sub-acute post-stroke period, the balance of activity between
CST and RST may matter more for the paretic phenotype than RST upregulation per
se.
Collapse
Affiliation(s)
- Ulrike Hammerbeck
- Geoffrey Jefferson Brain Research Centre, 158986Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Healthy, 5292University of Manchester, Manchester, UK.,Department of Health Professions, Faculty of Health, Psychology and Social Care, 5289Manchester Metropolitan University, Manchester, UK
| | - Sarah F Tyson
- Department of Health Professions, Faculty of Health, Psychology and Social Care, 5289Manchester Metropolitan University, Manchester, UK
| | - Prawin Samraj
- Department of Medical Physics, Northern Care Alliance NHS Trust, Salford, UK
| | - Kristen Hollands
- Department of Health Sciences, 105168University of Salford, Salford, UK
| | - John W Krakauer
- Departments of Neurology, Neuroscience and Physical Medicine & Rehabilitation, 1500The John Hopkins University School of Medicine, Baltimore, MD, USA.,The Santa Fe Institute, Santa Fe, NM, USA
| | - John Rothwell
- Institute of Neurology, University College London, London, UK
| |
Collapse
|
25
|
Smart Protocols for Physical Therapy of Foot Drop Based on Functional Electrical Stimulation: A Case Study. Healthcare (Basel) 2021; 9:healthcare9050502. [PMID: 33925814 PMCID: PMC8146368 DOI: 10.3390/healthcare9050502] [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: 03/02/2021] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Functional electrical stimulation (FES) is used for treating foot drop by delivering electrical pulses to the anterior tibialis muscle during the swing phase of gait. This treatment requires that a patient can walk, which is mostly possible in the later phases of rehabilitation. In the early phase of recovery, the therapy conventionally consists of stretching exercises, and less commonly of FES delivered cyclically. Nevertheless, both approaches minimize patient engagement, which is inconsistent with recent findings that the full rehabilitation potential could be achieved by an active psycho-physical engagement of the patient during physical therapy. Following this notion, we proposed smart protocols whereby the patient sits and ankle movements are FES-induced by self-control. In six smart protocols, movements of the paretic ankle were governed by the non-paretic ankle with different control strategies, while in the seventh voluntary movements of the paretic ankle were used for stimulation triggering. One stroke survivor in the acute phase of recovery participated in the study. During the therapy, the patient’s voluntary ankle range of motion increased and reached the value of normal gait after 15 sessions. Statistical analysis did not reveal the differences between the protocols in FES-induced movements.
Collapse
|
26
|
Cheng HJ, Ng KK, Qian X, Ji F, Lu ZK, Teo WP, Hong X, Nasrallah FA, Ang KK, Chuang KH, Guan C, Yu H, Chew E, Zhou JH. Task-related brain functional network reconfigurations relate to motor recovery in chronic subcortical stroke. Sci Rep 2021; 11:8442. [PMID: 33875691 PMCID: PMC8055891 DOI: 10.1038/s41598-021-87789-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/27/2021] [Indexed: 12/12/2022] Open
Abstract
Stroke leads to both regional brain functional disruptions and network reorganization. However, how brain functional networks reconfigure as task demand increases in stroke patients and whether such reorganization at baseline would facilitate post-stroke motor recovery are largely unknown. To address this gap, brain functional connectivity (FC) were examined at rest and motor tasks in eighteen chronic subcortical stroke patients and eleven age-matched healthy controls. Stroke patients underwent a 2-week intervention using a motor imagery-assisted brain computer interface-based (MI-BCI) training with or without transcranial direct current stimulation (tDCS). Motor recovery was determined by calculating the changes of the upper extremity component of the Fugl-Meyer Assessment (FMA) score between pre- and post-intervention divided by the pre-intervention FMA score. The results suggested that as task demand increased (i.e., from resting to passive unaffected hand gripping and to active affected hand gripping), patients showed greater FC disruptions in cognitive networks including the default and dorsal attention networks. Compared to controls, patients had lower task-related spatial similarity in the somatomotor-subcortical, default-somatomotor, salience/ventral attention-subcortical and subcortical-subcortical connections, suggesting greater inefficiency in motor execution. Importantly, higher baseline network-specific FC strength (e.g., dorsal attention and somatomotor) and more efficient brain network reconfigurations (e.g., somatomotor and subcortical) from rest to active affected hand gripping at baseline were related to better future motor recovery. Our findings underscore the importance of studying functional network reorganization during task-free and task conditions for motor recovery prediction in stroke.
Collapse
Affiliation(s)
- Hsiao-Ju Cheng
- Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Kwun Kei Ng
- Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Xing Qian
- Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fang Ji
- Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhong Kang Lu
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Wei Peng Teo
- National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Xin Hong
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, Singapore, Singapore
| | - Fatima Ali Nasrallah
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, Singapore, Singapore
- Queensland Brain Institute and Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Kai Keng Ang
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
- School of Computer Science and Engineering, Nanyang Technology University, Singapore, Singapore
| | - Kai-Hsiang Chuang
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, Singapore, Singapore
- Queensland Brain Institute and Centre for Advanced Imaging, The University of Queensland, Brisbane, Australia
| | - Cuntai Guan
- School of Computer Science and Engineering, Nanyang Technology University, Singapore, Singapore
| | - Haoyong Yu
- Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Effie Chew
- Division of Neurology/Rehabilitation Medicine, National University Hospital, Singapore, Singapore.
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
| | - Juan Helen Zhou
- Center for Sleep and Cognition, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
- Center for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, National University of Singapore, Tahir Foundation Building (MD1), 12 Science Drive 2, #13-05C, Singapore, 117549, Singapore.
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore.
- Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore.
| |
Collapse
|
27
|
Oblak E, Lewis-Peacock J, Sulzer J. Differential neural plasticity of individual fingers revealed by fMRI neurofeedback. J Neurophysiol 2021; 125:1720-1734. [PMID: 33788634 DOI: 10.1152/jn.00509.2020] [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: 12/24/2022] Open
Abstract
Previous work has shown that functional magnetic resonance imaging (fMRI) activity patterns associated with individual fingers can be shifted by temporary impairment of the hand. Here, we investigated whether these neural activity patterns could be modulated endogenously and whether any behavioral changes result from this modulation. We used decoded neurofeedback in healthy individuals to encourage participants to shift the neural activity pattern in sensorimotor cortex of the middle finger toward the index finger, and the ring finger toward the little finger. We first mapped the neural activity patterns for all fingers of the right hand in an fMRI pattern localizer session. Then, in three subsequent neurofeedback sessions, participants were rewarded after middle/ring finger presses according to their activity pattern overlap during each trial. A force-sensitive keyboard was used to ensure that participants were not altering their physical finger coordination patterns. We found evidence that participants could learn to shift the activity pattern of the ring finger but not of the middle finger. Increased variability of these activity patterns during the localizer session was associated with the ability of participants to modulate them using neurofeedback. Participants also showed an increased preference for the ring finger but not for the middle finger in a postneurofeedback motor task. Our results show that neural activity and behaviors associated with the ring finger are more readily modulated than those associated with the middle finger. These results have broader implications for rehabilitation of individual finger movements, which may be limited or enhanced by individual finger plasticity after neurological injury.NEW & NOTEWORTHY It may be possible to remobilize fingers after neurological injury by altering neural activity patterns. Toward this end, we examined whether finger-related neural activity patterns could be modified in healthy individuals without physical intervention, using fMRI neurofeedback. Our findings show that greater variability of neural patterns at baseline predicted a participant's ability to successfully shift these patterns. Because neural variability is common in individuals poststroke, this illustrates a potential clinical benefit of this procedure.
Collapse
Affiliation(s)
- Ethan Oblak
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas
| | | | - James Sulzer
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas
| |
Collapse
|
28
|
Cleland BT, Madhavan S. Ipsilateral Motor Pathways and Transcallosal Inhibition During Lower Limb Movement After Stroke. Neurorehabil Neural Repair 2021; 35:367-378. [PMID: 33703951 DOI: 10.1177/1545968321999049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stroke rehabilitation may be improved with a better understanding of the contribution of ipsilateral motor pathways to the paretic limb and alterations in transcallosal inhibition. Few studies have evaluated these factors during dynamic, bilateral lower limb movements, and it is unclear whether they relate to functional outcomes. OBJECTIVE Determine if lower limb ipsilateral excitability and transcallosal inhibition after stroke depend on target limb, task, or number of limbs involved, and whether these factors are related to clinical measures. METHODS In 29 individuals with stroke, ipsilateral and contralateral responses to transcranial magnetic stimulation were measured in the paretic and nonparetic tibialis anterior during dynamic (unilateral or bilateral ankle dorsiflexion/plantarflexion) and isometric (unilateral dorsiflexion) conditions. Relative ipsilateral excitability and transcallosal inhibition were assessed. Fugl-Meyer, ankle movement accuracy, and walking characteristics were assessed. RESULTS Relative ipsilateral excitability was greater during dynamic than isometric conditions in the paretic limb (P ≤ .02) and greater in the paretic than the nonparetic limb during dynamic conditions (P ≤ .004). Transcallosal inhibition was greater in the ipsilesional than contralesional hemisphere (P = .002) and during dynamic than isometric conditions (P = .03). Greater ipsilesional transcallosal inhibition was correlated with better ankle movement accuracy (R2 = 0.18, P = .04). Greater contralateral excitability to the nonparetic limb was correlated with improved walking symmetry (R2 = 0.19, P = .03). CONCLUSIONS Ipsilateral pathways have increased excitability to the paretic limb, particularly during dynamic tasks. Transcallosal inhibition is greater in the ipsilesional than contralesional hemisphere and during dynamic than isometric tasks. Ipsilateral pathways and transcallosal inhibition may influence walking asymmetry and ankle movement accuracy.
Collapse
|
29
|
Extensive Cortical Convergence to Primate Reticulospinal Pathways. J Neurosci 2021; 41:1005-1018. [PMID: 33268548 PMCID: PMC7880280 DOI: 10.1523/jneurosci.1379-20.2020] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022] Open
Abstract
Early evolution of the motor cortex included development of connections to brainstem reticulospinal neurons; these projections persist in primates. In this study, we examined the organization of corticoreticular connections in five macaque monkeys (one male) using both intracellular and extracellular recordings from reticular formation neurons, including identified reticulospinal cells. Synaptic responses to stimulation of different parts of primary motor cortex (M1) and supplementary motor area (SMA) bilaterally were assessed. Widespread short latency excitation, compatible with monosynaptic transmission over fast-conducting pathways, was observed, as well as longer latency responses likely reflecting a mixture of slower monosynaptic and oligosynaptic pathways. There was a high degree of convergence: 56% of reticulospinal cells with input from M1 received projections from M1 in both hemispheres; for SMA, the equivalent figure was even higher (70%). Of reticulospinal neurons with input from the cortex, 78% received projections from both M1 and SMA (regardless of hemisphere); 83% of reticulospinal cells with input from M1 received projections from more than one of the tested M1 sites. This convergence at the single cell level allows reticulospinal neurons to integrate information from across the motor areas of the cortex, taking account of the bilateral motor context. Reticulospinal connections are known to strengthen following damage to the corticospinal tract, such as after stroke, partially contributing to functional recovery. Extensive corticoreticular convergence provides redundancy of control, which may allow the cortex to continue to exploit this descending pathway even after damage to one area.SIGNIFICANCE STATEMENT The reticulospinal tract (RST) provides a parallel pathway for motor control in primates, alongside the more sophisticated corticospinal system. We found extensive convergent inputs to primate reticulospinal cells from primary and supplementary motor cortex bilaterally. These redundant connections could maintain transmission of voluntary commands to the spinal cord after damage (e.g., after stroke or spinal cord injury), possibly assisting recovery of function.
