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Danielli E, Simard N, DeMatteo CA, Kumbhare D, Ulmer S, Noseworthy MD. A review of brain regions and associated post-concussion symptoms. Front Neurol 2023; 14:1136367. [PMID: 37602240 PMCID: PMC10435092 DOI: 10.3389/fneur.2023.1136367] [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: 01/03/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023] Open
Abstract
The human brain is an exceptionally complex organ that is comprised of billions of neurons. Therefore, when a traumatic event such as a concussion occurs, somatic, cognitive, behavioral, and sleep impairments are the common outcome. Each concussion is unique in the sense that the magnitude of biomechanical forces and the direction, rotation, and source of those forces are different for each concussive event. This helps to explain the unpredictable nature of post-concussion symptoms that can arise and resolve. The purpose of this narrative review is to connect the anatomical location, healthy function, and associated post-concussion symptoms of some major cerebral gray and white matter brain regions and the cerebellum. As a non-exhaustive description of post-concussion symptoms nor comprehensive inclusion of all brain regions, we have aimed to amalgamate the research performed for specific brain regions into a single article to clarify and enhance clinical and research concussion assessment. The current status of concussion diagnosis is highly subjective and primarily based on self-report of symptoms, so this review may be able to provide a connection between brain anatomy and the clinical presentation of concussions to enhance medical imaging assessments. By explaining anatomical relevance in terms of clinical concussion symptom presentation, an increased understanding of concussions may also be achieved to improve concussion recognition and diagnosis.
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Affiliation(s)
- Ethan Danielli
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Nicholas Simard
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Carol A. DeMatteo
- ARiEAL Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Dinesh Kumbhare
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephan Ulmer
- Neurorad.ch, Zurich, Switzerland
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Michael D. Noseworthy
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
- Imaging Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
- ARiEAL Research Centre, McMaster University, Hamilton, ON, Canada
- Department of Radiology, McMaster University, Hamilton, ON, Canada
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Zhang K, Wu C, Lyu Y, Xiang J, Pan C, Guo X, Tong S. Upper-limb amputation disrupts the interhemispheric structural rather than functional connectivity. Brain Connect 2022; 13:133-142. [PMID: 36082989 DOI: 10.1089/brain.2022.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Recent neuroimaging studies on upper-limb amputation have revealed the reorganization of bilateral sensorimotor cortex after sensory deprivation, underpinning the assumption of changes in the interhemispheric connections. In the present study, using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI), we aim to explore the alterations in the interhemispheric functional and structural connectivity after upper-limb amputation. Methods: Twenty-two upper-limb amputees and 15 age- and sex-matched healthy controls were recruited for MRI scanning. The amputees were further divided into subgroups by amputation side and residual limb pain (RLP). DTI metrics of corpus callosum (CC) subregions and resting-state functional connectivity (FC) between the bilateral sensorimotor cortices were measured for each participant. Linear mixed models were carried out to investigate the relationship of interhemispheric connectivity with the amputation, amputation side, and RLP. Results: Compared with healthy controls, upper-limb amputees showed lower axial diffusivity (AD) in CC subregions II and III. Subgroup analyses showed that the dominant hand amputation induced significant microstructural changes in CC subregion III. In addition, only amputees with RLP showed decreased fractional anisotropy and AD in CC, which was also correlated with the intensity of RLP. No significant changes in interhemispheric FC were found after upper-limb amputation. Conclusion: The present study demonstrated that the interhemispheric structural connectivity rather than FC degenerated after upper-limb amputation, and the degeneration of interhemispheric structural connectivity was shown to be relevant to the amputation side and the intensity of RLP. Impact statement Neuroimaging studies have revealed the functional reorganization of bilateral sensorimotor cortex after amputation, with expanded activation from the intact hemisphere to the deprived hemisphere. Our findings indicated a degeneration of interhemispheric white matter connections in upper-limb amputees, unveiling the underlying structural basis for bilateral functional reorganization after amputation.
