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Abstract
Stroke remains a major cause of disability. Intensive rehabilitation therapy can improve outcomes, but most patients receive limited doses. Telehealth methods can overcome obstacles to delivering intensive therapy and thereby address this unmet need. A specific example is reviewed in detail, focused on a telerehabilitation system that targets upper extremity motor deficits after stroke. Strengths of this system include provision of daily therapy associated with very high patient compliance, safety and feasibility in the inpatient or home setting, comparable efficacy to dose-matched therapy provided in-clinic, and a holistic approach that includes assessment, education, prevention, and activity-based therapy.
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Affiliation(s)
- Steven C Cramer
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA.
| | - Brittany M Young
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Anne Schwarz
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Tracy Y Chang
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Michael Su
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
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Yoon H, Park C. Effectiveness of Proprioceptive Body Vibration Rehabilitation on Motor Function and Activities of Daily Living in Stroke Patients with Impaired Sensory Function. Healthcare (Basel) 2023; 12:35. [PMID: 38200941 PMCID: PMC10779045 DOI: 10.3390/healthcare12010035] [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: 11/18/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Stroke patients experience impaired sensory and motor functions, which impact their activities of daily living (ADL). The current study was designed to determine the best neurorehabilitation method to improve clinical outcomes, including the trunk-impairment scale (TIS), Berg balance scale (BBS), Fugl-Meyer assessment (FMA), and modified Barthel index (MBI), in stroke patients with impaired sensory function. Forty-four stroke survivors consistently underwent proprioceptive body vibration rehabilitation training (PBVT) or conventional physical therapy (CPT) for 30 min/session, 5 days a week for 8 weeks. Four clinical outcome variables-the FMA, TIS, BBS, and MBI-were examined pre- and post-intervention. We observed significant differences in the FMA, BBS, and MBI scores between the PBVT and CPT groups. PBVT and CPT showed significant improvements in FMA, BBS, TIS, and MBI scores. However, PVBT elicited more favorable results than CPT in patients with stroke and impaired sensory function. Collectively, this study provides the first clinical evidence of optimal neurorehabilitation in stroke patients with impaired sensory function.
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Affiliation(s)
- Hyunsik Yoon
- Chungnam National University Hospital, Daejeon 35015, Republic of Korea;
- Department of Physical Therapy, Yonsei University, Wonju 26493, Republic of Korea
| | - Chanhee Park
- Department of Physical Therapy, Yonsei University, Wonju 26493, Republic of Korea
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3
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Zhang Z, Duan Z, Cui Y. CD8 + T cells in brain injury and neurodegeneration. Front Cell Neurosci 2023; 17:1281763. [PMID: 38077952 PMCID: PMC10702747 DOI: 10.3389/fncel.2023.1281763] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/30/2023] [Indexed: 02/19/2024] Open
Abstract
The interaction between the peripheral immune system and the brain is increasingly being recognized as an important layer of neuroimmune regulation and plays vital roles in brain homeostasis as well as neurological disorders. As an important population of T-cell lymphocytes, the roles of CD8+ T cells in infectious diseases and tumor immunity have been well established. Recently, increasing number of complex functions of CD8+ T cells in brain disorders have been revealed. However, an advanced summary and discussion of the functions and mechanisms of CD8+ T cells in brain injury and neurodegeneration are still lacking. Here, we described the differentiation and function of CD8+ T cells, reviewed the involvement of CD8+ T cells in the regulation of brain injury including stroke and traumatic brain injury and neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD), and discussed therapeutic prospects and future study goals. Understanding these processes will promote the investigation of T-cell immunity in brain disorders and provide new intervention strategies for the treatment of brain injury and neurodegeneration.
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Affiliation(s)
- Zhaolong Zhang
- Department of Interventional Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhongying Duan
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, Shandong, China
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Yu Cui
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, Shandong, China
- Qingdao Medical College, Qingdao University, Qingdao, China
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Yang J, Gong Y, Yu L, Peng L, Cui Y, Huang H. Effect of exoskeleton robot-assisted training on gait function in chronic stroke survivors: a systematic review of randomised controlled trials. BMJ Open 2023; 13:e074481. [PMID: 37709309 PMCID: PMC10503387 DOI: 10.1136/bmjopen-2023-074481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES Numbers of research have reported the usage of robot-assisted gait training for walking restoration post-stroke. However, no consistent conclusion has been reached yet about the efficacy of exoskeleton robot-assisted training (ERAT) on gait function of stroke survivors, especially during the chronic period. We conducted a systematic review to investigate the efficacy of ERAT on gait function for chronic stroke survivors. DESIGN This review followed the Participant, Intervention, Comparison and Outcome principle. DATA SOURCES PubMed, Cochrane Library, Web of Science, Embase and Cumulative Index to Nursing and Allied Health Literature databases were systematically searched until December 2022. ELIGIBILITY CRITERIA Only randomised controlled trials (RCTs) were included and these RCTs took patients who had a chronic stroke as participants, exoskeleton robot-assisted gait training as intervention, regular rehabilitation therapy as comparison and gait-related functional assessments as outcomes. DATA EXTRACTION AND SYNTHESIS Data extraction and synthesis used the reporting checklist for systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The risk of bias and methodological quality of included studies were evaluated by two independent investigators under the guidance of Cochrane risk of bias. RESULTS Out of 278 studies, a total of 10 studies (n=323, mean age 57.6 years, 63.2% males) were identified in this systematic review. According to the Cochrane risk of bias, the quality of these studies was assessed as low risk. Six studies reported favourable effects of ERAT on gait function involving gait performance, balance function and physical endurance, and the ERAT group was significantly superior when compared with the control group. In contrast, the other four trials showed equal or negative effects of ERAT considering different study designs. All the included studies did not claim any serious adverse events. CONCLUSION ERAT could be an efficient intervention to improve gait function for individuals who had a chronic stroke. However, more rigorously designed trials are required to draw more solid evidence. PROSPERO REGISTRATION NUMBER CRD42023410796.
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Affiliation(s)
- Jinchao Yang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yu Gong
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lei Yu
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Laiying Peng
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yuanfen Cui
- Department of Pain Management, Wuhan No 1 Hospital, Wuhan, China
| | - Hailong Huang
- Department of Rehabilitation Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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Sokolowski JD, Soldozy S, Sharifi KA, Norat P, Kearns KN, Liu L, Williams AM, Yağmurlu K, Mastorakos P, Miller GW, Kalani MYS, Park MS, Kellogg RT, Tvrdik P. Preclinical models of middle cerebral artery occlusion: new imaging approaches to a classic technique. Front Neurol 2023; 14:1170675. [PMID: 37409019 PMCID: PMC10318149 DOI: 10.3389/fneur.2023.1170675] [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: 02/21/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Stroke remains a major burden on patients, families, and healthcare professionals, despite major advances in prevention, acute treatment, and rehabilitation. Preclinical basic research can help to better define mechanisms contributing to stroke pathology, and identify therapeutic interventions that can decrease ischemic injury and improve outcomes. Animal models play an essential role in this process, and mouse models are particularly well-suited due to their genetic accessibility and relatively low cost. Here, we review the focal cerebral ischemia models with an emphasis on the middle cerebral artery occlusion technique, a "gold standard" in surgical ischemic stroke models. Also, we highlight several histologic, genetic, and in vivo imaging approaches, including mouse stroke MRI techniques, that have the potential to enhance the rigor of preclinical stroke evaluation. Together, these efforts will pave the way for clinical interventions that can mitigate the negative impact of this devastating disease.
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Affiliation(s)
- Jennifer D. Sokolowski
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Sauson Soldozy
- Department of Neurological Surgery, Westchester Medical Center, Valhalla, NY, United States
| | - Khadijeh A. Sharifi
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
| | - Pedro Norat
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Kathryn N. Kearns
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Lei Liu
- Department of Neurological Surgery and Neuroscience, Northwestern University, Chicago, IL, United States
| | - Ashley M. Williams
- School of Medicine, Morsani College of Medicine, Tampa, FL, United States
| | - Kaan Yağmurlu
- Department of Neurological Surgery, University of Tennessee, Memphis, TN, United States
| | - Panagiotis Mastorakos
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | - G. Wilson Miller
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, United States
| | - M. Yashar S. Kalani
- Department of Neurological Surgery, St. John's Neuroscience Institute, Tulsa, OK, United States
| | - Min S. Park
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Ryan T. Kellogg
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
| | - Petr Tvrdik
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, United States
- Department of Neuroscience, University of Virginia, Charlottesville, VA, United States
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Marsh EB, Girgenti S, Llinas EJ, Brunson AO. Outcomes in Patients with Minor Stroke: Diagnosis and Management in the Post-thrombectomy Era. Neurotherapeutics 2023; 20:732-743. [PMID: 36752947 PMCID: PMC10275835 DOI: 10.1007/s13311-023-01349-5] [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] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
In the era of mechanical thrombectomy and better preventative strategies, a higher number of patients are being discharged home from the hospital with the so-called minor strokes. This has significantly changed the landscape of stroke recovery. Unfortunately, while symptoms may be categorized as mild compared to individuals with higher NIH Stroke Scale scores, the physical, cognitive, and emotional sequelae can be disabling and result in failure to return to work and poor quality of life in a population with significant potential to recover fully. In this review, we discuss the current state of minor stroke, the most common pattern of resulting deficits, what is known about the underlying pathophysiology that leads to a relatively global pattern of impaired cognition following an infarct in any location, and special considerations for treatment based on this population's unique needs. Raising awareness of the current morbidity associated with minor stroke, the need for a uniform definition that allows for comparisons of individuals across studies, and further research focused on this population to optimize outcomes, has the potential to significantly improve recovery.
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Affiliation(s)
- Elisabeth B Marsh
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA.
| | - Sophia Girgenti
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
| | - Edward J Llinas
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
| | - Autumn O Brunson
- Department of Neurology, Johns Hopkins Hospital, The Johns Hopkins University School of Medicine, 600 North Wolfe St, Baltimore, MD 21287, USA
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Altered Spontaneous Brain Activity in Poststroke Aphasia: A Resting-State fMRI Study. Brain Sci 2023; 13:brainsci13020300. [PMID: 36831843 PMCID: PMC9954170 DOI: 10.3390/brainsci13020300] [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: 12/10/2022] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/12/2023] Open
Abstract
PURPOSE Brain areas frequently implicated in language recovery after stroke comprise perilesional sites in the left hemisphere and homotopic regions in the right hemisphere. However, the neuronal mechanisms underlying language restoration are still largely unclear. METHODS AND MATERIALS In the present study, we investigated the brain function in 15 patients with poststroke aphasia and 30 matched control subjects by combining the regional homogeneity (ReHo) and amplitudes of low-frequency fluctuation (ALFF) analysis methods based on resting-state fMRI. RESULTS Compared to the control subjects, the patients with aphasia exhibited increased ReHo and ALFF values in the ipsilateral perilesional areas and increased ReHo in the contralesional right middle frontal gyrus. CONCLUSIONS The increased spontaneous brain activity in patients with poststroke aphasia during the recovery period, specifically in the ipsilateral perilesional regions and the homologous language regions of the right hemisphere, has potential implications for the treatment of patients with aphasia.