Collapse
|
30
|
Palomo-Carrión R, Zuil-Escobar JC, Cabrera-Guerra M, Barreda-Martínez P, Martínez-Cepa CB. Mirror Therapy and Action Observation Therapy to Increase the Affected Upper Limb Functionality in Children with Hemiplegia: A Randomized Controlled Trial Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031051. [PMID: 33504040 PMCID: PMC7908253 DOI: 10.3390/ijerph18031051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
The movements of the affected upper limb in infantile hemiplegia are slower and clumsy. This leads to a decrease in the use of the affected hand. The visual effect obtained using the mirror box and the observation of actions in another individual can activate the same structural neuronal cells responsible for the execution of these actions. This research will study the affected upper limb functionality in hemiplegia infantile from 6 to 12 years old after the application of two intervention protocols: observation action therapy and mirror therapy combined with observation action therapy. Children with a diagnose of congenital infantile hemiplegia will be recruited to participate in a randomized controlled trial with two intervention protocols during four weeks (1 h per/day; 5 sessions per/week): Mirror Therapy Action Observation (MTAO) or Action Observation Therapy (AOT). The study variables will be: spontaneous use, measured with the Assisting Hand Assessment (AHA); manual ability measured with the Jebsen Taylor Hand Function Test (JTHFT); surface electromyography of the flexors and extensors muscles of the wrist and grasp strength through a grip dynamometer. Four assessments will be performed: At baseline situation, at the end of treatment, 3 and 6 months after treatment (follow-up assessments). This study will study the effects of these therapies on the use of the affected upper limb in children with hemiplegia.
Collapse
Affiliation(s)
- Rocío Palomo-Carrión
- Department of Nursery, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursery, University of Castilla-La Mancha, 45071 Toledo, Spain;
| | - Juan Carlos Zuil-Escobar
- Department of Physiotherapy, Faculty of Medicine, CEU-San Pablo University, 28925 Madrid, Spain; (M.C.-G.); (P.B.-M.)
- Correspondence: (J.C.Z.-E.); (C.B.M.-C.)
| | - Myriam Cabrera-Guerra
- Department of Physiotherapy, Faculty of Medicine, CEU-San Pablo University, 28925 Madrid, Spain; (M.C.-G.); (P.B.-M.)
| | - Paloma Barreda-Martínez
- Department of Physiotherapy, Faculty of Medicine, CEU-San Pablo University, 28925 Madrid, Spain; (M.C.-G.); (P.B.-M.)
| | - Carmen Belén Martínez-Cepa
- Department of Physiotherapy, Faculty of Medicine, CEU-San Pablo University, 28925 Madrid, Spain; (M.C.-G.); (P.B.-M.)
- Correspondence: (J.C.Z.-E.); (C.B.M.-C.)
| |
Collapse
|
31
|
Casula EP, Pellicciari MC, Bonnì S, Spanò B, Ponzo V, Salsano I, Giulietti G, Martino Cinnera A, Maiella M, Borghi I, Rocchi L, Bozzali M, Sallustio F, Caltagirone C, Koch G. Evidence for interhemispheric imbalance in stroke patients as revealed by combining transcranial magnetic stimulation and electroencephalography. Hum Brain Mapp 2021; 42:1343-1358. [PMID: 33439537 PMCID: PMC7927297 DOI: 10.1002/hbm.25297] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/28/2020] [Accepted: 10/28/2020] [Indexed: 01/13/2023] Open
Abstract
Interhemispheric interactions in stroke patients are frequently characterized by abnormalities, in terms of balance and inhibition. Previous results showed an impressive variability, mostly given to the instability of motor-evoked potentials when evoked from the affected hemisphere. We aim to find reliable interhemispheric measures in stroke patients with a not-evocable motor-evoked potential from the affected hemisphere, by combining transcranial magnetic stimulation (TMS) and electroencephalography. Ninteen stroke patients (seven females; 61.26 ± 9.8 years) were studied for 6 months after a first-ever stroke in the middle cerebral artery territory. Patients underwent four evaluations: clinical, cortical, corticospinal, and structural. To test the reliability of our measures, the evaluations were repeated after 3 weeks. To test the sensitivity, 14 age-matched healthy controls were compared to stroke patients. In stroke patients, stimulation of the affected hemisphere did not result in any inhibition onto the unaffected. The stimulation of the unaffected hemisphere revealed a preservation of the inhibition mechanism onto the affected. This resulted in a remarkable interhemispheric imbalance, whereas this mechanism was steadily symmetric in healthy controls. This result was stable when cortical evaluation was repeated after 3 weeks. Importantly, patients with a better recovery of the affected hand strength were the ones with a more stable interhemispheric balance. Finally, we found an association between microstructural integrity of callosal fibers, suppression of interhemispheric TMS-evoked activity and interhemispheric connectivity. We provide direct and sensitive cortical measures of interhemispheric imbalance in stroke patients. These measures offer a reliable means of distinguishing healthy and pathological interhemispheric dynamics.