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Affiliation(s)
- Kexu Zhang
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai Jiao Tong University, Jiangchuan Road, Shanghai, 200240, China, Shanghai, China, 200240
| | - Chaowei Wu
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China
| | - Yuanyuan Lyu
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China
| | - Jianbo Xiang
- The 2nd People’s Hospital of Changzhou of Nanjing Medical University, the Department of Radiology, Changzhou, China,
| | - Changjie Pan
- The 2nd People’s Hospital of Changzhou of Nanjing Medical University, the Department of Radiology, Changzhou, China
| | - Xiaoli Guo
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China
| | - Shanbao Tong
- Shanghai Jiao Tong University, School of Biomedical Engineering, Shanghai, China
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Kazezian Z, Yu X, Ramette M, Macdonald W, Bull AMJ. Development of a rodent high-energy blast injury model for investigating conditions associated with traumatic amputations. Bone Joint Res 2021; 10:166-172. [PMID: 33663228 PMCID: PMC7998070 DOI: 10.1302/2046-3758.103.bjr-2020-0367.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
AIMS In recent conflicts, most injuries to the limbs are due to blasts resulting in a large number of lower limb amputations. These lead to heterotopic ossification (HO), phantom limb pain (PLP), and functional deficit. The mechanism of blast loading produces a combined fracture and amputation. Therefore, to study these conditions, in vivo models that replicate this combined effect are required. The aim of this study is to develop a preclinical model of blast-induced lower limb amputation. METHODS Cadaveric Sprague-Dawley rats' left hindlimbs were exposed to blast waves of 7 to 13 bar burst pressures and 7.76 ms to 12.68 ms positive duration using a shock tube. Radiographs and dissection were used to identify the injuries. RESULTS Higher burst pressures of 13 and 12 bar caused multiple fractures at the hip, and the right and left limbs. Lowering the pressure to 10 bar eliminated hip fractures; however, the remaining fractures were not isolated to the left limb. Further reducing the pressure to 9 bar resulted in the desired isolated fracture of the left tibia with a dramatic reduction in the fractures to other sites. CONCLUSION In this paper, a rodent blast injury model has been developed in the hindlimb of cadaveric rats that combines the blast and fracture in one insult, necessitating amputation. Experimental setup with 9 bar burst pressure and 9.13 ms positive duration created a fracture at the tibia with total reduction in non-targeted fractures, rendering 9 bar burst pressure suitable for translation to a survivable model to investigate blast injury-associated diseases. Cite this article: Bone Joint Res 2021;10(3):166-172.
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Affiliation(s)
- Zepur Kazezian
- Centre for Blast Injury Studies, Imperial College London, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - Xiancheng Yu
- Centre for Blast Injury Studies, Imperial College London, London, UK
- Dyson School of Design Engineering, Imperial College London, London, UK
| | - Martin Ramette
- Centre for Blast Injury Studies, Imperial College London, London, UK
- Department of Bioengineering, Imperial College London, London, UK
| | - Warren Macdonald
- Department of Bioengineering, Imperial College London, London, UK
| | - Anthony M. J. Bull
- Centre for Blast Injury Studies, Imperial College London, London, UK
- Department of Bioengineering, Imperial College London, London, UK
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Abstract
Acquired limb loss, whether from accident or amputation, occurs with an incidence of greater than 175,000 per year in the United States. Current prevalence is estimated at greater than 1.5 million and is expected to double within 30 years. While many patients with amputations may have no significant pain or sensory issues after healing from the initial loss, one-quarter to one-half of patients may have ongoing difficulties with residual limb pain, phantom limb pain, or phantom limb sensation. This review explores the potential etiologies of those symptoms, as well as a variety of treatment options that a practitioner may consider when approaching this condition.
