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Peng Y, Li N, Du X, Zhang G, Huang S, Ma J. Acupuncture combined with mirror therapy for post-stroke dyskinesia: A meta-analysis and systematic review. Medicine (Baltimore) 2024; 103:e38733. [PMID: 38941386 DOI: 10.1097/md.0000000000038733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Dyskinesia is one of the most common complications of stroke. Acupuncture therapy (AT) and mirror therapy (MT) are promising rehabilitation measures for the treatment of post-stroke dyskinesia. Although some studies suggested that AT and MT are effective and safe for dyskinesia, the effects, and safety remain uncertain due to lacking strong evidence. The purpose of this study is to investigate the efficacy and safety of AT combined with MT in the treatment of post-stroke dyskinesia. METHODS We searched the following databases: PubMed, Web of Science, Cochrane Library, EMBASE, Medline, China Knowledge Network, WANFANG, and China Biomedical Literature Database, from inception to 1 January 2023 to identify eligible studies. Total effective rate, the Fugl-Meyer assessment scale (FMA) upper and lower limb scores, modified Barthel index scores, Berg balance scale, modified Ashworth scale, and adverse reactions were adopted as outcome indicators. The Grading of Recommendations Assessment Development and Evaluation system was used by 2 independent reviewers to assess the quality of evidence for the outcome indicators included in the study. The statistical analysis was conducted by RevMan V.5.4 software. RESULTS A total of 24 randomized controlled studies included 2133 patients with post-stroke dyskinesia were included. The total effective rate of AT combined with MT was more advantageous in the treatment of post-stroke dyskinesia (relative risk = 1.31, 95% confidence interval [CI] [1.22-1.42], Z = 6.96, P < .0001). AT combined with MT was more advantageous for FMA upper limb score (mean difference [MD] = 6.67, 95% CI [5.21-8.13], Z = 8.97, P < .00001) and FMA lower limb score (MD = 3.72, 95% CI [2.81-4.63], Z = 7.98, P < .00001). Meta-analysis showed that AT combined with MT for post-stroke dyskinesia had a more advantageous modified Barthel index score (MD = 9.51, 95% CI [7.44-11.58], Z = 9.01, P < .00001). CONCLUSION AT combined with MT is effective in improving motor function and daily living ability of patients, especially in improving muscle spasms. However, these results should be regarded with caution given the low quality of evidence for the evaluation results.
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Affiliation(s)
- Yufeng Peng
- Acupuncture Department, Ningbo Zhenhai Hospital of Traditional Chinese Medicine, Ningbo, China
| | - Nan Li
- Clinical Skill Training Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaona Du
- Acupuncture Department, Ningbo Zhenhai Hospital of Traditional Chinese Medicine, Ningbo, China
| | - Guanghui Zhang
- Acupuncture Department, Ningbo Zhenhai Hospital of Traditional Chinese Medicine, Ningbo, China
| | - Shouqiang Huang
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiao Ma
- Department of Emergency Medicine, Taihe Hospital, Hubei, China
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2
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Christidi F, Orgianelis I, Merkouris E, Koutsokostas C, Tsiptsios D, Karavasilis E, Psatha EA, Tsiakiri A, Serdari A, Aggelousis N, Vadikolias K. A Comprehensive Review on the Role of Resting-State Functional Magnetic Resonance Imaging in Predicting Post-Stroke Motor and Sensory Outcomes. Neurol Int 2024; 16:189-201. [PMID: 38392953 PMCID: PMC10892788 DOI: 10.3390/neurolint16010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/25/2024] Open
Abstract
Stroke is a major leading cause of chronic disability, often affecting patients' motor and sensory functions. Functional magnetic resonance imaging (fMRI) is the most commonly used method of functional neuroimaging, and it allows for the non-invasive study of brain activity. The time-dependent coactivation of different brain regions at rest is described as resting-state activation. As a non-invasive task-independent functional neuroimaging approach, resting-state fMRI (rs-fMRI) may provide therapeutically useful information on both the focal vascular lesion and the connectivity-based reorganization and subsequent functional recovery in stroke patients. Considering the role of a prompt and accurate prognosis in stroke survivors along with the potential of rs-fMRI in identifying patterns of neuroplasticity in different post-stroke phases, this review provides a comprehensive overview of the latest literature regarding the role of rs-fMRI in stroke prognosis in terms of motor and sensory outcomes. Our comprehensive review suggests that with the advancement of MRI acquisition and data analysis methods, rs-fMRI emerges as a promising tool to study the motor and sensory outcomes in stroke patients and evaluate the effects of different interventions.