Collapse
Affiliation(s)
- Elias Paolo Casula
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Maria Concetta Pellicciari
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Sonia Bonnì
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Barbara Spanò
- Neuroimaging LaboratorySanta Lucia FoundationRomeItaly
| | - Viviana Ponzo
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | | | | | - Alex Martino Cinnera
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Michele Maiella
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Ilaria Borghi
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Lorenzo Rocchi
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Marco Bozzali
- Neuroimaging LaboratorySanta Lucia FoundationRomeItaly
- Brighton and Sussex Medical School, University of SussexBrightonUK
| | | | - Carlo Caltagirone
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
| | - Giacomo Koch
- Non‐Invasive Brain Stimulation Unit/Department of Behavioral and Clinical NeurologySanta Lucia FoundationRomeItaly
- Stroke Unit, Department of NeuroscienceTor Vergata PolyclinicRomeItaly
| |
Collapse
|
32
|
Abolins V, Stremoukhov A, Walter C, Latash ML. On the origin of finger enslaving: control with referent coordinates and effects of visual feedback. J Neurophysiol 2020; 124:1625-1636. [PMID: 32997555 DOI: 10.1152/jn.00322.2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
When a person tries to press with a finger, other fingers of the hand produce force unintentionally. We explored this phenomenon of enslaving during unintentional force drifts in the course of continuous force production by pairs of fingers of a hand. Healthy subjects performed accurate force production tasks by finger pairs Index-Middle, Middle-Ring, and Ring-Little with continuous visual feedback on the combined force of the instructed (master) fingers or of the noninstructed (enslaved) fingers. The feedback scale was adjusted to ensure that the subjects did not know the difference between these two, randomly presented, conditions. Across all finger pairs, enslaved force showed a drift upward under feedback on the master finger force, and master force showed a drift downward under feedback on the enslaved finger force. The subjects were unaware of the force drifts, which could reach over 50% of the initial force magnitude over 15 s. Across all conditions, the index of enslaving increased by ∼50% over the trial duration. The initial moment of force magnitude in pronation-supination was not a consistent predictor of the force drift magnitude. These results falsify the hypothesis that the counter-directional force drifts reflected drifts in the moment of force. They suggest that during continuous force production, enslaving increases with time, possibly due to the spread of excitation over cortical finger representations or other mechanisms, such as increased synchronization of firing of α-motoneurons innervating different compartments of extrinsic flexors. These changes in enslaving, interpreted at the level of control with referent coordinates for the fingers, can contribute to a variety of phenomena, including unintentional force drifts.NEW & NOTEWORTHY We report a consistent slow increase in finger enslaving (force production by noninstructed fingers) when visual feedback was presented on the force produced by either two instructed fingers or two noninstructed fingers of the hand. In contrast, force drifts could be in opposite directions depending on the visual feedback. We interpret enslaving and its drifts at the level of control with referent coordinates for the involved muscles, possibly reflecting spread of cortical excitation.
Collapse
Affiliation(s)
- Valters Abolins
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania.,Institute of Electronics and Computer Science, Riga, Latvia
| | - Alex Stremoukhov
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Caroline Walter
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| | - Mark L Latash
- Department of Kinesiology, The Pennsylvania State University, University Park, Pennsylvania
| |
Collapse
|
33
|
Makin TR, Flor H. Brain (re)organisation following amputation: Implications for phantom limb pain. Neuroimage 2020; 218:116943. [PMID: 32428706 PMCID: PMC7422832 DOI: 10.1016/j.neuroimage.2020.116943] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022] Open
Abstract
Following arm amputation the region that represented the missing hand in primary somatosensory cortex (S1) becomes deprived of its primary input, resulting in changed boundaries of the S1 body map. This remapping process has been termed 'reorganisation' and has been attributed to multiple mechanisms, including increased expression of previously masked inputs. In a maladaptive plasticity model, such reorganisation has been associated with phantom limb pain (PLP). Brain activity associated with phantom hand movements is also correlated with PLP, suggesting that preserved limb functional representation may serve as a complementary process. Here we review some of the most recent evidence for the potential drivers and consequences of brain (re)organisation following amputation, based on human neuroimaging. We emphasise other perceptual and behavioural factors consequential to arm amputation, such as non-painful phantom sensations, perceived limb ownership, intact hand compensatory behaviour or prosthesis use, which have also been related to both cortical changes and PLP. We also discuss new findings based on interventions designed to alter the brain representation of the phantom limb, including augmented/virtual reality applications and brain computer interfaces. These studies point to a close interaction of sensory changes and alterations in brain regions involved in body representation, pain processing and motor control. Finally, we review recent evidence based on methodological advances such as high field neuroimaging and multivariate techniques that provide new opportunities to interrogate somatosensory representations in the missing hand cortical territory. Collectively, this research highlights the need to consider potential contributions of additional brain mechanisms, beyond S1 remapping, and the dynamic interplay of contextual factors with brain changes for understanding and alleviating PLP.
Collapse
Affiliation(s)
- Tamar R Makin
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, UK.
| | - Herta Flor
- Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; Department of Psychology, School of Social Sciences, University of Mannheim, Germany; Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
34
|
Dietz V. Neural coordination of bilateral power and precision finger movements. Eur J Neurosci 2020; 54:8249-8255. [PMID: 32682343 DOI: 10.1111/ejn.14911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 07/02/2020] [Accepted: 07/03/2020] [Indexed: 11/29/2022]
Abstract
The dexterity of hands and fingers is related to the strength of control by cortico-motoneuronal connections which exclusively exist in primates. The cortical command is associated with a task-specific, rapid proprioceptive adaptation of forces applied by hands and fingers to an object. This neural control differs between "power grip" movements (e.g., reach and grasp of a cup) where hand and fingers act as a unity and "precision grip" movements (e.g., picking up a raspberry) where fingers move independently from the hand. In motor tasks requiring hands and fingers of both sides a "neural coupling" (reflected in bilateral reflex responses to unilateral stimulations) coordinates power grip movements (e.g., opening a bottle). In contrast, during bilateral precision movements, such as playing piano, the fingers of both hands move independently, due to a direct cortico-motoneuronal control, while the hands are coupled (e.g., to maintain the rhythm between the two sides). While most studies on prehension concern unilateral hand movements, many activities of daily life are tackled by bilateral power grips where a neural coupling serves for an automatic movement performance. In primates this mode of motor control is supplemented by a system that enables the uni- or bilateral performance of skilled individual finger movements.