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Affiliation(s)
- Gary Stover
- Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nathan Prahlow
- Department of Physical Medicine & Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
BACKGROUND Factors that are related to mobility apprehension were measured in a sample of persons with lower-limb amputation. OBJECTIVES The purpose was to determine whether intensity, interference, or catastrophizing are associated with mobility apprehension. STUDY DESIGN Cross-sectional study. METHODS Persons with amputation of a lower limb who were attending a national limb loss conference were recruited to complete a survey. Subjects were administered the Tampa Scale for Kinesiophobia to measure mobility apprehension. The Brief Pain Inventory was administered to quantify the affect of pain on general activity, walking ability, and enjoyment of life. The Pain Catastrophizing Scale was administered to assess the tendency to ruminate and magnify pain sensations. A multivariable linear regression was performed to determine factors associated with mobility apprehension. RESULTS Fifty-three people with lower-limb amputation participated in the study. The mean (standard deviation) score for mobility apprehension was 34.2 (6.0). Mean (standard deviation) pain intensity and interference scores were 1.6 (1.7) and 2.5 (2.6), respectively. The mean (standard deviation) pain catastrophizing score was 9.1 (10). Pain catastrophizing was the only variable associated with higher mobility apprehension (β = 0.31, p < 0.001, R2 = 0.32). Results suggest that for every one-point increase in the pain catastrophizing score, mobility apprehension will increase by 0.3 of a point. CONCLUSION These preliminary results suggest that pain catastrophizing was related to mobility apprehension in this cohort of persons with lower-limb amputation. This relationship indicates that the exploration of avoidance behaviors, such as pain catastrophizing, may be useful when developing a program for physical rehabilitation. CLINICAL RELEVANCE Pain catastrophizing, an avoidance behavior, may be associated with higher levels of mobility apprehension in persons with major lower-limb amputation. Understanding the impact of fear-avoidance behavior will allow clinicians to identify individuals at risk for poor outcomes following amputation surgery and to develop psychological strategies to complement treatment.
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Affiliation(s)
- Shannon L Mathis
- Department of Kinesiology, College of Education, The University of Alabama in Huntsville, Huntsville, AL, USA
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Liu H, Andoh J, Lyu Y, Milde C, Desch S, Zidda F, Schmelz M, Curio G, Flor H. Peripheral input and phantom limb pain: A somatosensory event-related potential study. Eur J Pain 2020; 24:1314-1329. [PMID: 32335979 DOI: 10.1002/ejp.1579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Following amputation, nearly all amputees report nonpainful phantom phenomena and many of them suffer from chronic phantom limb pain (PLP) and residual limb pain (RLP). The aetiology of PLP remains elusive and there is an ongoing debate on the role of peripheral and central mechanisms. Few studies have examined the entire somatosensory pathway from the truncated nerves to the cortex in amputees with PLP compared to those without PLP. The relationship among afferent input, somatosensory responses and the change in PLP remains unclear. METHODS Transcutaneous electrical nerve stimulation was applied on the truncated median nerve, the skin of the residual limb and the contralateral homologous nerve in 22 traumatic upper-limb amputees (12 with and 10 without PLP). Using somatosensory event-related potentials, the ascending volley was monitored from the brachial plexus, the spinal cord, the brainstem and the thalamus to the primary somatosensory cortex. RESULTS Peripheral input could evoke PLP in amputees with chronic PLP (7/12), but not in amputees without a history of PLP (0/10). The amplitudes of the somatosensory components were comparable between amputees with and without PLP. In addition, evoked potentials from the periphery through the spinal, subcortical and cortical segments were not significantly associated with PLP. CONCLUSIONS Peripheral input can modulate PLP but seems insufficient to cause PLP. These findings suggest the multifactorial complexity of PLP and different mechanisms for PLP and RLP. SIGNIFICANCE Peripheral afferent input plays a role in PLP and has been assumed to be sufficient to generate PLP. In this study we found no significant differences in the electrical potentials generated by peripheral stimulation from the truncated nerve and the skin of the residual limb in amputees with and without PLP. Peripheral input could enhance existing PLP but could not cause it. These findings indicate the multifactorial complexity of PLP and an important role of central processes in PLP.
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Affiliation(s)
- Hongcai Liu
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Jamila Andoh
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Yuanyuan Lyu
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Christopher Milde
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Biopsychology, Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Simon Desch
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Francesca Zidda
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Schmelz
- Department of Experimental Pain Research, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Gabriel Curio
- Neurophysics Group, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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