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Westlake K, Akinlosotu R, Udo J, Goldstein Shipper A, Waller SM, Whitall J. Some home-based self-managed rehabilitation interventions can improve arm activity after stroke: A systematic review and narrative synthesis. Front Neurol 2023; 14:1035256. [PMID: 36816549 PMCID: PMC9932529 DOI: 10.3389/fneur.2023.1035256] [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: 09/02/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
Background There is an increased need for home-based, self-managed, and low maintenance stroke rehabilitation as well as interest in targeting the arm, which often lags behind leg recovery. Previous reviews have not controlled for concurrent standard of care and the ratio of self-managed care to therapist input. Objectives To determine the effectiveness of home-based, self-managed and low maintenance programs for upper-limb motor recovery in individuals after stroke. A secondary objective explored the adherence to home-based self-managed programs. Data sources We searched PubMed (1809-present), Embase (embase.com, 1974-present), Cochrane CENTRAL Register of Controlled Trials (Wiley), CINAHL (EBSCOhost, 1937-present), Physiotherapy Evidence Database (pedro.org.au), OTseeker (otseeker.com), and REHABDATA (National Rehabilitation Information Center). All searches were completed on June 9, 2022. Bibliographic references of included articles also were searched. Eligibility criteria Randomized controlled trials (RCT) in adults after stroke, where both intervention and control were home-based, at least 75% self-managed and did not involve concurrent therapy as a confounding factor. Primary outcome was performance in functional motor activities after training. Secondary outcome was sensorimotor impairment. All outcomes after a retention period were also considered secondary outcomes. Data collection and analysis Two review authors independently screened titles/abstracts, three review authors screened full papers and extracted data, and two review authors undertook assessment of risk of bias (i.e., allocation bias, measurement bias, confounding factors) using the NHLBI Study Quality Assessment Tool. Main results We identified seven heterogenous studies, including five with fair to good quality. All studies had an alternative treatment, dose-equivalent control. Only one trial reported a positive, sustained, between-group effect on activity for the experimental group. The remaining studies reported seven interventions having a within-group training effect with three interventions having sustained effects at follow up. One study reported a between group effect on an impairment measure with no follow-up. Overall adherence rates were high, but three studies reported differential group rates. Compliance with daily logs was higher when the logs were collected on a weekly basis. Limitations By excluding studies that allowed concurrent therapy, we likely minimized the number of studies that included participants in the early sub-acute post-stroke stage. By focusing on RCTs, we are unable to comment on other potentially promising home-based, self-managed single cohort programs. By including only published and English language studies, we may have included publication bias. Conclusions and implications There is some evidence that a variety of home-based, self-managed training program can be beneficial after stroke. Future research could compare such programs with natural history controls. Clinicians might utilize home exercise programs with explicit directions and some form of weekly contact to aid compliance.
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Affiliation(s)
- Kelly Westlake
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Ruth Akinlosotu
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Jean Udo
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
| | - Andrea Goldstein Shipper
- Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, United States
| | - Sandy McCombe Waller
- Division of Health, Business, Technology, and Science, Frederick Community College, Frederick, MD, United States
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland, Baltimore, MD, United States
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Padawer-Curry JA, Bowen RM, Jarang A, Wang X, Lee JM, Bauer AQ. Wide-Field Optical Imaging in Mouse Models of Ischemic Stroke. Methods Mol Biol 2023; 2616:113-151. [PMID: 36715932 DOI: 10.1007/978-1-0716-2926-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Functional neuroimaging is a powerful tool for evaluating how local and global brain circuits evolve after focal ischemia and how these changes relate to functional recovery. For example, acutely after stroke, changes in functional brain organization relate to initial deficit and are predictive of recovery potential. During recovery, the reemergence and restoration of connections lost due to stroke correlate with recovery of function. Thus, information gleaned from functional neuroimaging can be used as a proxy for behavior and inform on the efficacy of interventional strategies designed to affect plasticity mechanisms after injury. And because these findings are consistently observed across species, bridge measurements can be made in animal models to enrich findings in human stroke populations. In mice, genetic engineering techniques have provided several new opportunities for extending optical neuroimaging methods to more direct measures of neuronal activity. These developments are especially useful in the context of stroke where neurovascular coupling can be altered, potentially limiting imaging measures based on hemodynamic activity alone. This chapter is designed to give an overview of functional wide-field optical imaging (WFOI) for applications in rodent models of stroke, primarily in the mouse. The goal is to provide a protocol for laboratories that want to incorporate an affordable functional neuroimaging assay into their current research thrusts, but perhaps lack the background knowledge or equipment for developing a new arm of research in their lab. Within, we offer a comprehensive guide developing and applying WFOI technology with the hope of facilitating accessibility of neuroimaging technology to other researchers in the stroke field.
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Affiliation(s)
- Jonah A Padawer-Curry
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
- Imaging Science PhD Program, Washington University in St. Louis, St. Louis, MO, USA
| | - Ryan M Bowen
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Anmol Jarang
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Xiaodan Wang
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Jin-Moo Lee
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, USA
| | - Adam Q Bauer
- Department of Radiology, Washington University in St. Louis, St. Louis, MO, USA.
- Imaging Science PhD Program, Washington University in St. Louis, St. Louis, MO, USA.
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, MO, USA.
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Mah SM, Goodwill AM, Seow HC, Teo WP. Evidence of High-Intensity Exercise on Lower Limb Functional Outcomes and Safety in Acute and Subacute Stroke Population: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:153. [PMID: 36612471 PMCID: PMC9819111 DOI: 10.3390/ijerph20010153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/07/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
This systematic review investigated the effects of high-intensity exercise (HIE) on lower limb (LL) function in acute and subacute stroke patients. A systematic electronic search was performed in PubMed, CINAHL and the Web of Science from inception to 30 June 2022. Outcomes examined included LL function and measures of activities of daily living such as the Barthel index, 6 min walk test (6MWT), gait speed and Berg balance scale (BBS), adverse events and safety outcomes. The methodological quality and the quality of evidence for each study was assessed using the PEDro scale and the Risk of Bias 2 tool (RoB 2). HIE was defined as achieving at least 60% of the heart rate reserve (HRR) or VO2 peak, 70% of maximal heart rate (HRmax), or attaining a score of 14 or more on the rate of perceived exertion Borg scale (6-20 rating scale). This study included randomized controlled trials (RCTs) which compared an intervention group of HIE to a control group of lower intensity exercise, or no intervention. All participants were in the acute (0-3 months) and subacute (3-6 months) stages of stroke recovery. Studies were excluded if they were not RCTs, included participants from a different stage of stroke recovery, or if the intervention did not meet the pre-defined HIE criteria. Overall, seven studies were included that used either high-intensity treadmill walking, stepping, cycling or overground walking exercises compared to either a low-intensity exercise (n = 4) or passive control condition (n = 3). Three studies reported significant improvements in 6MWT and gait speed performance, while only one showed improved BBS scores. No major adverse events were reported, although minor incidents were reported in only one study. This systematic review showed that HIE improved LL functional task performance, namely the 6MWT and gait speed. Previously, there was limited research demonstrating the efficacy of HIE early after stroke. This systematic review provides evidence that HIE may improve LL function with no significant adverse events report for stroke patients in their acute and subacute rehabilitation stages. Hence, HIE should be considered for implementation in this population, taking into account the possible benefits in terms of functional outcomes, as compared to lower intensity interventions.
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Affiliation(s)
- Shi Min Mah
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 639798, Singapore
- Department of Physiotherapy, Sengkang General Hospital, Singapore 544886, Singapore
| | - Alicia M. Goodwill
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 639798, Singapore
| | - Hui Chueng Seow
- Department of Physiotherapy, Singapore General Hospital, Singapore 168753, Singapore
| | - Wei-Peng Teo
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, Singapore 639798, Singapore
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Zhang Z, Lv M, Zhou X, Cui Y. Roles of peripheral immune cells in the recovery of neurological function after ischemic stroke. Front Cell Neurosci 2022; 16:1013905. [PMID: 36339825 PMCID: PMC9634819 DOI: 10.3389/fncel.2022.1013905] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/03/2022] [Indexed: 10/15/2023] Open
Abstract
Stroke is a leading cause of mortality and long-term disability worldwide, with limited spontaneous repair processes occurring after injury. Immune cells are involved in multiple aspects of ischemic stroke, from early damage processes to late recovery-related events. Compared with the substantial advances that have been made in elucidating how immune cells modulate acute ischemic injury, the understanding of the impact of the immune system on functional recovery is limited. In this review, we summarized the mechanisms of brain repair after ischemic stroke from both the neuronal and non-neuronal perspectives, and we review advances in understanding of the effects on functional recovery after ischemic stroke mediated by infiltrated peripheral innate and adaptive immune cells, immune cell-released cytokines and cell-cell interactions. We also highlight studies that advance our understanding of the mechanisms underlying functional recovery mediated by peripheral immune cells after ischemia. Insights into these processes will shed light on the double-edged role of infiltrated peripheral immune cells in functional recovery after ischemic stroke and provide clues for new therapies for improving neurological function.
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Affiliation(s)
- Zhaolong Zhang
- Department of Interventional Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mengfei Lv
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, Shandong, China
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Xin Zhou
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, Shandong, China
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Yu Cui
- Institute of Neuroregeneration and Neurorehabilitation, Qingdao University, Qingdao, Shandong, China
- Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
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Garcia A, Mayans B, Margelí C, Pamplona A, Molas C, Monràs J, Alpiste F, Torner J, Serrancolí G. A feasibility study to assess the effectiveness of Muvity: A telerehabilitation system for chronic post-stroke subjects. J Stroke Cerebrovasc Dis 2022; 31:106791. [PMID: 36156443 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/21/2022] [Accepted: 09/14/2022] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To assess the feasibility of a telerehabilitation system for chronic post-stroke subjects compared to a conventional treatment. METHODS A feasibility cross-over analysis was conducted in ten chronic post-stroke subjects. Two randomized groups followed two eight-weeks treatments, one with the telerehabilitation system Muvity and the other following conventional therapy (in random order). Before and after each treatment, physical evaluations were performed assessing functional independence, the perceived level of pain, balance control and self-reported health status. After the study, the participants answered a short questionnaire to measure the usability of the system. RESULTS Four out of six subjects demonstrated better performance in ADLs (equal or higher FIM scores) and five out of six reported lower pain (VAS score) after the treatment with Muvity when compared to the treatment without. There were no clear trends in terms of balance control (Berg scale) or self-reported health status (PCS score within SF-36). CONCLUSIONS The results suggest that the proposed telerehabilitation system aids users to overall maintain or improve their ability to perform ADLs without increasing pain, when compared to conventional therapy. Most subjects found the use of Muvity more motivating than the conventional rehabilitation treatment. This provides initial evidence that Muvity might be an appropriate complement for the telerehabilitation of patients with physical disabilities. However, the differences observed between both treatments were not statistically significant. A clinical study with a larger sample size will be necessary to obtain more robust results.