Collapse
Affiliation(s)
- Volker Dietz
- Spinal Injury Center, University Hospital Balgrist, Zürich, Switzerland
| |
Collapse
|
35
|
Cortical, Corticospinal, and Reticulospinal Contributions to Strength Training. J Neurosci 2020; 40:5820-5832. [PMID: 32601242 PMCID: PMC7380966 DOI: 10.1523/jneurosci.1923-19.2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/27/2020] [Accepted: 03/20/2020] [Indexed: 11/23/2022] Open
Abstract
Following a program of resistance training, there are neural and muscular contributions to the gain in strength. Here, we measured changes in important central motor pathways during strength training in 2 female macaque monkeys. Animals were trained to pull a handle with one arm; weights could be added to increase load. On each day, motor-evoked potentials in upper limb muscles were first measured after stimulation of the primary motor cortex (M1), corticospinal tract (CST), and reticulospinal tract (RST). Monkeys then completed 50 trials with weights progressively increased over 8-9 weeks (final weight ∼6 kg, close to the animal's body weight). Muscle responses to M1 and RST stimulation increased during strength training; there were no increases in CST responses. Changes persisted during a 2 week washout period without weights. After a further 3 months of strength training, an experiment under anesthesia mapped potential responses to CST and RST stimulation in the cervical enlargement of the spinal cord. We distinguished the early axonal volley and later spinal synaptic field potentials, and used the slope of the relationship between these at different stimulus intensities as a measure of spinal input-output gain. Spinal gain was increased on the trained compared with the untrained side of the cord within the intermediate zone and motor nuclei for RST, but not CST, stimulation. We conclude that neural adaptations to strength training involve adaptations in the RST, as well as intracortical circuits within M1. By contrast, there appears to be little contribution from the CST. SIGNIFICANCE STATEMENT We provide the first report of a strength training intervention in nonhuman primates. Our results indicate that strength training is associated with neural adaptations in intracortical and reticulospinal circuits, whereas corticospinal and motoneuronal adaptations are not dominant factors.
Collapse
|
36
|
Caria A, da Rocha JLD, Gallitto G, Birbaumer N, Sitaram R, Murguialday AR. Brain-Machine Interface Induced Morpho-Functional Remodeling of the Neural Motor System in Severe Chronic Stroke. Neurotherapeutics 2020; 17:635-650. [PMID: 31802435 PMCID: PMC7283440 DOI: 10.1007/s13311-019-00816-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Brain-machine interfaces (BMI) permit bypass motor system disruption by coupling contingent neuroelectric signals related to motor activity with prosthetic devices that enhance afferent and proprioceptive feedback to the somatosensory cortex. In this study, we investigated neural plasticity in the motor network of severely impaired chronic stroke patients after an EEG-BMI-based treatment reinforcing sensorimotor contingency of ipsilesional motor commands. Our structural connectivity analysis revealed decreased fractional anisotropy in the splenium and body of the corpus callosum, and in the contralesional hemisphere in the posterior limb of the internal capsule, the posterior thalamic radiation, and the superior corona radiata. Functional connectivity analysis showed decreased negative interhemispheric coupling between contralesional and ipsilesional sensorimotor regions, and decreased positive intrahemispheric coupling among contralesional sensorimotor regions. These findings indicate that BMI reinforcing ipsilesional brain activity and enhancing proprioceptive function of the affected hand elicits reorganization of contralesional and ipsilesional somatosensory and motor-assemblies as well as afferent and efferent connection-related motor circuits that support the partial re-establishment of the original neurophysiology of the motor system even in severe chronic stroke.
Collapse
Affiliation(s)
- Andrea Caria
- Department of Psychology and Cognitive Sciences, University of Trento, Corso Bettini 33, 38068, Rovereto, Italy.
- Istituto di Ricovero e Cura a Carattere Scientifico, Fondazione Ospedale San Camillo, Venice, Italy.
- Institut für Medizinische Psychologie und Verhaltensneurobiologie, Universität Tübingen, Tübingen, Germany.
| | - Josué Luiz Dalboni da Rocha
- Brain and Language Laboratory, Department of Clinical Neuroscience, University of Geneva, Geneva, Switzerland
| | - Giuseppe Gallitto
- Department of Psychology and Cognitive Sciences, University of Trento, Corso Bettini 33, 38068, Rovereto, Italy
| | - Niels Birbaumer
- Institut für Medizinische Psychologie und Verhaltensneurobiologie, Universität Tübingen, Tübingen, Germany
| | - Ranganatha Sitaram
- Institute of Biological and Medical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Psychiatry, Section of Neuroscience, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Laboratory for Brain-Machine Interfaces and Neuromodulation, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ander Ramos Murguialday
- Institut für Medizinische Psychologie und Verhaltensneurobiologie, Universität Tübingen, Tübingen, Germany
- Health Technologies Department, TECNALIA, San Sebastian, Spain
| |
Collapse
|
37
|
Caldelari P, Lemon R, Dietz V. Differential neural coordination of bilateral hand and finger movements. Physiol Rep 2020; 8:e14393. [PMID: 32198852 PMCID: PMC7083731 DOI: 10.14814/phy2.14393] [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: 01/15/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 11/24/2022] Open
Abstract
Cooperative hand movements (e.g., opening a bottle) require a close coordination of the hands. This is reflected in a neural coupling between the two sides. The aim of this study was to investigate in how far neural coupling is present not only during bilateral hand but also during bilateral finger movements. For this purpose unilateral mechanical and electrical nerve stimuli were delivered during bilateral sequentially and synchronously performed finger movements on a keyboard and, for comparison, during bilateral hand flexion movements. Electromyographic (EMG) activity and reflex responses in forearm flexor and extensor muscles of both sides were recorded and analyzed. Confounding EMG activity related to hand movements during the finger task was limited by wrist fixating braces. During the hand flexion task, complex reflex responses appeared in the forearm muscles of both sides to unilateral stimulation of the ulnar nerve (mean latency 57 ms), reflecting neural coupling between the two hands. In contrast, during the bilateral finger movement task, unilateral electrical nerve or mechanical stimulation of the right index finger was followed by dominant ipsilateral reflex responses (latency 45 and 58 ms, respectively). The results indicate that in contrast to the coupled hand movements, finger movements may not be coupled but can move independently on each side. Functionally this makes sense because during most activities of daily living, a close cooperation of the hands but not of individual fingers is needed. This independence of individual finger movements may rely on strong, specific, contralateral cortico‐motoneuronal control.
