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Zaidi KF, Harris-Love M. Upper extremity kinematics: development of a quantitative measure of impairment severity and dissimilarity after stroke. PeerJ 2023; 11:e16374. [PMID: 38089910 PMCID: PMC10712307 DOI: 10.7717/peerj.16374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/08/2023] [Indexed: 12/18/2023] Open
Abstract
Background Strokes are a leading cause of disability worldwide, with many survivors experiencing difficulty in recovering upper extremity movement, particularly hand function and grasping ability. There is currently no objective measure of movement quality, and without it, rehabilitative interventions remain at best informed estimations of the underlying neural structures' response to produce movement. In this article, we utilize a novel modification to Procrustean distance to quantify curve dissimilarity and propose the Reach Severity and Dissimilarity Index (RSDI) as an objective measure of motor deficits. Methods All experiments took place at the Medstar National Rehabilitation Hospital; persons with stroke were recruited from the hospital patient population. Using Fugl-Meyer (FM) scores and reach capacities, stroke survivors were placed in either mild or severe impairment groups. Individuals completed sets of reach-to-target tasks to extrapolate kinematic metrics describing motor performance. The Procrustes method of statistical shape analysis was modified to identify reaching sub-movements that were congruous to able-bodied sub-movements. Findings Movement initiation proceeds comparably to the reference curve in both two- and three-dimensional representations of mild impairment movement. There were significant effects of the location of congruent segments between subject and reference curves, mean velocities, peak roll angle, and target error. These metrics were used to calculate a preliminary RSDI score with severity and dissimilarity sub-scores, and subjects were reclassified in terms of rehabilitation goals as Speed Emphasis, Strength Emphasis, and Combined Emphasis. Interpretation The modified Procrustes method shows promise in identifying disruptions in movement and monitoring recovery without adding to patient or clinician burden. The proposed RSDI score can be adapted and expanded to other functional movements and used as an objective clinical tool. By reducing the impact of stroke on disability, there is a significant potential to improve quality of life through individualized rehabilitation.
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Affiliation(s)
- Khadija F. Zaidi
- Department of Bioengineering, George Mason University, Fairfax, United States
| | - Michelle Harris-Love
- University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
- Medstar National Rehabilitation Hospital, Washington, District of Columbia, United States of America
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Harrington RM, Krishnamurthy LC, Ossowski A, Jeter M, Davis A, Bledniak E, Ware AL, Morris R, Arrington CN. Preliminary evidence of prolonged timing effects of theta-burst stimulation in the reading system. Front Hum Neurosci 2023; 17:1227194. [PMID: 37706172 PMCID: PMC10496289 DOI: 10.3389/fnhum.2023.1227194] [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: 05/22/2023] [Accepted: 07/31/2023] [Indexed: 09/15/2023] Open
Abstract
Theta-burst stimulation (TBS) is a repetitive transcranial magnetic stimulation technique that can be used to upregulate or downregulate different brain regions. However, the timing of its effects and the differing effects of continuous TBS (cTBS) versus intermittent TBS (iTBS) in the reading system have not been explored. This study assessed how stimulation type and post-stimulation timing affected change in performance during a phonological discrimination and sight word recognition task after stimulation of supramarginal gyrus (SMG). Fourteen right-handed young adults (age 18-27 years; 44% male) were block-randomized to receive either iTBS or cTBS to the supramarginal gyrus. Participants then performed a pseudoword discrimination task and an orthographic awareness task (behavioral control) at four different time points and change in reaction time compared to baseline was measured from each time point. There was no effect of stimulation type on change in reaction time [t(16) = -0.2, p = 0.9], suggesting that both types of TBS caused similar effects. Percent change in reaction time decreased over time in the pseudoword task [t(50) = -5.9, p < 0.001], indicating faster pseudoword processing speed with better performance 60-70 min after stimulation. In contrast, no change was demonstrated over time for the behavioral control task [t(43) = -0.6, p = 0.6], suggesting that the change over time seen in the test condition was not a learning effect. These findings provide insight into the effects of TBS on the reading system and can guide future study designs.