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Affiliation(s)
- Andrés Garcia
- Multimedia Applications Lab, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Berta Mayans
- Multimedia Applications Lab, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Carles Margelí
- Multimedia Applications Lab, Universitat Politècnica de Catalunya, Barcelona, Spain
| | | | | | - Júlia Monràs
- Osona Association for Functional Diversity, Vic, Spain
| | - Francesc Alpiste
- Multimedia Applications Lab, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Jordi Torner
- Multimedia Applications Lab, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Gil Serrancolí
- Multimedia Applications Lab, Universitat Politècnica de Catalunya, Barcelona, Spain.
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13
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Remsik AB, van Kan PLE, Gloe S, Gjini K, Williams L, Nair V, Caldera K, Williams JC, Prabhakaran V. BCI-FES With Multimodal Feedback for Motor Recovery Poststroke. Front Hum Neurosci 2022; 16:725715. [PMID: 35874158 PMCID: PMC9296822 DOI: 10.3389/fnhum.2022.725715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/26/2022] [Indexed: 01/31/2023] Open
Abstract
An increasing number of research teams are investigating the efficacy of brain-computer interface (BCI)-mediated interventions for promoting motor recovery following stroke. A growing body of evidence suggests that of the various BCI designs, most effective are those that deliver functional electrical stimulation (FES) of upper extremity (UE) muscles contingent on movement intent. More specifically, BCI-FES interventions utilize algorithms that isolate motor signals-user-generated intent-to-move neural activity recorded from cerebral cortical motor areas-to drive electrical stimulation of individual muscles or muscle synergies. BCI-FES interventions aim to recover sensorimotor function of an impaired extremity by facilitating and/or inducing long-term motor learning-related neuroplastic changes in appropriate control circuitry. We developed a non-invasive, electroencephalogram (EEG)-based BCI-FES system that delivers closed-loop neural activity-triggered electrical stimulation of targeted distal muscles while providing the user with multimodal sensory feedback. This BCI-FES system consists of three components: (1) EEG acquisition and signal processing to extract real-time volitional and task-dependent neural command signals from cerebral cortical motor areas, (2) FES of muscles of the impaired hand contingent on the motor cortical neural command signals, and (3) multimodal sensory feedback associated with performance of the behavioral task, including visual information, linked activation of somatosensory afferents through intact sensorimotor circuits, and electro-tactile stimulation of the tongue. In this report, we describe device parameters and intervention protocols of our BCI-FES system which, combined with standard physical rehabilitation approaches, has proven efficacious in treating UE motor impairment in stroke survivors, regardless of level of impairment and chronicity.
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Affiliation(s)
- Alexander B. Remsik
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- School of Medicine and Public Health, Institute for Clinical and Translational Research, University of Wisconsin–Madison, Madison, WI, United States
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Peter L. E. van Kan
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, United States
- Neuroscience Training Program, University of Wisconsin–Madison, Madison, WI, United States
| | - Shawna Gloe
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Klevest Gjini
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurology, University of Wisconsin–Madison, Madison, WI, United States
| | - Leroy Williams
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Educational Psychology, University of Wisconsin–Madison, Madison, WI, United States
| | - Veena Nair
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Kristin Caldera
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
| | - Justin C. Williams
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Neuroscience Training Program, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
- Medical Scientist Training Program, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
- Department of Psychology, University of Wisconsin–Madison, Madison, WI, United States
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14
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Bice AR, Xiao Q, Kong J, Yan P, Rosenthal ZP, Kraft AW, Smith KP, Wieloch T, Lee JM, Culver JP, Bauer AQ. Homotopic contralesional excitation suppresses spontaneous circuit repair and global network reconnections following ischemic stroke. eLife 2022; 11:e68852. [PMID: 35723585 PMCID: PMC9333991 DOI: 10.7554/elife.68852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Understanding circuit-level manipulations that affect the brain's capacity for plasticity will inform the design of targeted interventions that enhance recovery after stroke. Following stroke, increased contralesional activity (e.g. use of the unaffected limb) can negatively influence recovery, but it is unknown which specific neural connections exert this influence, and to what extent increased contralesional activity affects systems- and molecular-level biomarkers of recovery. Here, we combine optogenetic photostimulation with optical intrinsic signal imaging to examine how contralesional excitatory activity affects cortical remodeling after stroke in mice. Following photothrombosis of left primary somatosensory forepaw (S1FP) cortex, mice either recovered spontaneously or received chronic optogenetic excitation of right S1FP over the course of 4 weeks. Contralesional excitation suppressed perilesional S1FP remapping and was associated with abnormal patterns of stimulus-evoked activity in the unaffected limb. This maneuver also prevented the restoration of resting-state functional connectivity (RSFC) within the S1FP network, RSFC in several networks functionally distinct from somatomotor regions, and resulted in persistent limb-use asymmetry. In stimulated mice, perilesional tissue exhibited transcriptional changes in several genes relevant for recovery. Our results suggest that contralesional excitation impedes local and global circuit reconnection through suppression of cortical activity and several neuroplasticity-related genes after stroke, and highlight the importance of site selection for targeted therapeutic interventions after focal ischemia.
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Affiliation(s)
- Annie R Bice
- Department of Radiology, Washington University in St. LouisSaint LouisUnited States
| | - Qingli Xiao
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | - Justin Kong
- Department of Biology, Washington University in St. LouisSaint LouisUnited States
| | - Ping Yan
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | | | - Andrew W Kraft
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | - Karen P Smith
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | | | - Jin-Moo Lee
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | - Joseph P Culver
- Department of Radiology, Washington University in St. LouisSt. LouisUnited States
| | - Adam Q Bauer
- Department of Radiology, Washington University in St. LouisSaint LouisUnited States
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15
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Dresang HC, Harvey DY, Xie SX, Shah-Basak PP, DeLoretta L, Wurzman R, Parchure SY, Sacchetti D, Faseyitan O, Lohoff FW, Hamilton RH. Genetic and Neurophysiological Biomarkers of Neuroplasticity Inform Post-Stroke Language Recovery. Neurorehabil Neural Repair 2022; 36:371-380. [PMID: 35428413 PMCID: PMC9133188 DOI: 10.1177/15459683221096391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is high variability in post-stroke aphasia severity and predicting recovery remains imprecise. Standard prognostics do not include neurophysiological indicators or genetic biomarkers of neuroplasticity, which may be critical sources of variability. OBJECTIVE To evaluate whether a common polymorphism (Val66Met) in the gene for brain-derived neurotrophic factor (BDNF) contributes to variability in post-stroke aphasia, and to assess whether BDNF polymorphism interacts with neurophysiological indicators of neuroplasticity (cortical excitability and stimulation-induced neuroplasticity) to improve estimates of aphasia severity. METHODS Saliva samples and motor-evoked potentials (MEPs) were collected from participants with chronic aphasia subsequent to left-hemisphere stroke. MEPs were collected prior to continuous theta burst stimulation (cTBS; index for cortical excitability) and 10 minutes following cTBS (index for stimulation-induced neuroplasticity) to the right primary motor cortex. Analyses assessed the extent to which BDNF polymorphism interacted with cortical excitability and stimulation-induced neuroplasticity to predict aphasia severity beyond established predictors. RESULTS Val66Val carriers showed less aphasia severity than Val66Met carriers, after controlling for lesion volume and time post-stroke. Furthermore, Val66Val carriers showed expected effects of age on aphasia severity, and positive associations between severity and both cortical excitability and stimulation-induced neuroplasticity. In contrast, Val66Met carriers showed weaker effects of age and negative associations between cortical excitability, stimulation-induced neuroplasticity and aphasia severity. CONCLUSIONS Neurophysiological indicators and genetic biomarkers of neuroplasticity improved aphasia severity predictions. Furthermore, BDNF polymorphism interacted with cortical excitability and stimulation-induced neuroplasticity to improve predictions. These findings provide novel insights into mechanisms of variability in stroke recovery and may improve aphasia prognostics.
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Affiliation(s)
- Haley C. Dresang
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104,Moss Rehabilitation Research Institute, Einstein Medical Center, 50 Township Line Road, Philadelphia, PA 19027,Corresponding author:, Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Denise Y. Harvey
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Sharon Xiangwen Xie
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Perelman School of Medicine, 607 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104
| | - Priyanka P. Shah-Basak
- Medical College of Wisconsin, Department of Neurology, 8701 Watertown Plank Road Milwaukee, WI 53226
| | - Laura DeLoretta
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Rachel Wurzman
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Shreya Y. Parchure
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Daniela Sacchetti
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Olufunsho Faseyitan
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
| | - Falk W. Lohoff
- National Institute for Alcohol Abuse and Alcoholism, National Institutes of Health (NIH), 10 Center Drive (10CRC/2-2352), Bethesda, MD 20892
| | - Roy H. Hamilton
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, 3710 Hamilton Walk, Philadelphia, PA 19104
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16
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Chen Q, Shen W, Sun H, Zhang H, Liu C, Chen Z, Yu L, Cai X, Ke J, Li L, Zhang L, Fang Q. The effect of coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation on shaping early reorganization of the motor network after stroke. Brain Res 2022; 1790:147959. [PMID: 35654120 DOI: 10.1016/j.brainres.2022.147959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
Neural plasticity is a major factor driving cortical reorganization after stroke. This study aimed to evaluate functional connectivity (FC) changes in the cortical motor network after coupled inhibitory-facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment and to assess the correlation between FC changes and functional recovery, further characterizing the neural mechanisms underlying the beneficial effects of rTMS. We randomly divided 63 patients with acute stroke into four groups: (1) Group A received coupled inhibitory-facilitatory rTMS [1 Hz over the contralesional primary motor cortex (M1) and 10 Hz over ipsilesional M1]; (2) Group B received a contralesional sham stimulation and ipsilesional 10 Hz stimulation; (3) Group C received a contralesional 1 Hz rTMS and ipsilesional sham stimulation; and (4) Group D received bilateral sham stimulation only. Standardized rehabilitation therapy was performed immediately after rTMS, and each group was treated with their respective treatment modalities for 4 weeks. Twenty-four hours before and after the intervention, participants underwent resting-state functional magnetic resonance imaging. Additional functional assessments were conducted at baseline, after treatment, and at the 3 month follow-up. The rTMS treatment significantly changed the FCs of intra- and inter-hemispheric cortical motor networks in the rTMS groups (A and B) compared with the sham group (Group D). This effect was more pronounced in Group A, which displayed a changed FC between the contralesional postcentral gyrus and contralesional superior parietal gyrus, between the contralesional precentral gyrus and contralesional postcentral gyrus, and between the ipsilesional postcentral gyrus and contralesional superior parietal gyrus, when compared with Groups B and C. Importantly, FC changes were significantly correlated with improvement of motor function. In the early stages of ischemic stroke, coupled rTMS was more conducive to motor recovery by modulating the FCs of intra-hemispheric and inter-hemispheric motor networks. Our results suggested that FC changes were related to motor function recovery for early-stage cerebral stroke patients treated with coupled rTMS. These findings could help to understand the mechanism of coupled rTMS and further the use of this therapy as an adjunct rehabilitation technique in motor recovery.