Collapse
Affiliation(s)
- Paolo Caldelari
- Spinal Cord Injury Center, University Hospital Balgrist, Zürich, Switzerland
| | - Roger Lemon
- Queen Square Institute of Neurology, University College London, London, UK
| | - Volker Dietz
- Spinal Cord Injury Center, University Hospital Balgrist, Zürich, Switzerland
| |
Collapse
|
38
|
Possible Contributions of Ipsilateral Pathways From the Contralesional Motor Cortex to the Voluntary Contraction of the Spastic Elbow Flexors in Stroke Survivors: A TMS Study. Am J Phys Med Rehabil 2020; 98:558-565. [PMID: 30672773 DOI: 10.1097/phm.0000000000001147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The contribution of the contralesional motor cortex to the impaired limbs is still controversial. The aim of this study was to investigate the role of descending projections from the contralesional hemisphere during voluntary elbow flexion on the paretic side. DESIGN Eleven healthy and 10 stroke subjects performed unilateral isometric elbow flexion tasks at various submaximal levels. Transcranial magnetic stimulation was delivered to the hotspot of biceps muscles ipsilateral to the target side (paretic side in stroke subjects or right side in controls) at rest and during elbow flexion tasks. Motor-evoked potential amplitudes of the contralateral resting biceps muscles, transcranial magnetic stimulation-induced ipsilateral force increment, and reflex torque and weakness of spastic elbow flexors were quantified. RESULTS The normalized motor-evoked potential amplitude increased with force level in both healthy and stroke subjects. However, stroke subjects exhibited significantly higher force increment compared with healthy subjects only at low level of elbow flexion but similar at moderate to high levels. The greater force increment significantly correlated with reflex torque of the spastic elbow flexors, but not weakness. CONCLUSIONS These results provide novel evidence that ipsilateral projections are not likely to contribute to strength but are correlated to spasticity of spastic-paretic elbow flexors after stroke.
Collapse
|
39
|
Jiang S, Zhong D, Yan Y, Zhu Q, Wang C, Bai X, Cao T, Wu B. Mirror movements induced by hemiballism due to putamen infarction: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:19. [PMID: 32055610 DOI: 10.21037/atm.2019.10.86] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mirror movements (MMs), which are involuntary movements of one limb that synchronously mirror voluntary movements of the contralateral limb, are a relatively uncommon complication of strokes. Here we report what appears to be the first case of putamen infarction manifesting as MMs in one side of the body induced by contralateral hemiballism. MMs and hemiballism were nearly entirely eliminated after one week of clonazepam and haloperidol therapy. During the subsequent one year of standard ischemic stroke prevention measures, no further episodes of involuntary movement occurred. Our case and literature review highlight that acute stroke can manifest as hemiballism and MMs, which should be recognized as soon as possible to ensure timely management.
Collapse
Affiliation(s)
- Shuai Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China.,Department of Neurology, The Third People's Hospital of Chengdu, Chengdu 610015, China
| | - Di Zhong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yuying Yan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiange Zhu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Changyi Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xueling Bai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tian Cao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China
| |
Collapse
|
40
|
Bani-Ahmed A, Cirstea CM. Ipsilateral primary motor cortex and behavioral compensation after stroke: a case series study. Exp Brain Res 2020; 238:439-452. [PMID: 31950216 DOI: 10.1007/s00221-020-05728-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 01/07/2020] [Indexed: 12/25/2022]
Abstract
Arm motor recovery after stroke is mainly attributed to reorganization of the primary motor cortex (M1). While M1 contralateral to the paretic arm (cM1) is critical for recovery, the role of ipsilateral M1 (iM1) is still inconclusive. Whether iM1 activity is related to recovery, behavioral compensation, or both is still far from settled. We hypothesized that the magnitude of iM1 activity in chronic stroke survivors will increase or decrease in direct proportion to the degree that movements of the paretic arm are compensated. Movement kinematics (VICON, Oxford Metrics) and functional MRI data (3T MR system) were collected in 11 patients before and after a 4-week training designed to improve motor control of the paretic arm and decrease compensatory trunk recruitment. Twelve matched controls underwent similar evaluations and training. Relationships between iM1 activity and trunk motion were analyzed. At baseline, patients exhibited increased iM1 activity (p = 0.001) and relied more on trunk movement (p = 0.02) than controls. These two variables were directly and significantly related in patients (r = 0.74, p = 0.01) but not in controls (r = 0.28, p = 0.4). After training, patients displayed a significant reduction in iM1 activity (p = 0.008) and a trend toward decreased trunk use (p = 0.1). The relationship between these two variables remained significant (r = 0.66, p = 0.03) and different from controls (r = 0.26, p = 0.4). Our preliminary results suggest that iM1 may play a role in compensating for brain damage rather than directly gaining control of the paretic arm. However, we recommend caution in interpreting these results until more work is completed.
Collapse
Affiliation(s)
- Ali Bani-Ahmed
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA
- Department of Physical Therapy, University of Tabuk, Tabuk, Saudi Arabia
| | - Carmen M Cirstea
- Hoglund Brain Imaging Center, University of Kansas Medical Center, Kansas City, KS, USA.
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
- Department of Physical Medicine and Rehabilitation, University of Missouri, One Hospital Drive, DC046.00, Columbia, MO, 65212, USA.
| |
Collapse
|
41
|
Pandey S, Rawat C. Clinical signs in movement disorders: Phenomenology of mirror movements. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_11_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
42
|
Kwakkel G, van Wegen EEH, Burridge JH, Winstein CJ, van Dokkum LEH, Alt Murphy M, Levin MF, Krakauer JW. Standardized Measurement of Quality of Upper Limb Movement After Stroke: Consensus-Based Core Recommendations From the Second Stroke Recovery and Rehabilitation Roundtable. Neurorehabil Neural Repair 2019; 33:951-958. [PMID: 31660781 DOI: 10.1177/1545968319886477] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The second Stroke Recovery and Rehabilitation Roundtable "metrics" task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.