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Affiliation(s)
- Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.C.); (I.O.); (E.M.); (C.K.); (A.T.); (K.V.)
| | - Ilias Orgianelis
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.C.); (I.O.); (E.M.); (C.K.); (A.T.); (K.V.)
| | - Ermis Merkouris
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.C.); (I.O.); (E.M.); (C.K.); (A.T.); (K.V.)
| | - Christos Koutsokostas
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.C.); (I.O.); (E.M.); (C.K.); (A.T.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.C.); (I.O.); (E.M.); (C.K.); (A.T.); (K.V.)
| | - Efstratios Karavasilis
- Department of Radiology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.K.); (E.A.P.)
| | - Evlampia A. Psatha
- Department of Radiology, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.K.); (E.A.P.)
| | - Anna Tsiakiri
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.C.); (I.O.); (E.M.); (C.K.); (A.T.); (K.V.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece;
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.C.); (I.O.); (E.M.); (C.K.); (A.T.); (K.V.)
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Liu T, Li B, Zhang C, Chen P, Zhao W, Yan B. Real-Time Classification of Motor Imagery Using Dynamic Window-Level Granger Causality Analysis of fMRI Data. Brain Sci 2023; 13:1406. [PMID: 37891775 PMCID: PMC10604978 DOI: 10.3390/brainsci13101406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
This article presents a method for extracting neural signal features to identify the imagination of left- and right-hand grasping movements. A functional magnetic resonance imaging (fMRI) experiment is employed to identify four brain regions with significant activations during motor imagery (MI) and the effective connections between these regions of interest (ROIs) were calculated using Dynamic Window-level Granger Causality (DWGC). Then, a real-time fMRI (rt-fMRI) classification system for left- and right-hand MI is developed using the Open-NFT platform. We conducted data acquisition and processing on three subjects, and all of whom were recruited from a local college. As a result, the maximum accuracy of using Support Vector Machine (SVM) classifier on real-time three-class classification (rest, left hand, and right hand) with effective connections is 69.3%. And it is 3% higher than that of traditional multivoxel pattern classification analysis on average. Moreover, it significantly improves classification accuracy during the initial stage of MI tasks while reducing the latency effects in real-time decoding. The study suggests that the effective connections obtained through the DWGC method serve as valuable features for real-time decoding of MI using fMRI. Moreover, they exhibit higher sensitivity to changes in brain states. This research offers theoretical support and technical guidance for extracting neural signal features in the context of fMRI-based studies.
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Affiliation(s)
| | | | | | | | | | - Bin Yan
- Henan Key Laboratory of Imaging and Intelligent Processing, PLA Strategic Support Force Information Engineering University, Zhengzhou 450001, China; (T.L.)
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Liu Y, Gong Y, Wu XL, Hao XM, Liu JP, Li YY, Yang KZ, Gao XY, Zhang J, Zhang L, Zhang XD, Wang J, Liu QG. Fire acupuncture for anti-LGI1 antibody autoimmune encephalitis: a case report. Front Neurosci 2023; 17:1203915. [PMID: 37539383 PMCID: PMC10395828 DOI: 10.3389/fnins.2023.1203915] [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: 04/11/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
Autoimmune encephalitis, a class of encephalitis, is clinically characterized by multifocal or diffuse brain injury, including aberrant mental behavior, convulsions, and near-event memory impairment. In this article, we describe a female patient with autoimmune encephalitis who tested positive for leucine-rich glioma inactivated 1 (LGI1) antibodies and had hippocampal inflammatory edema in the lesion area. During the first 3 months of her illness, the patient primarily experienced memory loss, the onset of rigid twitching in her extremities that lasted for 1 min while in remission, and incontinence. After gamma globulin administration, methylprednisolone shock, and other symptomatic therapies during hospitalization, the patient's psychiatric symptoms and seizures improved considerably; however, she did not fully recover her memory. After receiving fire acupuncture for 6 months, the patient's understanding, orientation, and calculation skills improved considerably. Her memory and mental state were also improved at the follow-up visit. In this case, the use of fire acupuncture for the treatment of autoimmune encephalitis resulted in favorable outcomes with important benefits for conditions affecting the central nervous system; however, more convincing data are required to support the effectiveness of this treatment method.