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Affiliation(s)
- Qingmei Chen
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China; Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Wenjun Shen
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Haiwei Sun
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Hanjun Zhang
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Chuandao Liu
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Zhiguo Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Liqiang Yu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Xiuying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China
| | - Li Li
- Department of Physical Medicine &Rehabilitation, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China.
| | - Lichi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, 200030, China.
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215000, Jiangsu Province, China.
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17
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You Y, Wang D, Liu J, Chen Y, Ma X, Li W. Physical Exercise in the Context of Air Pollution: An Emerging Research Topic. Front Physiol 2022; 13:784705. [PMID: 35295574 PMCID: PMC8918627 DOI: 10.3389/fphys.2022.784705] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/18/2022] [Indexed: 12/12/2022] Open
Abstract
Physical exercise (PE) brings physiological benefits to human health; paradoxically, exposure to air pollution (AP) is harmful. Hence, the combined effects of AP and PE are interesting issues worth exploring. The objective of this study is to review literature involved in AP-PE fields to perform a knowledge-map analysis and explore the collaborations, current hotspots, physiological applications, and future perspectives. Herein, cluster, co-citation, and co-occurrence analysis were applied using CiteSpace and VOSviewer software. The results demonstrated that AP-PE domains have been springing up and in rapid growth since the 21st century. Subsequently, active countries and institutions were identified, and the productive institutions were mainly located in USA, China, UK, Spain, and Canada. Developed countries seemed to be the major promoters. Additionally, subject analysis found that environmental science, public health, and sports medicine were the core subjects, and multidimensional communications were forming. Thereafter, a holistic presentation of reference co-citation clusters was conducted to discover the research topics and trace the development focuses. Youth, elite athletes, and rural population were regarded as the noteworthy subjects. Commuter exposure and moderate aerobic exercise represented the common research context and exercise strategy, respectively. Simultaneously, the research hotspots and application fields were elaborated by keyword co-occurrence distribution. It was noted that physiological adaptations including respiratory, cardiovascular, metabolic, and mental health were the major themes; oxidative stress and inflammatory response were the mostly referred mechanisms. Finally, several challenges were proposed, which are beneficial to promote the development of the research field. Molecular mechanisms and specific pathways are still unknown and the equilibrium points and dose-effect relationships remain to be further explored. We are highly confident that this study provides a unique perspective to systematically and comprehensively review the pieces of AP-PE research and its related physiological mechanisms for future investigations.
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Affiliation(s)
- Yanwei You
- Division of Sports Science and Physical Education, Tsinghua University, Beijing, China
| | - Dizhi Wang
- Division of Sports Science and Physical Education, Tsinghua University, Beijing, China
| | - Jianxiu Liu
- Division of Sports Science and Physical Education, Tsinghua University, Beijing, China
| | - Yuquan Chen
- Institute of Medical Information/Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xindong Ma
- Division of Sports Science and Physical Education, Tsinghua University, Beijing, China
- *Correspondence: Xindong Ma
| | - Wenkai Li
- China Table Tennis College, Shanghai University of Sport, Shanghai, China
- Wenkai Li
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18
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Liew SL, Lin DJ, Cramer SC. Interventions to Improve Recovery After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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19
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Zheng Z, Chen J, Chopp M. Mechanisms of Plasticity Remodeling and Recovery. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00011-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Gupta SS, Manthalkar RR, Gajre SS. Mindfulness intervention for improving cognitive abilities using EEG signal. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.103072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Hybbinette H, Schalling E, Plantin J, Nygren-Deboussard C, Schütz M, Östberg P, Lindberg PG. Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke. Front Neurol 2021; 12:634065. [PMID: 33868144 PMCID: PMC8044583 DOI: 10.3389/fneur.2021.634065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/03/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS. Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months. Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery. Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.
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Affiliation(s)
- Helena Hybbinette
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Ellika Schalling
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Jeanette Plantin
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Catharina Nygren-Deboussard
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Marika Schütz
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Per Östberg
- Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Unit Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | - Påvel G. Lindberg
- Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden
- Institut de Psychiatrie et Neurosciences Paris, Inserm U1266, Université de Paris, Paris, France
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22
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Cramer SC, Dodakian L, Le V, McKenzie A, See J, Augsburger R, Zhou RJ, Raefsky SM, Nguyen T, Vanderschelden B, Wong G, Bandak D, Nazarzai L, Dhand A, Scacchi W, Heckhausen J. A Feasibility Study of Expanded Home-Based Telerehabilitation After Stroke. Front Neurol 2021; 11:611453. [PMID: 33613417 PMCID: PMC7888185 DOI: 10.3389/fneur.2020.611453] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/04/2020] [Indexed: 01/17/2023] Open
Abstract
Introduction: High doses of activity-based rehabilitation therapy improve outcomes after stroke, but many patients do not receive this for various reasons such as poor access, transportation difficulties, and low compliance. Home-based telerehabilitation (TR) can address these issues. The current study evaluated the feasibility of an expanded TR program. Methods: Under the supervision of a licensed therapist, adults with stroke and limb weakness received home-based TR (1 h/day, 6 days/week) delivered using games and exercises. New features examined include extending therapy to 12 weeks duration, treating both arm and leg motor deficits, patient assessments performed with no therapist supervision, adding sensors to real objects, ingesting a daily experimental (placebo) pill, and generating automated actionable reports. Results: Enrollees (n = 13) were median age 61 (IQR 52-65.5), and 129 (52-486) days post-stroke. Patients initiated therapy on 79.9% of assigned days and completed therapy on 65.7% of days; median therapy dose was 50.4 (33.3-56.7) h. Non-compliance doubled during weeks 7-12. Modified Rankin scores improved in 6/13 patients, 3 of whom were >3 months post-stroke. Fugl-Meyer motor scores increased by 6 (2.5-12.5) points in the arm and 1 (-0.5 to 5) point in the leg. Assessments spanning numerous dimensions of stroke outcomes were successfully implemented; some, including a weekly measure that documented a decline in fatigue (p = 0.004), were successfully scored without therapist supervision. Using data from an attached sensor, real objects could be used to drive game play. The experimental pill was taken on 90.9% of therapy days. Automatic actionable reports reliably notified study personnel when critical values were reached. Conclusions: Several new features performed well, and useful insights were obtained for those that did not. A home-based telehealth system supports a holistic approach to rehabilitation care, including intensive rehabilitation therapy, secondary stroke prevention, screening for complications of stroke, and daily ingestion of a pill. This feasibility study informs future efforts to expand stroke TR. Clinical Trial Registration: Clinicaltrials.gov, # NCT03460587.
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Affiliation(s)
- Steven C. Cramer
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
- California Rehabilitation Institute, Los Angeles, CA, United States
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Lucy Dodakian
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Vu Le
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Alison McKenzie
- Department of Physical Therapy, Chapman University, Orange, CA, United States
| | - Jill See
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Renee Augsburger
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Robert J. Zhou
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Sophia M. Raefsky
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Thalia Nguyen
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | | | - Gene Wong
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Daniel Bandak
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Laila Nazarzai
- Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Amar Dhand
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, United States
| | - Walt Scacchi
- Institute for Software Research, University of California, Irvine, Irvine, CA, United States
| | - Jutta Heckhausen
- Department of Psychological Science, University of California, Irvine, Irvine, CA, United States
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23
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Ashaie SA, Hung J, Funkhouser CJ, Shankman SA, Cherney LR. Depression over Time in Persons with Stroke: A Network Analysis Approach. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 4:10.1016/j.jadr.2021.100131. [PMID: 34528021 PMCID: PMC8438599 DOI: 10.1016/j.jadr.2021.100131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Network analysis has been used to elucidate the relationships among depressive symptoms, but this approach has not been typically used in persons with stroke. METHOD Using a sample of 835 persons with stroke from Stroke Recovery in Underserved Populations 2005-2006 dataset, this study used network analysis to (1) examine changes in relationships between depressive symptoms over time, and (2) test whether baseline network characteristics were prognostic for depression persistence. Network analysis was performed on depressive symptoms collected at discharge from inpatient rehabilitation and at 3-months and 12-months post-discharge. RESULTS The depressive symptom network at discharge was less connected than at both post-discharge follow-ups. Trouble focusing and feeling good as others were the most predictable symptoms at post-discharge, even though they were less connected to other depressive symptoms. Among participants with elevated baseline depression severity, those whose depression persisted 12 months later had more strongly connected networks at discharge than those who recovered 12 months later. LIMITATIONS This study was unable to determine the directionality of edges. The depression scale was administered differently across time points. CONCLUSION These results suggest that baseline network connectivity can predict the course of post-stroke depression, similar to non-stroke populations. More broadly, the study highlights the importance of examining relationships between individual depressive symptoms rather than only sum-scores.
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Affiliation(s)
- Sameer A Ashaie
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
| | - Jinyi Hung
- Department of Audiology and Speech Language Pathology, Mackay Medical College, Taipei, Taiwan
| | - Carter J. Funkhouser
- Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
- Department of Psychology, University of Illinois at Chicago
| | - Stewart A. Shankman
- Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University
| | - Leora R Cherney
- Center for Aphasia Research and Treatment, Shirley Ryan AbilityLab
- Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
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“Hyperacute” Stroke Rehabilitation Care: Common Issues and Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Cheng N, Phua KS, Lai HS, Tam PK, Tang KY, Cheng KK, Yeow RCH, Ang KK, Guan C, Lim JH. Brain-Computer Interface-Based Soft Robotic Glove Rehabilitation for Stroke. IEEE Trans Biomed Eng 2020; 67:3339-3351. [DOI: 10.1109/tbme.2020.2984003] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhao C, Zhao S, Guan M, Cheng X, Wang H, Liu C, Zhong S, Zhou Z, Liang Y. Forced forelimb use following stroke enhances oligodendrogenesis and functional recovery in the rat. Brain Res 2020; 1746:147016. [PMID: 32679116 DOI: 10.1016/j.brainres.2020.147016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/23/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Abstract
Forced limb use, which forces the use of the impaired arm following stroke, improves functional recovery. The study was designed to investigate the mechanisms of recovery underlying forced impaired limbuse. Furthermore, forced unimpaired arm use was also performed in order to explore its effect on functional behavior. We hypothesized that forced forelimb use could improve functional recovery in rats that have had an experimentally induced ischemic stroke, through promoting the recruitment and differentiation of the oligodendrocyte progenitor cells (OPCs). Indeed the proliferation of Olig2 and NG2 positive cells, as well as the expression of myelin basic protein (MBP)were increased in the perilesional striatum, whereas quantitative changes of Olig2+ and NG2+ oligodendrocyte progenitor cells was not observed in the subventricular zone. Through comparing rats forced to rely on affected or unaffected forelimb, the results demonstrated that forced impaired limb use boosted functional recovery. At the same time forced unimpaired limb use deteriorated limb movement of injured side. In addition, the expression of NogoA is reduced, when the injured limb was used more, suggesting that it played a role in the repair of white matter.