Collapse
Affiliation(s)
- G Kwakkel
- Amsterdam UMC, VU Medical Centre, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - E E H van Wegen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - J H Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - C J Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - L E H van Dokkum
- I2FH, Institue d'imagerie Fonctionelle Humaine, Montpellier University Hospital Guide, Chauliac, France
| | - M Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - M F Levin
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - J W Krakauer
- Departments of Neurology, Neuroscience, Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | |
Collapse
|
43
|
Kwakkel G, Van Wegen EEH, Burridge JH, Winstein CJ, van Dokkum LEH, Alt Murphy M, Levin MF, Krakauer JW. Standardized measurement of quality of upper limb movement after stroke: Consensus-based core recommendations from the Second Stroke Recovery and Rehabilitation Roundtable. Int J Stroke 2019; 14:783-791. [DOI: 10.1177/1747493019873519] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The second Stroke Recovery and Rehabilitation Roundtable “metrics” task force developed consensus around the recognized need to add kinematic and kinetic movement quantification to its core recommendations for standardized measurements of sensorimotor recovery in stroke trials. Specifically, we focused on measurement of the quality of upper limb movement. We agreed that the recommended protocols for measurement should be conceptually rigorous, reliable, valid and responsive to change. The recommended measurement protocols include four performance assays (i.e. 2D planar reaching, finger individuation, grip strength, and precision grip at body function level) and one functional task (3D drinking task at activity level) that address body function and activity respectively. This document describes the criteria for assessment and makes recommendations about the type of technology that should be used for reliable and valid movement capture. Standardization of kinematic measurement protocols will allow pooling of participant data across sites, thereby increasing sample size aiding meta-analyses of published trials, more detailed exploration of recovery profiles, the generation of new research questions with testable hypotheses, and development of new treatment approaches focused on impairment. We urge the clinical and research community to consider adopting these recommendations.
Collapse
Affiliation(s)
- G Kwakkel
- Amsterdam UMC, VU Medical Centre, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - EEH Van Wegen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - JH Burridge
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - CJ Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - LEH van Dokkum
- I2FH, Institue d'imagerie Fonctionelle Humaine, Montpellier University Hospital Guide, Chauliac, France
| | - M Alt Murphy
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - MF Levin
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - JW Krakauer
- Departments of Neurology, Neuroscience, Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
44
|
Calautti C, Jones PS, Naccarato M, Sharma N, Carpenter TA, Warburton EA, Baron JC. Further evidence for a non-cortical origin of mirror movements after stroke. Brain 2019; 142:e1. [PMID: 30596902 DOI: 10.1093/brain/awy308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Cinzia Calautti
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - P Simon Jones
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Marcello Naccarato
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Nikhil Sharma
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - T Adrian Carpenter
- Wolfson Brain Imaging Centre, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Elisabeth A Warburton
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK
| | - Jean-Claude Baron
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, UK.,Department of Neurology, Sainte-Anne Hospital, Université Paris Descartes, INSERM U894, Paris, France
| |
Collapse
|
45
|
Ejaz N, Xu J, Branscheidt M, Hertler B, Schambra H, Widmer M, Faria AV, Harran M, Cortes JC, Kim N, Celnik PA, Kitago T, Luft A, Krakauer JW, Diedrichsen J. Reply: Further evidence for a non-cortical origin of mirror movements after stroke. Brain 2019; 142:e2. [PMID: 30596904 DOI: 10.1093/brain/awy309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Naveed Ejaz
- Brain and Mind Institute, Western University, London, Canada
| | - Jing Xu
- Department of Neurology and Neurosciences, Johns Hopkins University, Baltimore, MD, USA
| | - Meret Branscheidt
- Department of Neurology, University of Zurich, Zurich, Switzerland.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Benjamin Hertler
- Department of Neurology, University of Zurich, Zurich, Switzerland
| | | | - Mario Widmer
- Department of Neurology, University of Zurich, Zurich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Andreia V Faria
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Michelle Harran
- Department of Neurology and Neurosciences, Johns Hopkins University, Baltimore, MD, USA
| | - Juan C Cortes
- Department of Neurology and Neurosciences, Johns Hopkins University, Baltimore, MD, USA
| | - Nathan Kim
- Department of Neurology and Neurosciences, Johns Hopkins University, Baltimore, MD, USA
| | - Pablo A Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
| | - Tomoko Kitago
- Department of Neurology, New York University, NY, USA
| | - Andreas Luft
- Department of Neurology, University of Zurich, Zurich, Switzerland.,Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - John W Krakauer
- Department of Neurology and Neurosciences, Johns Hopkins University, Baltimore, MD, USA
| | | |
Collapse
|
46
|
Li S, Chen YT, Francisco GE, Zhou P, Rymer WZ. A Unifying Pathophysiological Account for Post-stroke Spasticity and Disordered Motor Control. Front Neurol 2019; 10:468. [PMID: 31133971 PMCID: PMC6524557 DOI: 10.3389/fneur.2019.00468] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/17/2019] [Indexed: 11/18/2022] Open
Abstract
Cortical and subcortical plastic reorganization occurs in the course of motor recovery after stroke. It is largely accepted that plasticity of ipsilesional motor cortex primarily contributes to recovery of motor function, while the contributions of contralesional motor cortex are not completely understood. As a result of damages to motor cortex and its descending pathways and subsequent unmasking of inhibition, there is evidence of upregulation of reticulospinal tract (RST) excitability in the contralesional side. Both animal studies and human studies with stroke survivors suggest and support the role of RST hyperexcitability in post-stroke spasticity. Findings from animal studies demonstrate the compensatory role of RST hyperexcitability in recovery of motor function. In contrast, RST hyperexcitability appears to be related more to abnormal motor synergy and disordered motor control in stroke survivors. It does not contribute to recovery of normal motor function. Recent animal studies highlight laterality dominance of corticoreticular projections. In particular, there exists upregulation of ipsilateral corticoreticular projections from contralesional premotor cortex (PM) and supplementary motor area (SMA) to medial reticular nuclei. We revisit and revise the previous theoretical framework and propose a unifying account. This account highlights the importance of ipsilateral PM/SMA-cortico-reticulospinal tract hyperexcitability from the contralesional motor cortex as a result of disinhibition after stroke. This account provides a pathophysiological basis for post-stroke spasticity and related movement impairments, such as abnormal motor synergy and disordered motor control. However, further research is needed to examine this pathway in stroke survivors to better understand its potential roles, especially in muscle strength and motor recovery. This account could provide a pathophysiological target for developing neuromodulatory interventions to manage spasticity and thus possibly to facilitate motor recovery.