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Affiliation(s)
- Rachael M. Harrington
- Center for Research on the Challenges of Acquiring Language and Literacy, Georgia State University, Atlanta, GA, United States
- Department of Communication Sciences and Disorders, Georgia State University, Atlanta, GA, United States
- Center for Advanced Brain Imaging, Georgia State University, Atlanta, GA, United States
| | - Lisa C. Krishnamurthy
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States
- Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Atlanta, GA, United States
- Department of Physics and Astronomy, Georgia State University, Atlanta, GA, United States
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, United States
| | - Alexandra Ossowski
- Center for Advanced Brain Imaging, Georgia State University, Atlanta, GA, United States
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - Mykayla Jeter
- Center for Advanced Brain Imaging, Georgia State University, Atlanta, GA, United States
- Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA, United States
| | - Adriane Davis
- Center for Advanced Brain Imaging, Georgia State University, Atlanta, GA, United States
| | - Ewelina Bledniak
- Center for Advanced Brain Imaging, Georgia State University, Atlanta, GA, United States
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - Ashley L. Ware
- Center for Advanced Brain Imaging, Georgia State University, Atlanta, GA, United States
- Department of Psychology, Georgia State University, Atlanta, GA, United States
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Robin Morris
- Center for Research on the Challenges of Acquiring Language and Literacy, Georgia State University, Atlanta, GA, United States
- Center for Advanced Brain Imaging, Georgia State University, Atlanta, GA, United States
- Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Atlanta, GA, United States
- Department of Psychology, Georgia State University, Atlanta, GA, United States
| | - C. Nikki Arrington
- Center for Advanced Brain Imaging, Georgia State University, Atlanta, GA, United States
- Center for Translational Research in Neuroimaging and Data Science, Georgia State University, Atlanta, GA, United States
- Department of Psychology, Georgia State University, Atlanta, GA, United States
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Alcon CA, Wang-Price S. Non-invasive brain stimulation and pain neuroscience education in the cognitive-affective treatment of chronic low back pain: Evidence and future directions. FRONTIERS IN PAIN RESEARCH 2022; 3:959609. [PMID: 36438443 PMCID: PMC9686004 DOI: 10.3389/fpain.2022.959609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Chronic low back pain (CLBP) is among the leading causes of disability worldwide. Beyond the physical and functional limitations, people's beliefs, cognitions, and perceptions of their pain can negatively influence their prognosis. Altered cognitive and affective behaviors, such as pain catastrophizing and kinesiophobia, are correlated with changes in the brain and share a dynamic and bidirectional relationship. Similarly, in the presence of persistent pain, attentional control mechanisms, which serve to organize relevant task information are impaired. These deficits demonstrate that pain may be a predominant focus of attentional resources, leaving limited reserve for other cognitively demanding tasks. Cognitive dysfunction may limit one's capacity to evaluate, interpret, and revise the maladaptive thoughts and behaviors associated with catastrophizing and fear. As such, interventions targeting the brain and resultant behaviors are compelling. Pain neuroscience education (PNE), a cognitive intervention used to reconceptualize a person's pain experiences, has been shown to reduce the effects of pain catastrophizing and kinesiophobia. However, cognitive deficits associated with chronic pain may impact the efficacy of such interventions. Non-invasive brain stimulation (NIBS), such as transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) has been shown to be effective in the treatment of anxiety, depression, and pain. In addition, as with the treatment of most physical and psychological diagnoses, an active multimodal approach is considered to be optimal. Therefore, combining the neuromodulatory effects of NIBS with a cognitive intervention such as PNE could be promising. This review highlights the cognitive-affective deficits associated with CLBP while focusing on current evidence for cognition-based therapies and NIBS.