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Affiliation(s)
- Chuansheng Zhao
- The First Hospital of China Medical University, Shenyang, China.
| | - Shanshan Zhao
- The First Hospital of China Medical University, Shenyang, China.
| | - Meiting Guan
- The First Hospital of China Medical University, Shenyang, China.
| | - Xi Cheng
- The First Hospital of China Medical University, Shenyang, China.
| | - Huibin Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Chang Liu
- The First Hospital of China Medical University, Shenyang, China.
| | - Shanshan Zhong
- The First Hospital of China Medical University, Shenyang, China.
| | - Zhike Zhou
- The First Hospital of China Medical University, Shenyang, China.
| | - Yifan Liang
- The First Hospital of China Medical University, Shenyang, China.
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Characterizing upper extremity motor behavior in the first week after stroke. PLoS One 2020; 15:e0221668. [PMID: 32776927 PMCID: PMC7416933 DOI: 10.1371/journal.pone.0221668] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 06/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background Animal models of brain recovery identify the first days after lesioning as a time of great flux in sensorimotor function and physiology. After rodent motor system lesioning, daily skill training in the less affected forelimb reduces skill acquisition in the more affected forelimb. We asked whether spontaneous human motor behaviors of the less affected upper extremity (UE) early after stroke resemble the animal training model, with the potential to suppress clinical recovery. Methods This prospective observational study used a convenience sample of patients (n = 25, mean 4.5 ±1.8) days after stroke with a wide severity range; Controls were hospitalized for non-neurological conditions (n = 12). Outcome measures were Accelerometry, Upper-Extremity Fugl-Meyer (UEFM), Action Research Arm Test (ARAT), Shoulder Abduction/ Finger Extension Test (SAFE), NIH Stroke Scale (NIHSS). Results Accelerometry indicated total paretic UE movement was reduced compared to controls, primarily due to a 44% reduction of bilateral UE use. Unilateral paretic movement was unchanged. Thus, movement shifted early after stroke; bilateral use was reduced and unilateral use of the non-paretic UE was increased by 77%. Low correlations between movement time and motor performance prompted an exploratory factor analysis (EFA) revealing a 2-component solution; motor performance tests load on one component (motor performance) whereas accelerometry-derived variables load on a second orthogonal component (quantity of movement). Conclusions Early after stroke, spontaneous overall UE movement is reduced, and movement shifts to unilateral use of the non-paretic UE. Two mechanisms that could influence motor recovery may already be in place 4.5 ± 1.8 days post stroke: (1) the overuse of the less affected UE, which could set the stage for learned non-use and (2) skill acquisition in the non-paretic limb that could impede recovery. Accurate UE motor assessment requires two independent constructs: motor performance and quantity of movement. These findings provide opportunities and measurement methods for studies to develop new behaviorally-based stroke recovery treatments that begin early after onset.
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Lange Canhos L, Chen M, Falk S, Popper B, Straub T, Götz M, Sirko S. Repetitive injury and absence of monocytes promote astrocyte self-renewal and neurological recovery. Glia 2020; 69:165-181. [PMID: 32744730 DOI: 10.1002/glia.23893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/24/2022]
Abstract
Unlike microglia and NG2 glia, astrocytes are incapable of migrating to sites of injury in the posttraumatic cerebral cortex, instead relying on proliferation to replenish their numbers and distribution in the affected region. However, neither the spectrum of their proliferative repertoire nor their postinjury distribution has been examined in vivo. Using a combination of different thymidine analogs and clonal analysis in a model of repetitive traumatic brain injury, we show for the first time that astrocytes that are quiescent following an initial injury can be coerced to proliferate after a repeated insult in the cerebral cortex grey matter. Interestingly, this process is promoted by invasion of monocytes to the injury site, as their genetic ablation (using CCR2-/- mice) increased the number of repetitively dividing astrocytes at the expense of newly proliferating astrocytes in repeatedly injured parenchyma. These differences profoundly affected both the distribution of astrocytes and recovery period for posttraumatic behavior deficits suggesting key roles of astrocyte self-renewal in brain repair after injury.
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Affiliation(s)
- Luisa Lange Canhos
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Stem Cell Research, Helmholtz Zentrum Munich, Neuherberg, Germany.,Graduate School of Systemic Neurosciences (GSN-LMU), Ludwig-Maximilians-University Munich, Munich, Germany
| | - Muxin Chen
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Sven Falk
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Stem Cell Research, Helmholtz Zentrum Munich, Neuherberg, Germany
| | - Bastian Popper
- Core Facility Animal Models, Biomedical Center, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Tobias Straub
- Core Facility Bioinformatics, Biomedical Center, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Magdalena Götz
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Stem Cell Research, Helmholtz Zentrum Munich, Neuherberg, Germany.,Excellence Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Swetlana Sirko
- Physiological Genomics, Biomedical Center, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Stem Cell Research, Helmholtz Zentrum Munich, Neuherberg, Germany
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Stockert A, Wawrzyniak M, Klingbeil J, Wrede K, Kümmerer D, Hartwigsen G, Kaller CP, Weiller C, Saur D. Dynamics of language reorganization after left temporo-parietal and frontal stroke. Brain 2020; 143:844-861. [PMID: 32068789 DOI: 10.1093/brain/awaa023] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/25/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
The loss and recovery of language functions are still incompletely understood. This longitudinal functional MRI study investigated the neural mechanisms underlying language recovery in patients with post-stroke aphasia putting particular emphasis on the impact of lesion site. To identify patterns of language-related activation, an auditory functional MRI sentence comprehension paradigm was administered to patients with circumscribed lesions of either left frontal (n = 17) or temporo-parietal (n = 17) cortex. Patients were examined repeatedly during the acute (≤1 week, t1), subacute (1-2 weeks, t2) and chronic phase (>6 months, t3) post-stroke; healthy age-matched control subjects (n = 17) were tested once. The separation into two patient groups with circumscribed lesions allowed for a direct comparison of the contributions of distinct lesion-dependent network components to language reorganization between both groups. We hypothesized that activation of left hemisphere spared and perilesional cortex as well as lesion-homologue cortex in the right hemisphere varies between patient groups and across time. In addition, we expected that domain-general networks serving cognitive control independently contribute to language recovery. First, we found a global network disturbance in the acute phase that is characterized by reduced functional MRI language activation including areas distant to the lesion (i.e. diaschisis) and subsequent subacute network reactivation (i.e. resolution of diaschisis). These phenomena were driven by temporo-parietal lesions. Second, we identified a lesion-independent sequential activation pattern with increased activity of perilesional cortex and bilateral domain-general networks in the subacute phase followed by reorganization of left temporal language areas in the chronic phase. Third, we observed involvement of lesion-homologue cortex only in patients with frontal but not temporo-parietal lesions. Fourth, irrespective of lesion location, language reorganization predominantly occurred in pre-existing networks showing comparable activation in healthy controls. Finally, we detected different relationships of performance and activation in language and domain-general networks demonstrating the functional relevance for language recovery. Our findings highlight that the dynamics of language reorganization clearly depend on lesion location and hence open new perspectives for neurobiologically motivated strategies of language rehabilitation, such as individually-tailored targeted application of neuro-stimulation.
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Affiliation(s)
- Anika Stockert
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Max Wawrzyniak
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Julian Klingbeil
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Katrin Wrede
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Dorothee Kümmerer
- Department of Neurology, University of Freiburg, 79106 Freiburg, Germany
| | - Gesa Hartwigsen
- Lise Meitner Research Group, Cognition and Plasticity, Max Planck Institute of Human and Cognitive Brain Sciences, 04103 Leipzig, Germany
| | - Christoph P Kaller
- Department of Neurology, University of Freiburg, 79106 Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology, University of Freiburg, 79106 Freiburg, Germany
| | - Dorothee Saur
- Language and Aphasia Laboratory, Department of Neurology, University of Leipzig Medical Center, 04103 Leipzig, Germany
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Min YS, Park JW, Park E, Kim AR, Cha H, Gwak DW, Jung SH, Chang Y, Jung TD. Interhemispheric Functional Connectivity in the Primary Motor Cortex Assessed by Resting-State Functional Magnetic Resonance Imaging Aids Long-Term Recovery Prediction among Subacute Stroke Patients with Severe Hand Weakness. J Clin Med 2020; 9:jcm9040975. [PMID: 32244596 PMCID: PMC7230262 DOI: 10.3390/jcm9040975] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 12/31/2022] Open
Abstract
This study aimed to evaluate the usefulness of interhemispheric functional connectivity (FC) as a predictor of motor recovery in severe hand impairment and to determine the cutoff FC level as a clinically useful parameter. Patients with stroke (n = 22; age, 59.9 ± 13.7 years) who presented with unilateral severe upper-limb paresis and were confirmed to elicit no motor-evoked potential responses were selected. FC was measured using resting-state functional magnetic resonance imaging (rsfMRI) scans at 1 month from stroke onset. The good recovery group showed a higher FC value than the poor recovery group (p = 0.034). In contrast, there was no statistical difference in FC value between the good recovery and healthy control groups (p = 0.182). Additionally, the healthy control group showed a higher FC value than that shown by the poor recovery group (p = 0.0002). Good and poor recovery were determined based on Brunnstrom stage of upper-limb function at 6 months as the standard, and receiver operating characteristic curve indicated that a cutoff score of 0.013 had the greatest prognostic ability. In conclusion, interhemispheric FC measurement using rsfMRI scans may provide useful clinical information for predicting hand motor recovery during stroke rehabilitation.
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Affiliation(s)
- Yu-Sun Min
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (Y.-S.M.); (E.P.); (A.-R.K.)
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (D.-W.G.); (S.-H.J.)
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jang Woo Park
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu 41944, Korea; (J.W.P.); (H.C.)
| | - Eunhee Park
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (Y.-S.M.); (E.P.); (A.-R.K.)
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (D.-W.G.); (S.-H.J.)
| | - Ae-Ryoung Kim
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (Y.-S.M.); (E.P.); (A.-R.K.)
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (D.-W.G.); (S.-H.J.)
| | - Hyunsil Cha
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu 41944, Korea; (J.W.P.); (H.C.)
| | - Dae-Won Gwak
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (D.-W.G.); (S.-H.J.)
| | - Seung-Hwan Jung
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (D.-W.G.); (S.-H.J.)
| | - Yongmin Chang
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu 41944, Korea; (J.W.P.); (H.C.)
- Department of Radiology, Kyungpook National University Hospital, Daegu 41944, Korea
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea
- Correspondence: (Y.C.); (T.-D.J.); Tel.: +82-53-420-5471 (Y.C.); +82-53-200-2167 (T.-D.J.)
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Korea; (Y.-S.M.); (E.P.); (A.-R.K.)
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea; (D.-W.G.); (S.-H.J.)