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Affiliation(s)
- Yu Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Gong
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-li Wu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-min Hao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ji-peng Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yin-yin Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ke-zhen Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xin-yu Gao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Lin Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xu-dong Zhang
- Department of Chinese Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Jun Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qing-guo Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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5
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Ma J, Yang B, Qiu W, Zhang J, Yan L, Wang W. Recognizable Rehabilitation Movements of Multiple Unilateral Upper Limb: an fMRI Study of Motor Execution and Motor Imagery. J Neurosci Methods 2023; 392:109861. [PMID: 37075914 DOI: 10.1016/j.jneumeth.2023.109861] [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: 08/30/2022] [Revised: 02/18/2023] [Accepted: 04/15/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND This paper presents a study investigating the recognizability of multiple unilateral upper limb movements in stroke rehabilitation. METHODS A functional magnetic experiment is employed to study motor execution (ME) and motor imagery (MI) of four movements for the unilateral upper limb: hand-grasping, hand-handling, arm-reaching, and wrist-twisting. The functional magnetic resonance imaging (fMRI) images of ME and MI tasks are statistically analyzed to delineate the region of interest (ROI). Then parameter estimation associated with ROIs for each ME and MI task are evaluated, where differences in ROIs for different movements are compared using analysis of covariance (ANCOVA). RESULTS All movements of ME and MI tasks activate motor areas of the brain, and there are significant differences (p<0.05) in ROIs evoked by different movements. The activation area is larger when executing the hand-grasping task instead of the others. CONCLUSION The four movements we propose can be adopted as MI tasks, especially for stroke rehabilitation, since they are highly recognizable and capable of activating more brain areas during MI and ME.
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Affiliation(s)
- Jun Ma
- School of Mechatronic Engineering and Automation, School of Medicine, Research Center of Brain Computer Engineering, Shanghai University, Shanghai, 200441, China
| | - Banghua Yang
- School of Mechatronic Engineering and Automation, School of Medicine, Research Center of Brain Computer Engineering, Shanghai University, Shanghai, 200441, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, 201203, Shanghai, China.
| | - Wenzheng Qiu
- School of Mechatronic Engineering and Automation, School of Medicine, Research Center of Brain Computer Engineering, Shanghai University, Shanghai, 200441, China
| | - Jian Zhang
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai University, 200441, Shanghai China
| | - Linfeng Yan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, 710038, Shaanxi, China
| | - Wen Wang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, 710038, Shaanxi, China.
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Cao X, Wang Z, Chen X, Liu Y, Abdoulaye IA, Ju S, Zhang S, Wu S, Wang Y, Guo Y. Changes in Resting-State Neural Activity and Nerve Fibres in Ischaemic Stroke Patients with Hemiplegia. Brain Topogr 2023; 36:255-268. [PMID: 36604349 DOI: 10.1007/s10548-022-00937-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
Many neuroimaging studies have reported that stroke induces abnormal brain activity. However, little is known about resting-state networks (RSNs) and the corresponding white matter changes in stroke patients with hemiplegia. Here, we utilized functional magnetic resonance imaging (fMRI) to measure neural activity and related fibre tracts in 14 ischaemic stroke patients with hemiplegia and 12 healthy controls. Fractional amplitude of low-frequency fluctuations (fALFF) calculation and correlation analyses were used to assess the relationship between regional neural activity and movement scores. Tractography was performed using diffusion tensor imaging (DTI) data to analyse the fibres passing through the regions of interest. Compared with controls, stroke patients showed abnormal functional connectivity (FC) between some brain regions in the RSNs. The fALFF was increased in the contralesional parietal lobe, with the regional fALFF being correlated with behavioural scores in stroke patients. Additionally, the passage of fibres across regions with reduced FC in the RSNs was increased in stroke patients. This study suggests that structural remodelling of functionally relevant white matter tracts is probably an adaptive response that compensates for injury to the brain.