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Affiliation(s)
- Cory A. Alcon
- Department of Physical Therapy, High Point University, High Point, NC, United States
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
- Correspondence: Cory A. Alcon
| | - Sharon Wang-Price
- School of Physical Therapy, Texas Woman’s University, Dallas, TX, United States
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Effects of Meaningful Action Observation Therapy on Occupational Performance, Upper Limb Function, and Corticospinal Excitability Poststroke: A Double-Blind Randomized Control Trial. Neural Plast 2022; 2022:5284044. [PMID: 36160327 PMCID: PMC9507745 DOI: 10.1155/2022/5284044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/05/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Action observation therapy (AOT) is a mirror neuron-based approach that has been recently used in poststroke rehabilitation. The main goal of this study was to investigate the effectiveness of AOT of occupations and tasks that are meaningful for chronic stroke patients on occupational performance, upper-extremity function, and corticospinal changes. Method A randomized control trial was designed to compare between experimental (n = 13) and control groups (n = 14). In both groups, the execution of meaningful tasks was practiced, but the videos of those tasks were just shown to the experiment group. Instead, patients in the control group watched nature videos as a placebo. Clinical outcomes were evaluated using the Canadian Occupational Performance Measure (COPM), Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box-Block Test (BBT) on 3 occasions: baseline, post (at 4 weeks), and follow-up (at 8 weeks). The assessments of central motor conduction time (CMCT) for abductor policis brevis (APB) and extensor indicis (EI) were only recorded at baseline and posttreatment. Both assessors of clinical and neurophysiological outcomes were blinded to the allocation of subjects. Result Finally, the results of outcomes in 24 patients who completed the study were analyzed. In both groups, significant improvements after treatment were seen for most outcomes (p ≤ 0.05). These changes were persistent until follow-up. There were significant differences in COPM performance (p = 0.03) and satisfaction (p = 0.001) between the experimental and control groups. In contrast, other clinical assessments such as FMA, ARAT, and BBT did not show significant differences between the two treatments (p ≥ 0.05). The results of CMCT related to APB showed a more significant change in the experiment group compared to the control group (p = 0.022). There was no difference in change detected between the two groups for CMCT related to EI after treatments. Conclusion Observation and execution of meaningful activities can enhance the effects of simply practicing those activities on occupational performance/satisfaction and corticospinal excitability poststroke.
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Betancur DFA, Tarragó MDGL, Torres ILDS, Fregni F, Caumo W. Central Post-Stroke Pain: An Integrative Review of Somatotopic Damage, Clinical Symptoms, and Neurophysiological Measures. Front Neurol 2021; 12:678198. [PMID: 34484097 PMCID: PMC8416310 DOI: 10.3389/fneur.2021.678198] [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: 03/10/2021] [Accepted: 07/02/2021] [Indexed: 01/26/2023] Open
Abstract
Introduction: The physiopathology of central post-stroke pain (CPSP) is poorly understood, which may contribute to the limitations of diagnostic and therapeutic advancements. Thus, the current systematic review was conducted to examine, from an integrated perspective, the cortical neurophysiological changes observed via transcranial magnetic stimulation (TMS), focusing on the structural damage, and clinical symptoms in patients with CPSP. Methods: The literature review included the databases EMBASE, PubMed, and ScienceDirect using the following search terms by MeSH or Entree descriptors: [("Cerebral Stroke") AND ("Pain" OR "Transcranial Magnetic Stimulation") AND ("Transcranial Magnetic Stimulation")] (through September 29, 2020). A total of 297 articles related to CPSP were identified. Of these, only four quantitatively recorded cortical measurements. Results: We found four studies with different methodologies and results of the TMS measures. According to the National Institutes of Health (NIH) guidelines, two studies had low methodological quality and the other two studies had satisfactory methodological quality. The four studies compared the motor threshold (MT) of the stroke-affected hemisphere with the unaffected hemisphere or with healthy controls. Two studies assessed other cortical excitability measures, such as cortical silent period (CSP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF). The main limitations in the interpretation of the results were the heterogeneity in parameter measurements, unknown cortical excitability measures as potential prognostic markers, the lack of a control group without pain, and the absence of consistent and validated diagnosis criteria. Conclusion: Despite the limited number of studies that prevented us from conducting a meta-analysis, the dataset of this systematic review provides evidence to improve the understanding of CPSP physiopathology. Additionally, these studies support the construction of a framework for diagnosis and will help improve the methodological quality of future research in somatosensory sequelae following stroke. Furthermore, they offer a way to integrate dysfunctional neuroplasticity markers that are indirectly assessed by neurophysiological measures with their correlated clinical symptoms.