- Correspondence: (Y.C.); (T.-D.J.); Tel.: +82-53-420-5471 (Y.C.); +82-53-200-2167 (T.-D.J.)
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Gamifying Motor Rehabilitation Therapies: Challenges and Opportunities of Immersive Technologies. INFORMATION 2020. [DOI: 10.3390/info11020088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Recovering from a traumatic incident (e.g, a stroke) implies rigorous and demanding therapies to ensure recovery of the lost capabilities. Due to the lack of short-term visible results, stroke patients tend to lose interest in their recovery process and frequently do not follow their therapists’ suggestions to continue performing their training at home, between physiotherapy sessions. This article explores the extent to which common computer games or specifically crafted games can serve as a rehabilitation practice, but also how conventional therapeutic devices might be transformed to be incorporated into games. Furthermore, we propose a platform that follows the opportunity of creating serious games that are designed for stroke patients with reduced upper limb mobility while following the same principles of common therapeutic procedures. This platform was carefully built with the purpose of allowing patients to comply tele-rehabilitation and promoting the execution of the recommended training at home. Following these ideas, we integrated two carefully designed games that have been tested and validated in our previous works, and we added a top-layer characterized by an online back-end application for therapists that allows them to observe their patients’ progress over time and draw different conclusions.
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Wright CJ, Colley J, Knudsen K, Kendall E. Housing for People with an Acquired Brain or Spinal Injury: Mapping the Australian Funding Landscape. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162822. [PMID: 31394883 PMCID: PMC6721709 DOI: 10.3390/ijerph16162822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 12/11/2022]
Abstract
This research aimed to synthesize housing supports funded by 20 major insurance-based schemes for Australians with an acquired brain injury (ABI) or spinal cord injury (SCI). Publicly available grey literature (i.e., primary information from respective scheme websites) was systematically reviewed and compared. There were notable differences between the different scheme types (disability vs. workers compensation schemes) and across different States. Collectively, scheme funding was more likely to be focused on housing infrastructure and service delivery, than on tenancy support. Australians who are least likely to benefit from the current funding context are those whose home cannot be reasonably modified, are wanting to build or purchase a new home, do not have suitable, alternative short- or long-term housing options if their current home is not feasible, require support to maintain occupancy of their home or financial assistance to move into a new home, may benefit from case management services, family supports, and assistance animals, and/or cannot afford their rent or home loan repayments. Several interactions, inconsistencies, contradictions, and gaps that warrant further attention were also revealed. This review has highlighted the need for policy makers to provide transparent information about housing entitlements for individuals with ABI or SCI, and their families. A unified, evidence-based framework to guide the funding of housing and housing support services may increase the consistency of interventions available to people with ABI or SCI and, therefore, improve outcomes.
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Affiliation(s)
- Courtney J Wright
- The Hopkins Centre, Griffith University, Meadowbrook, Queensland 4131, Australia.
| | - Jacinta Colley
- The Hopkins Centre, Griffith University, Meadowbrook, Queensland 4131, Australia
| | - Kate Knudsen
- The Hopkins Centre, Griffith University, Meadowbrook, Queensland 4131, Australia
| | - Elizabeth Kendall
- The Hopkins Centre, Griffith University, Meadowbrook, Queensland 4131, Australia
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Beaulieu LD, Blanchette AK, Mercier C, Bernard-Larocque V, Milot MH. Efficacy, safety, and tolerability of bilateral transcranial direct current stimulation combined to a resistance training program in chronic stroke survivors: A double-blind, randomized, placebo-controlled pilot study. Restor Neurol Neurosci 2019; 37:333-346. [DOI: 10.3233/rnn-190908] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Louis-David Beaulieu
- Laboratoire de recherche BioNR, Unité d’enseignement en physiothérapie, Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, QC, Canada
| | - Andréanne K. Blanchette
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Département de Réadaptation, Faculté de médecine, Université Laval, Quebec city, QC, Canada
| | - Catherine Mercier
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Département de Réadaptation, Faculté de médecine, Université Laval, Quebec city, QC, Canada
| | - Vincent Bernard-Larocque
- Centre de recherche sur le vieillissement, École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Hélène Milot
- Centre de recherche sur le vieillissement, École de réadaptation, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
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Zhang T, Wu C, Yang X, Liu Y, Yang H, Yuan L, Liu Y, Sun S, Yang J. Pseudoginsenoside-F11 Protects against Transient Cerebral Ischemia Injury in Rats Involving Repressing Calcium Overload. Neuroscience 2019; 411:86-104. [DOI: 10.1016/j.neuroscience.2019.05.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/06/2019] [Accepted: 05/15/2019] [Indexed: 01/04/2023]
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Carey L, Walsh A, Adikari A, Goodin P, Alahakoon D, De Silva D, Ong KL, Nilsson M, Boyd L. Finding the Intersection of Neuroplasticity, Stroke Recovery, and Learning: Scope and Contributions to Stroke Rehabilitation. Neural Plast 2019; 2019:5232374. [PMID: 31191637 PMCID: PMC6525913 DOI: 10.1155/2019/5232374] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/04/2019] [Accepted: 03/24/2019] [Indexed: 11/17/2022] Open
Abstract
Aim Neural plastic changes are experience and learning dependent, yet exploiting this knowledge to enhance clinical outcomes after stroke is in its infancy. Our aim was to search the available evidence for the core concepts of neuroplasticity, stroke recovery, and learning; identify links between these concepts; and identify and review the themes that best characterise the intersection of these three concepts. Methods We developed a novel approach to identify the common research topics among the three areas: neuroplasticity, stroke recovery, and learning. A concept map was created a priori, and separate searches were conducted for each concept. The methodology involved three main phases: data collection and filtering, development of a clinical vocabulary, and the development of an automatic clinical text processing engine to aid the process and identify the unique and common topics. The common themes from the intersection of the three concepts were identified. These were then reviewed, with particular reference to the top 30 articles identified as intersecting these concepts. Results The search of the three concepts separately yielded 405,636 publications. Publications were filtered to include only human studies, generating 263,751 publications related to the concepts of neuroplasticity (n = 6,498), stroke recovery (n = 79,060), and learning (n = 178,193). A cluster concept map (network graph) was generated from the results; indicating the concept nodes, strength of link between nodes, and the intersection between all three concepts. We identified 23 common themes (topics) and the top 30 articles that best represent the intersecting themes. A time-linked pattern emerged. Discussion and Conclusions Our novel approach developed for this review allowed the identification of the common themes/topics that intersect the concepts of neuroplasticity, stroke recovery, and learning. These may be synthesised to advance a neuroscience-informed approach to stroke rehabilitation. We also identified gaps in available literature using this approach. These may help guide future targeted research.
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Affiliation(s)
- Leeanne Carey
- Occupational Therapy, School of Allied Health, Human Sciences and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC 3084, Australia
| | - Alistair Walsh
- Occupational Therapy, School of Allied Health, Human Sciences and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC 3084, Australia
| | - Achini Adikari
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Peter Goodin
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC 3084, Australia
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Damminda Alahakoon
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Daswin De Silva
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Kok-Leong Ong
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Michael Nilsson
- Occupational Therapy, School of Allied Health, Human Sciences and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia
- Faculty of Health and Medicine and Centre for Rehab Innovations, The University of Newcastle, Callaghan NSW 2308, Australia
- LKC School of Medicine, Nanyang Technological University (NTU), 308232, Singapore
| | - Lara Boyd
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 1Z3
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ALK5 signaling pathway mediates neurogenesis and functional recovery after cerebral ischemia/reperfusion in rats via Gadd45b. Cell Death Dis 2019; 10:360. [PMID: 31043581 PMCID: PMC6494915 DOI: 10.1038/s41419-019-1596-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/26/2019] [Accepted: 04/15/2019] [Indexed: 12/11/2022]
Abstract
Transforming growth factor β (TGF-β) serves critical functions in brain injury, especially in cerebral ischemia; however, apart from its neuroprotective effects, its role in regulating neurogenesis is unclear. TGF-β acts in different ways; the most important, canonical TGF-β activity involves TGF-β receptor I (TβRI) or the activin receptor-like kinase 5 (ALK5) signaling pathway. ALK5 signaling is a major determinant of adult neurogenesis. In our previous studies, growth arrest and DNA damage protein 45b (Gadd45b) mediated axonal plasticity after stroke. Here, we hypothesized that ALK5 signaling regulates neural plasticity and neurological function recovery after cerebral ischemia/reperfusion (I/R) via Gadd45b. First, ALK5 expression was significantly increased in middle cerebral artery occlusion/reperfusion (MCAO/R) rats. Then, we knocked down or overexpressed ALK5 with lentivirus (LV) in vivo. ALK5 knockdown reduced axonal and dendritic plasticity, with a concomitant decrease in neurological function recovery. Conversely, ALK5 overexpression significantly increased neurogenesis as well as functional recovery. Furthermore, ALK5 mediated Gadd45b protein levels by regulating Smad2/3 phosphorylation. Finally, ALK5 coimmunoprecipitated with Gadd45b. Our results suggested that the ALK5 signaling pathway plays a critical role in mediating neural plasticity and neurological function recovery via Gadd45b after cerebral ischemia, representing a new potential target for cerebral I/R injury.
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Abstract
PURPOSE/BACKGROUND Loss of gray matter after stroke has been associated with cognitive impairment. This pilot study aimed to investigate the therapeutic potential of lithium, a putative neurotrophic agent, in the stroke recovery process within a year of stroke occurrence. METHODS Twelve stroke patients (mean ± SD age, 71.1 ± 11.9 years) were recruited to the study, and eligible participants were prescribed open-label lithium for 60 days. Magnetic resonance imaging was used to assess global gray matter at baseline and end of treatment; global cognition was assessed using the standardized Mini-Mental State Examination and Montreal Cognitive Assessment, and verbal memory was evaluated using the Hopkins Verbal Learning Test-Revised. FINDINGS/RESULTS There was no difference in global gray matter volume between baseline and follow-up (t = 1.977, P = 0.074). There was a significant interaction between higher lithium dose and increased global gray matter volume (F = 14.25, P = 0.004) and a correlation between higher lithium dose and improved verbal memory (r = 0.576, P = 0.05). IMPLICATIONS/CONCLUSIONS Lithium pharmacotherapy may be associated with gray matter volume change and verbal memory improvement in stroke patients, providing a rationale for future trials assessing therapeutic potential of lithium in a poststroke population.