Collapse
Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center – Houston and TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Yen-Ting Chen
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center – Houston and TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Gerard E. Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center – Houston and TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center – Houston and TIRR Memorial Hermann Hospital, Houston, TX, United States
| | | |
Collapse
|
47
|
Chen YT, Li S, Zhou P, Li S. A startling acoustic stimulation (SAS)-TMS approach to assess the reticulospinal system in healthy and stroke subjects. J Neurol Sci 2019; 399:82-88. [PMID: 30782527 DOI: 10.1016/j.jns.2019.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 12/21/2022]
Abstract
Reticulospinal (RS) hyperexcitability is observed in stroke survivors with spastic hemiparesis. Habituated startle acoustic stimuli (SAS) can be used to stimulate the RS pathways non-reflexively. However, the role of RS pathways in motor function and its interactions with the corticospinal system after stroke still remain unclear. Therefore, the purpose of this study was to investigate the effects of conditioning SAS on the corticospinal system in healthy subjects and in stroke subjects with spastic hemiparesis. An established conditioning SAS- transcranial magnetic stimulation (TMS) paradigm was used to test the interactions between the RS pathways and the corticospinal system. TMS was delivered to the right hemisphere of eleven healthy subjects and the contralesional hemisphere of eleven stroke subjects during isometric elbow flexor contraction on the non-impaired (or left) side. Conditioning SAS had similar effects on the corticospinal motor system in both healthy and stroke subjects, including similar SAS-induced motor evoked potential (MEP) reduction at rest, but not during voluntary contraction tasks; similar magnitudes of TMS-induced MEP and force increment and shortening of the silent period during voluntary elbow flexor contraction. This study provides evidence that RS excitability on the contralesional side in stroke subjects with spastic hemiparesis is not abnormal, and suggests that RS projections are likely to be primarily unilateral in humans.
Collapse
Affiliation(s)
- Yen-Ting Chen
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, United States; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, United States
| | - Shengai Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, United States; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, United States.
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, United States; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, United States; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, United States
| |
Collapse
|
48
|
Chen YT, Li S, Magat E, Zhou P, Li S. Motor Overflow and Spasticity in Chronic Stroke Share a Common Pathophysiological Process: Analysis of Within-Limb and Between-Limb EMG-EMG Coherence. Front Neurol 2018; 9:795. [PMID: 30356703 PMCID: PMC6189334 DOI: 10.3389/fneur.2018.00795] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 09/04/2018] [Indexed: 01/06/2023] Open
Abstract
The phenomenon of exaggerated motor overflow is well documented in stroke survivors with spasticity. However, the mechanism underlying the abnormal motor overflow remains unclear. In this study, we aimed to investigate the possible mechanisms behind abnormal motor overflow and its possible relations with post-stroke spasticity. 11 stroke patients (63.6 ± 6.4 yrs; 4 women) and 11 healthy subjects (31.18 ± 6.18 yrs; 2 women) were recruited. All of them were asked to perform unilateral isometric elbow flexion at submaximal levels (10, 30, and 60% of maximum voluntary contraction). Electromyogram (EMG) was measured from the contracting biceps (iBiceps) muscle and resting contralateral biceps (cBiceps), ipsilateral flexor digitorum superficialis (iFDS), and contralateral FDS (cFDS) muscles. Motor overflow was quantified as the normalized EMG of the resting muscles. The severity of motor impairment was quantified through reflex torque (spasticity) and weakness. EMG-EMG coherence was calculated between the contracting muscle and each of the resting muscles. During elbow flexion on the impaired side, stroke subjects exhibited significant higher motor overflow to the iFDS muscle compared with healthy subjects (ipsilateral or intralimb motor overflow). Stroke subjects exhibited significantly higher motor overflow to the contralateral spastic muscles (cBiceps and cFDS) during elbow flexion on the non-impaired side (contralateral or interlimb motor overflow), compared with healthy subjects. Moreover, there was significantly high EMG-EMG coherence in the alpha band (6–12 Hz) between the contracting muscle and all other resting muscles during elbow flexion on the non-impaired side. Our results of diffuse ipsilateral and contralateral motor overflow with EMG-EMG coherence in the alpha band suggest subcortical origins of motor overflow. Furthermore, correlation between contralateral motor overflow to contralateral spastic elbow and finger flexors and their spasticity was consistently at moderate to high levels. A high correlation suggests that diffuse motor overflow to the impaired side and spasticity likely share a common pathophysiological process. Possible mechanisms are discussed.
Collapse
Affiliation(s)
- Yen-Ting Chen
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center - Houston, Houston, TX, United States.,TIRR Research Center, TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Shengai Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center - Houston, Houston, TX, United States.,TIRR Research Center, TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Elaine Magat
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center - Houston, Houston, TX, United States.,TIRR Research Center, TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center - Houston, Houston, TX, United States.,TIRR Research Center, TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center - Houston, Houston, TX, United States.,TIRR Research Center, TIRR Memorial Hermann Hospital, Houston, TX, United States
| |
Collapse
|