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Affiliation(s)
- Daniel Fernando Arias Betancur
- Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain & Neuromodulation, Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | | | - Iraci Lucena da Silva Torres
- Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Pharmacology of Pain and Neuromodulation: Pre-clinical Investigations Research Group, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Felipe Fregni
- Laboratory of Neuromodulation and Center for Clinical Research Learning, Physics, and Rehabilitation Department, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Wolnei Caumo
- Graduate Program in Medical Sciences, School of Medicine, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
- Laboratory of Pain & Neuromodulation, Clinical Research Center, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Pain and Palliative Care Service, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
- Department of Surgery, School of Medicine, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
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Zhong M, Cywiak C, Metto AC, Liu X, Qian C, Pelled G. Multi-session delivery of synchronous rTMS and sensory stimulation induces long-term plasticity. Brain Stimul 2021; 14:884-894. [PMID: 34029768 DOI: 10.1016/j.brs.2021.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/17/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Combining training or sensory stimulation with non-invasive brain stimulation has shown to improve performance in healthy subjects and improve brain function in patients after brain injury. However, the plasticity mechanisms and the optimal parameters to induce long-term and sustainable enhanced performance remain unknown. OBJECTIVE This work was designed to identify the protocols of which combining sensory stimulation with repetitive transcranial magnetic stimulation (rTMS) will facilitate the greatest changes in fMRI activation maps in the rat's primary somatosensory cortex (S1). METHODS Several protocols of combining forepaw electrical stimulation with rTMS were tested, including a single stimulation session compared to multiple, daily stimulation sessions, as well as synchronous and asynchronous delivery of both modalities. High-resolution fMRI was used to determine how pairing sensory stimulation with rTMS induced short and long-term plasticity in the rat S1. RESULTS All groups that received a single session of rTMS showed short-term increases in S1 activity, but these increases did not last three days after the session. The group that received a stimulation protocol of 10 Hz forepaw stimulation that was delivered simultaneously with 10 Hz rTMS for five consecutive days demonstrated the greatest increases in the extent of the evoked fMRI responses compared to groups that received other stimulation protocols. CONCLUSIONS Our results provide direct indication that pairing peripheral stimulation with rTMS induces long-term plasticity, and this phenomenon appears to follow a time-dependent plasticity mechanism. These results will be important to lead the design of new training and rehabilitation paradigms and training towards achieving maximal performance in healthy subjects.
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Affiliation(s)
- Ming Zhong
- Neuroengineering Division, The Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Carolina Cywiak
- Neuroengineering Division, The Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA; Department of Biomedical Engineering, Michigan State University, East Lansing, MI, USA
| | - Abigael C Metto
- Neuroengineering Division, The Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA; Department of Biomedical Engineering, Michigan State University, East Lansing, MI, USA
| | - Xiang Liu
- Neuroengineering Division, The Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Chunqi Qian
- Department of Radiology, Michigan State University, East Lansing, MI, USA
| | - Galit Pelled
- Neuroengineering Division, The Institute for Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA; Department of Biomedical Engineering, Michigan State University, East Lansing, MI, USA; Department of Radiology, Michigan State University, East Lansing, MI, USA.