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Du J, Yang F, Hu J, Hu J, Xu Q, Cong N, Zhang Q, Liu L, Mantini D, Zhang Z, Lu G, Liu X. Effects of high- and low-frequency repetitive transcranial magnetic stimulation on motor recovery in early stroke patients: Evidence from a randomized controlled trial with clinical, neurophysiological and functional imaging assessments. NEUROIMAGE-CLINICAL 2018; 21:101620. [PMID: 30527907 PMCID: PMC6411653 DOI: 10.1016/j.nicl.2018.101620] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/11/2018] [Accepted: 12/01/2018] [Indexed: 01/23/2023]
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) can modulate cortical excitability, and may be beneficial for motor recovery after stroke. However, the neuroplasticity effects of rTMS have not been thoroughly investigated in the early stage after stroke. Objective To comprehensively assess the effects of high- and low-frequency repetitive transcranial magnetic stimulations on motor recovery in early stroke patients, using a randomized controlled trial based on clinical, neurophysiological and functional imaging assessments. Methods Sixty hospitalized, first-ever ischemic stroke patients (within 2 weeks after stroke) with motor deficits were randomly allocated to receive, in addition to standard physical therapy, five consecutive sessions of either: (1) High-frequency (HF) rTMS at 10 Hz over the ipsilesional primary motor cortex (M1); (2) Low-frequency (LF) rTMS at 1 Hz over the contralesional M1; (3) sham rTMS. The primary outcome measure was a motor impairment score (Upper Extremity Fugl-Meyer) evaluated at baseline, after rTMS intervention, and at 3-month follow-up. Cortical excitability and functional magnetic resonance imaging (fMRI) data were obtained within 24 h before and after rTMS intervention. Analyses of variance were conducted to compare the recovery effects among the three rTMS groups, assessed using clinical, neurophysiological and fMRI tests. Results Motor improvement was significantly larger in the two rTMS groups than in the control group. The HF-rTMS group showed significantly increased cortical excitability and motor-evoked fMRI activation in ipsilesional motor areas, whereas the LF-rTMS group had significantly decreased cortical excitability and motor-evoked fMRI activation in contralesional motor areas. Activity in ipsilesional motor cortex significantly correlated with motor function, after intervention as well as at 3-month follow-up. Conclusion HF- and LF-rTMS can both improve motor function by modulating motor cortical activation in the early phase of stroke. rTMS is an effective neurorehabilitative strategy for enhancing motor recovery in the early stage after stroke. Effects of high- versus low-frequency rTMS on motor regions reflect different neuroplastic mechanisms supporting motor recovery. Functional reorganization of the ipsilesional M1 after stroke plays a critical role in long-term motor recovery.
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Affiliation(s)
- Juan Du
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Fang Yang
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jianping Hu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jingze Hu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qiang Xu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Nathan Cong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qirui Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ling Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Dante Mantini
- Research Center for Motor Control and Neuroplasticity, KU Leuven, Tervuursevest 101, 3001 Leuven, Belgium; Department of Neurorehabilitation, IRCCS San Camillo Hospital Foundation, Via Alberoni, 70, 30126 Venice Lido, Italy
| | - Zhiqiang Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210002, China.
| | - Guangming Lu
- Department of Medical Imaging, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China; State Key Laboratory of Analytical Chemistry for Life Science, Nanjing University, Nanjing 210002, China.
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
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Guerra ZF, Bellose LC, Coelho de Morais Faria CD, Lucchetti G. The effects of mental practice based on motor imagery for mobility recovery after subacute stroke: Protocol for a randomized controlled trial. Complement Ther Clin Pract 2018; 33:36-42. [PMID: 30396624 DOI: 10.1016/j.ctcp.2018.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/25/2018] [Accepted: 08/05/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Mental practice of motor imagery has shown beneficial effects in stroke recovery. However, there are few clinical trials investigating it on the subacute phase. This study will investigate the effects of mental practice in the mobility of patients with subacute stroke. MATERIALS AND METHODS Randomized controlled trial including persons with subacute stroke (<3 months). All participants will receive physical exercises and will be randomly allocated into an experimental group (Mental Practice) or into a control group (cognitive training) for 4 weeks(12 sessions). RESULTS Primary outcomes will be assessed at baseline and after intervention and will be related to mobility, using Timed Up and Go test and 5 m walking speed test. Whereas secondary outcomes will be muscular strength, biomechanical strategies, mental health and quality of life. CONCLUSION The beneficial effects that may be found in this trial can be greatly relevant in clinical practice, justifying this scientific question.
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Affiliation(s)
- Zaqueline Fernandes Guerra
- Post Graduation Health Program, Federal University of Juiz de Fora, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA) and UNIVERSO - Universidade Salgado de Oliveira, Brazil
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Aberrances of Cortex Excitability and Connectivity Underlying Motor Deficit in Acute Stroke. Neural Plast 2018; 2018:1318093. [PMID: 30420876 PMCID: PMC6215555 DOI: 10.1155/2018/1318093] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 06/19/2018] [Indexed: 12/23/2022] Open
Abstract
Purpose This study was aimed at evaluating the motor cortical excitability and connectivity underlying the neural mechanism of motor deficit in acute stroke by the combination of functional magnetic resonance imaging (fMRI) and electrophysiological measures. Methods Twenty-five patients with motor deficit after acute ischemic stroke were involved. General linear model and dynamic causal model analyses were applied to fMRI data for detecting motor-related activation and effective connectivity of the motor cortices. Motor cortical excitability was determined as a resting motor threshold (RMT) of motor evoked potential detected by transcranial magnetic stimulation (TMS). fMRI results were correlated with cortical excitability and upper extremity Fugl-Meyer assessment scores, respectively. Results Greater fMRI activation likelihood and motor cortical excitability in the ipsilesional primary motor area (M1) region were associated with better motor performance. During hand movements, the inhibitory connectivity from the contralesional to the ipsilesional M1 was correlated with the degree of motor impairment. Furthermore, ipsilesional motor cortex excitability was correlated with an enhancement of promoting connectivity in ipsilesional M1 or a reduction of interhemispheric inhibition in contralesional M1. Conclusions The study suggested that a dysfunction of the ipsilesional M1 and abnormal interhemispheric interactions might underlie the motor disability in acute ischemic stroke. Modifying the excitability of the motor cortex and correcting the abnormal motor network connectivity associated with the motor deficit might be the therapeutic target in early neurorehabilitation for stroke patients.
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Brunner C, Korostelev M, Raja S, Montaldo G, Urban A, Baron JC. Evidence from functional ultrasound imaging of enhanced contralesional microvascular response to somatosensory stimulation in acute middle cerebral artery occlusion/reperfusion in rats: A marker of ultra-early network reorganization? J Cereb Blood Flow Metab 2018; 38:1690-1700. [PMID: 29972329 PMCID: PMC6168914 DOI: 10.1177/0271678x18786359] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Following middle cerebral artery (MCA) stroke, enhanced contralesional evoked responses have been consistently reported both in man and rodents as part of plastic processes thought to influence motor recovery. How early this marker of large-scale network reorganization develops has however been little addressed, yet has clinical relevance for rehabilitation strategies targeting plasticity. Previous work in mice has reported enhanced contralesional responses to unaffected-side forepaw stimulation as early as 45 min after MCA small branch occlusion. Using functional ultrasound imaging (fUSi) in anesthetized rats subjected to distal temporary MCA occlusion (MCAo), we assessed here (i) whether enhanced contralesional responses also occurred with unaffected-side whisker pad stimulation, and if so, how early after MCAo; and (ii) the time course of this abnormal response during occlusion and after reperfusion. We replicate in a more proximal MCA occlusion model the earlier findings of ultra-early enhanced contralesional evoked responses. In addition, we document this phenomenon within minutes after MCAo, and its persistence throughout the entire 90-min occlusion as well as 90-min reperfusion periods studied. These findings suggest that plastic processes may start within minutes following MCAo in rodents. If replicated in man, they might have implications regarding how early plasticity-enhancing therapies can be initiated after stroke.
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Affiliation(s)
- Clément Brunner
- 1 Inserm U894, Université Paris Descartes, Paris, France.,2 Neuro-Electronics Research Flanders (NERF; A Research Initiative by IMEC, VIB and KU Leuven), Catholic University Leuven, Leuven, Belgium
| | | | - Sushmitha Raja
- 1 Inserm U894, Université Paris Descartes, Paris, France
| | - Gabriel Montaldo
- 2 Neuro-Electronics Research Flanders (NERF; A Research Initiative by IMEC, VIB and KU Leuven), Catholic University Leuven, Leuven, Belgium
| | - Alan Urban
- 2 Neuro-Electronics Research Flanders (NERF; A Research Initiative by IMEC, VIB and KU Leuven), Catholic University Leuven, Leuven, Belgium
| | - Jean-Claude Baron
- 1 Inserm U894, Université Paris Descartes, Paris, France.,3 Department of Neurology, Hôpital Sainte-Anne, Paris, France
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Elderly Stroke Rehabilitation: Overcoming the Complications and Its Associated Challenges. Curr Gerontol Geriatr Res 2018; 2018:9853837. [PMID: 30050573 PMCID: PMC6040254 DOI: 10.1155/2018/9853837] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/22/2018] [Indexed: 01/19/2023] Open
Abstract
There have been many advances in management of cerebrovascular diseases. However, stroke is still one of the leading causes of disabilities and mortality worldwide with significant socioeconomic burden. This review summarizes the consequences of stroke in the elderly, predictors of stroke rehabilitation outcomes, role of rehabilitation in neuronal recovery, importance of stroke rehabilitation units, and types of rehabilitation resources and services available in Singapore. We also present the challenges faced by the elderly stroke survivors in the local setting and propose strategies to overcome the barriers to rehabilitation in this aging population.
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Cooper AN, Anderson V, Hearps S, Greenham M, Ditchfield M, Coleman L, Hunt RW, Mackay MT, Monagle P, Gordon AL. Trajectories of Motor Recovery in the First Year After Pediatric Arterial Ischemic Stroke. Pediatrics 2017; 140:peds.2016-3870. [PMID: 28710246 DOI: 10.1542/peds.2016-3870] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Neuromotor impairments are common after pediatric stroke, but little is known about functional motor outcomes. We evaluated motor function and how it changed over the first 12 months after diagnosis. We also examined differences in outcome according to age at diagnosis and whether fine motor (FM) or gross motor (GM) function at 12 months was associated with adaptive behavior. METHODS This prospective, longitudinal study recruited children (N = 64) from The Royal Children's Hospital, Melbourne who were diagnosed with acute arterial ischemic stroke (AIS) between December 2007 and November 2013. Motor assessments were completed at 3 time points after the diagnosis of AIS (1, 6, and 12 months). Children were grouped as follows: neonates (n = 27), preschool-aged (n = 19), and school-aged (n = 18). RESULTS A larger lesion size was associated with poorer GM outcomes at 12 months (P = .016). Neonatal AIS was associated with better FM and GM function initially but with a reduction in z scores over time. For the preschool- and school-aged groups, FM remained relatively stable over time. For GM outcomes, the preschool- and the school-aged age groups displayed similar profiles, with gradual recovery over time. Overall, poor FM and GM outcomes at 12 months were associated with poorer adaptive behavior scores. CONCLUSIONS Motor outcomes and the trajectory of recovery post-AIS differed according to a child's age at stroke onset. These findings indicate that an individualized approach to surveillance and intervention may be needed that is informed in part by age at diagnosis.