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Affiliation(s)
- Xuejin Cao
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
| | - Zan Wang
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
| | - Xiaohui Chen
- Department of Radiology, Affiliated ZhongDa Hospital of Southeast University, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Yanli Liu
- Department of Rehabilitation, Affiliated ZhongDa Hospital of Southeast University, Nanjing, China
| | - Idriss Ali Abdoulaye
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
| | - Shenghong Ju
- Department of Radiology, Affiliated ZhongDa Hospital of Southeast University, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Shiyao Zhang
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
| | - Shanshan Wu
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China
| | - Yuancheng Wang
- Department of Radiology, Affiliated ZhongDa Hospital of Southeast University, Jiangsu Key Laboratory of Molecular and Functional Imaging, Medical School of Southeast University, Nanjing, China
| | - Yijing Guo
- Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, China. .,Department of Neurology, Affiliated ZhongDa Hospital of Southeast University, Medical School of Southeast University, Nanjing, 210009, Jiangsu Province, China.
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7
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Neuroplasticity of Acupuncture for Stroke: An Evidence-Based Review of MRI. Neural Plast 2021; 2021:2662585. [PMID: 34456996 PMCID: PMC8397547 DOI: 10.1155/2021/2662585] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/06/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
Acupuncture is widely recognized as a potentially effective treatment for stroke rehabilitation. Researchers in this area are actively investigating its therapeutic mechanisms. Magnetic resonance imaging (MRI), as a noninvasive, high anatomical resolution technique, has been employed to investigate neuroplasticity on acupuncture in stroke patients from a system level. However, there is no review on the mechanism of acupuncture treatment for stroke based on MRI. Therefore, we aim to summarize the current evidence about this aspect and provide useful information for future research. After searching PubMed, Web of Science, and Embase databases, 24 human and five animal studies were identified. This review focuses on the evidence on the possible mechanisms underlying mechanisms of acupuncture therapy in treating stroke by regulating brain plasticity. We found that acupuncture reorganizes not only motor-related network, including primary motor cortex (M1), premotor cortex, supplementary motor area (SMA), frontoparietal network (LFPN and RFPN), and sensorimotor network (SMN), as well as default mode network (aDMN and pDMN), but also language-related brain areas including inferior frontal gyrus frontal, temporal, parietal, and occipital lobes, as well as cognition-related brain regions. In addition, acupuncture therapy can modulate the function and structural plasticity of post-stroke, which may be linked to the mechanism effect of acupuncture.
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8
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Hu M, Cheng HJ, Ji F, Chong JSX, Lu Z, Huang W, Ang KK, Phua KS, Chuang KH, Jiang X, Chew E, Guan C, Zhou JH. Brain Functional Changes in Stroke Following Rehabilitation Using Brain-Computer Interface-Assisted Motor Imagery With and Without tDCS: A Pilot Study. Front Hum Neurosci 2021; 15:692304. [PMID: 34335210 PMCID: PMC8322606 DOI: 10.3389/fnhum.2021.692304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been proven effective in post-stroke motor function enhancement, yet whether the combination of MI-BCI and tDCS may further benefit the rehabilitation of motor functions remains unknown. This study investigated brain functional activity and connectivity changes after a 2 week MI-BCI and tDCS combined intervention in 19 chronic subcortical stroke patients. Patients were randomized into MI-BCI with tDCS group and MI-BCI only group who underwent 10 sessions of 20 min real or sham tDCS followed by 1 h MI-BCI training with robotic feedback. We derived amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) from resting-state functional magnetic resonance imaging (fMRI) data pre- and post-intervention. At baseline, stroke patients had lower ALFF in the ipsilesional somatomotor network (SMN), lower ReHo in the contralesional insula, and higher ALFF/Reho in the bilateral posterior default mode network (DMN) compared to age-matched healthy controls. After the intervention, the MI-BCI only group showed increased ALFF in contralesional SMN and decreased ALFF/Reho in the posterior DMN. In contrast, no post-intervention changes were detected in the MI-BCI + tDCS group. Furthermore, higher increases in ALFF/ReHo/FC measures were related to better motor function recovery (measured by the Fugl-Meyer Assessment scores) in the MI-BCI group while the opposite association was detected in the MI-BCI + tDCS group. Taken together, our findings suggest that brain functional re-normalization and network-specific compensation were found in the MI-BCI only group but not in the MI-BCI + tDCS group although both groups gained significant motor function improvement post-intervention with no group difference. MI-BCI and tDCS may exert differential or even opposing impact on brain functional reorganization during post-stroke motor rehabilitation; therefore, the integration of the two strategies requires further refinement to improve efficacy and effectiveness.