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Effects of Repetitive Transcranial Magnetic Stimulation on Walking and Balance Function after Stroke: A Systematic Review and Meta-Analysis. Am J Phys Med Rehabil 2019; 97:773-781. [PMID: 29734235 DOI: 10.1097/phm.0000000000000948] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on walking and balance function in patients with stroke. DESIGN MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CENTRAL, and the Physiotherapy Evidence Database were comprehensively searched for randomized controlled trials published through March 2017 that investigated the effects of rTMS on lower limb function. Main outcomes included walking speed, balance function, motor function, and cortical excitability. RESULTS Nine studies were included. The meta-analysis revealed a significant effect of rTMS on walking speed (standardized mean difference, 0.64; 95% confidence interval [CI], 0.32-0.95), particularly ipsilesional stimulation (standardized mean difference, 0.80; 95% CI, 0.36-1.24). No significant effects were found for balance function (standardized mean difference, 0.10; 95% CI, -0.26 to 0.45), motor function (mean difference, 0.50, 95% CI: -0.68 to 1.68), or cortical excitability (motor-evoked potentials of the affected hemisphere: mean difference, 0.21 mV; 95% CI, -0.11 to 0.54; motor-evoked potentials of the unaffected hemisphere: mean difference, 0.09 mV; 95% CI, -0.16 to -0.02). CONCLUSION These results suggest that rTMS, particularly ipsilesional stimulation, significantly improves walking speed. Future studies with larger sample sizes and an adequate follow-up period are required to further understand the effects of rTMS on lower limb function and its relationship with changes in cortical excitability with the help of functional neuroimaging techniques. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: 1) Understand the potential neurophysiologic effects of rTMS; 2) Appreciate the potential benefits of rTMS on stroke recovery; and 3) Identify indications for including rTMS in a stroke rehabilitation program. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Shin SS, Krishnan V, Stokes W, Robertson C, Celnik P, Chen Y, Song X, Lu H, Liu P, Pelled G. Transcranial magnetic stimulation and environmental enrichment enhances cortical excitability and functional outcomes after traumatic brain injury. Brain Stimul 2018; 11:1306-1313. [PMID: 30082198 DOI: 10.1016/j.brs.2018.07.050] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Therapeutic strategies for traumatic brain injury (TBI) in the last three decades have failed to show significant benefit in large scale studies. Given the multitude of pathological mechanisms involved in TBI, strategies focusing on multimodality regimen have gained interest as promising future interventions. HYPOTHESIS We hypothesized that combining noninvasive transcranial magnetic stimulation (TMS) with rehabilitative training in an environmental enrichment (EE) can facilitate post-TBI recovery in rats via cortical excitability and reorganization. METHODS We subjected rats to controlled cortical impact, and then assigned them to one of four groups: 1. No treatments (TBI), 2. EE after injury (TBI + EE), 3. TMS for one week (TBI + TMS), and 4. TMS for one week combined with EE (TBI + TMS/EE). For TMS, a 10 Hz repetitive TMS protocol was used. RESULTS At 7 days, TBI + TMS and TBI + TMS/EE groups had significantly increased primary somatosensory cortex local field potential (LFP) compared to TBI and TBI + EE groups (P < 0.05). Also, TBI + TMS/EE group had significantly improved performance on beam walk test compared to TBI group (P < 0.005). At 6 weeks, there was significantly higher response in TBI + TMS/EE group compared to TBI + TMS for somatosensory cortex LFP (P < 0.05), bicep motor evoked potentials (MEP) (P < 0.05), challenge ladder test performance (P < 0.01), and fMRI responses to tactile forepaw stimulation. CONCLUSIONS We demonstrate here for the first time the mechanism by which combined therapy using TMS and EE after TBI leads to functional improvement, possibly via cortical excitability and reorganization.
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Affiliation(s)
- Samuel S Shin
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Vijai Krishnan
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Michigan State University, East Lansing, MI, USA; The Institute of Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - William Stokes
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Courtney Robertson
- Department of Anesthesiology/Critical Care Medicine and Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pablo Celnik
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Yanrong Chen
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaolei Song
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hanzhang Lu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Peiying Liu
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Galit Pelled
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA; Russell H. Morgan Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Michigan State University, East Lansing, MI, USA; The Institute of Quantitative Health Science and Engineering, Michigan State University, East Lansing, MI, USA; Department of Radiology, Michigan State University, East Lansing, MI, USA.