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Affiliation(s)
- Anna N Cooper
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Vicki Anderson
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephen Hearps
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Mardee Greenham
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Ditchfield
- Monash Medical Centre, Southern Health, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
| | - Lee Coleman
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rod W Hunt
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Mark T Mackay
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Paul Monagle
- Clinical Sciences, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,University of Melbourne, Melbourne, Victoria, Australia.,The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anne L Gordon
- Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; and .,Kings College London, London, United Kingdom
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Beaulieu LD, Milot MH. Changes in transcranial magnetic stimulation outcome measures in response to upper-limb physical training in stroke: A systematic review of randomized controlled trials. Ann Phys Rehabil Med 2017; 61:224-234. [PMID: 28579362 DOI: 10.1016/j.rehab.2017.04.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Physical training is known to be an effective intervention to improve sensorimotor impairments after stroke. However, the link between brain plastic changes, assessed by transcranial magnetic stimulation (TMS), and sensorimotor recovery in response to physical training is still misunderstood. We systematically reviewed reports of randomized controlled trials (RCTs) involving the use of TMS over the primary motor cortex (M1) to probe brain plasticity after upper-limb physical training interventions in people with stroke. METHODS We searched 5 databases for articles published up to October 2016, with additional studies identified by hand-searching. RCTs had to investigate pre/post-intervention changes in at least one TMS outcome measure. Two independent raters assessed the eligibility of potential studies and reviewed the selected articles' quality by using 2 critical appraisal scales. RESULTS In total, 14 reports of RCTs (pooled participants=358; mean 26±12 per study) met the selection criteria. Overall, 11 studies detected plastic changes with TMS in the presence of clinical improvements after training, and these changes were more often detected in the affected hemisphere by using map area and motor evoked potential (MEP) latency outcome measures. Plastic changes mostly pointed to increased M1/corticospinal excitability and potential interhemispheric rebalancing of M1 excitability, despite sometimes controversial results among studies. Also, the strength of the review observations was affected by heterogeneous TMS methods and upper-limb interventions across studies as well as several sources of bias within the selected studies. CONCLUSIONS The current evidence encourages the use of TMS outcome measures, especially MEP latency and map area to investigate plastic changes in the brain after upper-limb physical training post-stroke. However, more studies involving rigorous and standardized TMS procedures are needed to validate these observations.
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Affiliation(s)
- Louis-David Beaulieu
- Centre de recherche sur le vieillissement, faculté de médecine et des sciences de la santé de l'université de Sherbrooke, Sherbrooke, Québec (QC), Canada
| | - Marie-Hélène Milot
- Centre de recherche sur le vieillissement, faculté de médecine et des sciences de la santé de l'université de Sherbrooke, Sherbrooke, Québec (QC), Canada.
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Zhang R, Zhang Z, Chopp M. Function of neural stem cells in ischemic brain repair processes. J Cereb Blood Flow Metab 2016; 36:2034-2043. [PMID: 27742890 PMCID: PMC5363673 DOI: 10.1177/0271678x16674487] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/19/2016] [Accepted: 08/24/2016] [Indexed: 12/21/2022]
Abstract
Hypoxic/ischemic injury is the single most important cause of disabilities in infants, while stroke remains a leading cause of morbidity in children and adults around the world. The injured brain has limited repair capacity, and thereby only modest improvement of neurological function is evident post injury. In rodents, embryonic neural stem cells in the ventricular zone generate cortical neurons, and adult neural stem cells in the ventricular-subventricular zone of the lateral ventricle produce new neurons through animal life. In addition to generation of new neurons, neural stem cells contribute to oligodendrogenesis. Neurogenesis and oligodendrogenesis are essential for repair of injured brain. Much progress has been made in preclinical studies on elucidating the cellular and molecular mechanisms that control and coordinate neurogenesis and oligodendrogenesis in perinatal hypoxic/ischemic injury and the adult ischemic brain. This article will review these findings with a focus on the ventricular-subventricular zone neurogenic niche and discuss potential applications to facilitate endogenous neurogenesis and thereby to improve neurological function post perinatal hypoxic/ischemic injury and stroke.
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Affiliation(s)
- Ruilan Zhang
- Department of Neurology, Henry Ford Hospital, Detroit, USA
| | | | - Michael Chopp
- Department of Neurology, Henry Ford Hospital, Detroit, USA
- Department of Physics, Oakland University, Rochester, USA
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Lindgren A, Maguire J. Stroke Recovery Genetics. Stroke 2016; 47:2427-34. [DOI: 10.1161/strokeaha.116.010648] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/11/2016] [Indexed: 01/28/2023]
Affiliation(s)
- Arne Lindgren
- From the Department of Clinical Sciences Lund, Neurology, Lund University, Sweden (A.L.); Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); and School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, NSW, Australia (J.M.)
| | - Jane Maguire
- From the Department of Clinical Sciences Lund, Neurology, Lund University, Sweden (A.L.); Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden (A.L.); and School of Nursing and Midwifery, Faculty of Health and Medicine, University of Newcastle, NSW, Australia (J.M.)
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Robotic neurorehabilitation in patients with chronic stroke: psychological well-being beyond motor improvement. Int J Rehabil Res 2016; 38:219-25. [PMID: 25816006 DOI: 10.1097/mrr.0000000000000114] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although gait abnormality is one of the most disabling events following stroke, cognitive, and psychological impairments can be devastating. The Lokomat is a robotic that has been used widely for gait rehabilitation in several movement disorders, especially in the acute and subacute phases. The aim of this study was to evaluate the effectiveness of gait robotic rehabilitation in patients affected by chronic stroke. Psychological impact was also taken into consideration. Thirty patients (13 women and 17 men) affected by chronic stroke entered the study. All participants underwent neurological examination with respect to ambulation, Ashworth, Functional Independence Measure, and Tinetti scales to assess their physical status, and Hamilton Rating Scale for Depression, Psychological General Well-being Index, and Coping Orientation to Problem Experienced to evaluate the Lokomat-related psychological impact before and after either a conventional treatment or the robotic training. During each rehabilitation period (separated by a no-treatment period), patients underwent a total of 40 1 h training sessions (i.e. five times a week for 8 weeks). After the conventional treatment, the patients did not achieve a significant improvement in the functional status, except balance (P<0.001) and walking ability (P<0.01), as per the Tinetti scale. Indeed, after the robotic rehabilitation, significant improvements were detected in almost all the motor and psychological scales that we investigated, particularly for Psychological General Well-being Index and Coping Orientation to Problem Experienced. Manual and robotic-assisted body weight-supported treadmill training optimizes the sensory inputs relevant to step training, repeated practice, as well as neuroplasticity. Several controlled trials have shown a superior effect of Lokomat treatment in stroke patients' walking ability and velocity in particular. Therefore, our preliminary results proved that active robotic training not only facilitates gait and physical function but also the psychological status, even in patients affected by chronic stroke.
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van Kammen K, Boonstra AM, van der Woude LHV, Reinders-Messelink HA, den Otter R. The combined effects of guidance force, bodyweight support and gait speed on muscle activity during able-bodied walking in the Lokomat. Clin Biomech (Bristol, Avon) 2016; 36:65-73. [PMID: 27214248 DOI: 10.1016/j.clinbiomech.2016.04.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 04/08/2016] [Accepted: 04/25/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The ability to provide automated movement guidance is unique for robot assisted gait trainers such as the Lokomat. For the design of training protocols for the Lokomat it is crucial to understand how movement guidance affects the patterning of muscle activity that underlies walking, and how these effects interact with settings for bodyweight support and gait speed. METHODS Ten healthy participants walked in the Lokomat, with varying levels of guidance (0, 50 and 100%), bodyweight support (0 or 50% of participants' body weight) and gait speed (0.22, 0.5 or 0.78m/s). Surface electromyography of Erector Spinae, Gluteus Medius, Vastus Lateralis, Biceps Femoris, Medial Gastrocnemius and Tibialis Anterior were recorded. Group averaged levels of muscle activity were compared between conditions, within specific phases of the gait cycle. FINDINGS The provision of guidance reduced the amplitude of activity in muscles associated with stability and propulsion (i.e. Erector Spinae, Gluteus Medius, Biceps Femoris and Medial Gastrocnemius) and normalized abnormally high levels of activity observed in a number of muscles (i.e. Gluteus Medius, Biceps Femoris, and Tibialis anterior). The magnitude of guidance effects depended on both speed and bodyweight support, as reductions in activity were most prominent at low speeds and high levels of bodyweight support. INTERPRETATION The Lokomat can be effective in eliciting normal patterns of muscle activity, but only under specific settings of its training parameters.
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Affiliation(s)
- Klaske van Kammen
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands; Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands.
| | - Anne M Boonstra
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands.
| | - Lucas H V van der Woude
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands.
| | - Heleen A Reinders-Messelink
- Rehabilitation Center 'Revalidatie Friesland', Beetsterzwaag, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Groningen, The Netherlands.
| | - Rob den Otter
- University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands.
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Beristain X, Golombievski E. Pharmacotherapy to Enhance Cognitive and Motor Recovery Following Stroke. Drugs Aging 2016; 32:765-72. [PMID: 26423272 DOI: 10.1007/s40266-015-0299-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Stroke is a leading cause of disability among older adults and more than half of stroke survivors have some residual neurological impairment. Traditionally, managing the aftermath of stroke has been by the implementation of several physical and language therapy modalities. The limitations of these rehabilitation efforts have sparked an interest in finding other ways to enhance neurological recovery. Some of these novel approaches have included pharmacological interventions, cell-derived treatments, and cortical magnetic stimulation. Mounting evidence over the last 2 decades suggests that pharmacological manipulations may have the potential to modulate practice-dependent neuroplasticity and potentially improve neurological recovery after stroke. Multiple pharmacological agents with different mechanisms of action have been evaluated, showing conflicting results. Some studies suggest some promise, yet the quality of the available studies is suboptimal overall, with most of the studies being underpowered. So far, the most promising agents include the antidepressants for motor recovery and acetylcholinesterase inhibitors and memantine for aphasia. However, large, well-designed clinical trials are needed to address the shortcomings of the available data and before any pharmacological agent can be recommended for routine use as part of the standard algorithm of stroke management.
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Affiliation(s)
- Xabier Beristain
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, Maguire Building, #2700, 2160 South 1st Avenue, Maywood, IL, 60153, USA.
| | - Esteban Golombievski
- Department of Neurology, Stritch School of Medicine, Loyola University Medical Center, Maguire Building, #2700, 2160 South 1st Avenue, Maywood, IL, 60153, USA
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Duret C, Courtial O, Grosmaire AG. Kinematic measures for upper limb motor assessment during robot-mediated training in patients with severe sub-acute stroke. Restor Neurol Neurosci 2016; 34:237-45. [DOI: 10.3233/rnn-150565] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Christophe Duret
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi, France
- Centre Hospitalier Sud Francilien, Neurologie, Corbeil-Essonnes, France
| | - Ophélie Courtial
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi, France
| | - Anne Gaelle Grosmaire
- CRF Les Trois Soleils, Médecine Physique et de Réadaptation, Unité de Rééducation Neurologique, Boissise-Le-Roi, France
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