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Affiliation(s)
- Mengjiao Hu
- NTU Institute for Health Technologies, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore, Singapore.,Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsiao-Ju Cheng
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Fang Ji
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joanna Su Xian Chong
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhongkang Lu
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Kai Keng Ang
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore.,School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Kok Soon Phua
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Kai-Hsiang Chuang
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, Singapore, Singapore.,Queensland Brain Institute and Centre for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - Xudong Jiang
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Effie Chew
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Cuntai Guan
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Juan Helen Zhou
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore.,Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore
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9
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Lim SB, Louie DR, Peters S, Liu-Ambrose T, Boyd LA, Eng JJ. Brain activity during real-time walking and with walking interventions after stroke: a systematic review. J Neuroeng Rehabil 2021; 18:8. [PMID: 33451346 PMCID: PMC7811232 DOI: 10.1186/s12984-020-00797-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/09/2020] [Indexed: 12/27/2022] Open
Abstract
Investigations of real-time brain activations during walking have become increasingly important to aid in recovery of walking after a stroke. Individual brain activation patterns can be a valuable biomarker of neuroplasticity during the rehabilitation process and can result in improved personalized medicine for rehabilitation. The purpose of this systematic review is to explore the brain activation characteristics during walking post-stroke by determining: (1) if different components of gait (i.e., initiation/acceleration, steady-state, complex) result in different brain activations, (2) whether brain activations differ from healthy individuals. Six databases were searched resulting in 22 studies. Initiation/acceleration showed bilateral activation in frontal areas; steady-state and complex walking showed broad activations with the majority exploring and finding increases in frontal regions and some studies also showing increases in parietal activation. Asymmetrical activations were often related to performance asymmetry and were more common in studies with slower gait speed. Hyperactivations and asymmetrical activations commonly decreased with walking interventions and as walking performance improved. Hyperactivations often persisted in individuals who had experienced severe strokes. Only a third of the studies included comparisons to a healthy group: individuals post-stroke employed greater brain activation compared to young adults, while comparisons to older adults were less clear and limited. Current literature suggests some indicators of walking recovery however future studies investigating more brain regions and comparisons with healthy age-matched adults are needed to further understand the effect of stroke on walking-related brain activation.
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Affiliation(s)
- Shannon B Lim
- Graduate Studies in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada.,Rehabiliation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC, V5Z 2G9, Canada
| | - Dennis R Louie
- Graduate Studies in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada.,Rehabiliation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC, V5Z 2G9, Canada
| | - Sue Peters
- Rehabiliation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC, V5Z 2G9, Canada.,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,The Djavad Mowafaghian Centre for Brain Health, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Hip Health and Mobility, Vancouver, Canada
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,The Djavad Mowafaghian Centre for Brain Health, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Janice J Eng
- Rehabiliation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC, V5Z 2G9, Canada. .,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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10
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Bihemispheric changes associated with cognition in patients with chronic brainstem stroke. Neuroreport 2019; 30:1278-1283. [PMID: 31651705 DOI: 10.1097/wnr.0000000000001356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to identify brain changes associated with preserved cognitive function in patients with chronic brainstem stroke. METHODS Twelve patients with chronic brainstem stroke and 24 age-matched healthy controls were included in this retrospective study. All participants underwent T1-weighted, diffusion tensor, and resting-state functional MRI. Gray matter density, fractional anisotropy, and mean diffusivity maps from diffusion tensor imaging and seven cognition-related independent component maps from resting-state functional MRI were used to identify differences in brain volume, structural connectivity, and functional connectivity. Independent t-tests were used to determine the statistical significance of changes in gray matter density, fractional anisotropy, mean diffusivity, and inter-network functional connectivity maps. RESULTS Bilateral cerebellum volumes and structural connectivity of the diffuse bilateral cerebral hemispheres were significantly lower in the patient than in the control group. However, patients exhibited increased gray matter volume and increased structural connectivity of the temporal lobe in the contra-lesional hemisphere and basal forebrain, compared with healthy controls. Furthermore, the intra-network functional connectivity in the frontal and temporal lobes was significantly higher in patients than in controls (PFWE < 0.05). CONCLUSION In the patient group, the brain regions mainly associated with the cholinergic system exhibited increased volume, structural connectivity, and functional connectivity. In contrast, the regions connected with the brainstem via cortico-ponto-cerebellar fibers exhibited decreased volume or structural connectivity. Cognitive function may be preserved in patients with brainstem stroke due to significant increases in frontal and temporal inter-network connectivity.
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