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Palmer JA, Hsiao H, Awad LN, Binder-Macleod SA. Symmetry of corticomotor input to plantarflexors influences the propulsive strategy used to increase walking speed post-stroke. Clin Neurophysiol 2015; 127:1837-44. [PMID: 26724913 DOI: 10.1016/j.clinph.2015.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/28/2015] [Accepted: 12/05/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A deficit in paretic limb propulsion has been identified as a major biomechanical factor limiting walking speed after stroke. The purpose of this study was to determine the influence of corticomotor symmetry between paretic and nonparetic plantarflexors on the propulsive strategy used to increase walking speed. METHODS Twenty-three participants with post-stroke hemiparesis underwent transcranial magnetic stimulation and biomechanical testing at their self-selected and fastest walking speeds. Plantarflexor corticomotor symmetry (CS(PF)) was calculated as a ratio of the average paretic versus nonparetic soleus motor evoked potential amplitude. The ratio of the paretic and nonparetic peak ankle plantarflexion moments (PF(sym)) was calculated at each speed. RESULTS CS(PF) predicted the ΔPF(sym) from self-selected and fastest speeds (R(2)=.629, F(1,21)=35.56, p<.001). An interaction between CS(PF) and ΔPF(sym) (β=.596, p=.04) was observed when predicting Δspeed ((adj)R(2)=.772, F(3,19)=20.48, p<.001). Specifically, the ΔPF(sym) with speed modulation was positively related to the Δspeed (p=.03) in those with greater CS(PF), but was not related in those with poor CS(PF) (p=.30). CONCLUSIONS Symmetry of the corticomotor input to the plantarflexors influences the propulsive strategy used to increase post-stroke walking speed. SIGNIFICANCE Rehabilitation strategies that promote corticomotor symmetry may positively influence gait mechanics and enhance post-stroke walking function.
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Affiliation(s)
- Jacqueline A Palmer
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 19713, USA.
| | - HaoYuan Hsiao
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 19713, USA
| | - Louis N Awad
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA 02138, USA
| | - Stuart A Binder-Macleod
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 19713, USA
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Palmer JA, Needle AR, Pohlig RT, Binder-Macleod SA. Atypical cortical drive during activation of the paretic and nonparetic tibialis anterior is related to gait deficits in chronic stroke. Clin Neurophysiol 2015; 127:716-723. [PMID: 26142877 DOI: 10.1016/j.clinph.2015.06.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 06/09/2015] [Accepted: 06/12/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The role of cortical drive in stroke recovery for the lower extremity remains ambiguous. The purpose of this study was to investigate the relationship between cortical drive and gait speed in a group of stroke survivors. METHODS Eighteen individuals with stroke were dichotomized into fast or slow walking groups. Transcranial magnetic stimulation (TMS) was used to collect motor evoked potentials (MEPs) from the tibialis anterior of each lower extremity during rest, paretic muscle contractions, and nonparetic muscle contractions. An asymmetry-index (AI) was calculated using motor thresholds and compared between groups. The average MEP of the paretic leg during TMS at maximal intensity (MEP100) for each condition was compared within and between groups. RESULTS A significant positive correlation was found between AI and walking speed. Slow-walkers had greater MEP100s during the nonparetic contraction than during the paretic contraction or rest conditions. In contrast, fast-walkers had greatest MEP100s during the paretic contraction. CONCLUSIONS Alterations in the balance of corticomotor excitability occur in the lower extremity of individuals with poor motor recovery post-stroke. This atypical cortical drive is dependent on activation of the unaffected hemisphere and contraction of the nonparetic leg. SIGNIFICANCE Understanding mechanisms underlying motor function can help to identify specific patient deficits that impair function.
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Affiliation(s)
- Jacqueline A Palmer
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 19713, USA.
| | - Alan R Needle
- Department of Health and Exercise Science, Appalachian State University, Boone, NC 28608, USA
| | - Ryan T Pohlig
- Biostatistics Core Facility, University of Delaware, Newark, DE 19713, USA
| | - Stuart A Binder-Macleod
- Department of Physical Therapy, University of Delaware, Newark, DE 19713, USA; Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE 19713, USA
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