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Ke W, Luo Z. Analysis of Cortico-Muscular Coupling and Functional Brain Network under Different Standing Balance Paradigms. Brain Sci 2024; 14:81. [PMID: 38248296 PMCID: PMC10813745 DOI: 10.3390/brainsci14010081] [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: 01/04/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
Maintaining standing balance is essential for people to engage in productive activities in daily life. However, the process of interaction between the cortex and the muscles during balance regulation is understudied. Four balance paradigms of different difficulty were designed by closing eyes and laying sponge pad under feet. Ten healthy subjects were recruited to stand for ten 15 s trials in each paradigm. This study used simultaneously acquired electroencephalography (EEG) and electromyography (EMG) to investigate changes in the human cortico-muscular coupling relationship and functional brain network characteristics during balance control. The coherence and causality of EEG and EMG signals were calculated by magnitude-squared coherence (MSC) and transfer entropy (TE). It was found that changes in balance strategies may lead to a shift in cortico-muscular coherence (CMC) from the beta band to the gamma band when the difficulty of balance increased. As subjects performed the four standing balance paradigms, the causality of the beta band and the gamma band was stronger in the descending neural pathway than that in the ascending neural pathway. A multi-rhythmic functional brain network with 19 EEG channels was constructed and analyzed based on graph theory, showing that its topology also changed with changes in balance difficulty. These results show an active adjustment of the sensorimotor system under different balance paradigms and provide new insights into the endogenous physiological mechanisms underlying the control of standing balance.
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Affiliation(s)
| | - Zhizeng Luo
- Institute of Intelligent Control and Robotics, Hangzhou Dianzi University, Hangzhou 310018, China;
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Xie Q, Wu J, Zhang Q, Zhang Y, Sheng B, Wang X, Huang J. Neurobiomechanical mechanism of Tai Chi to improve upper limb coordination function in post-stroke patients: a study protocol for a randomized controlled trial. Trials 2023; 24:788. [PMID: 38049898 PMCID: PMC10696787 DOI: 10.1186/s13063-023-07743-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/24/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Upper limb dysfunction seriously affects the ability of stroke patients to perform activities of daily living. As a popular exercise therapy, Tai Chi may become an alternative intervention. However, the neurophysiological mechanism by which Tai Chi improves upper limb dysfunction in stroke patients is still unclear, which limits its further promotion and application. Therefore, conducting a strict randomized clinical trial is necessary to observe how Tai Chi affects upper limb dysfunction in stroke patients and to explore its neurophysiological mechanism. METHODS/DESIGN This report describes a randomized, parallel-controlled trial with distributive concealment and evaluator blinding. A total of 84 eligible participants will be randomly assigned to the Tai Chi group or the control group in a 1:1 ratio. The participants in the Tai Chi group will receive 4 weeks of Tai Chi training: five 60-min sessions a week for a total of 20 sessions. The participants in the control group will not receive Tai Chi training. Both groups will receive medical treatment and routine rehabilitation training. The primary outcome measure is the mean change in the Fugl-Meyer Assessment Upper Extremity (FMA-UE) scale score between baseline and 4 weeks; the secondary outcomes are the mean changes in kinematic characteristics and the Wolf Motor Function Test (WMFT) and Stroke Impact Scale (SIS) scores. In addition, the corticomuscular coupling level and near-infrared brain functional imaging will be monitored to explore the mechanism by which Tai Chi improves upper limb function of stroke patients. DISCUSSION This randomized controlled trial will examine the effectiveness of Tai Chi in stroke patients with upper limb dysfunction and explore the neurophysiological mechanism. Positive results will verify that Tai Chi can improve upper limb function of stroke patients. TRIAL REGISTRATION Chinese Clinical Trial Registration Center, ChiCTR2200061376 (retrospectively registered). Registered June 22, 2022. http://www.chictr.org.cn/listbycreater.aspx . Manuscript Version: 3.0 Manuscript Date: October 10, 2023.
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Affiliation(s)
- Qiurong Xie
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, 350122, China
| | - Jinsong Wu
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, 350122, China
| | - Qi Zhang
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, 350122, China
| | - Yanxin Zhang
- The University of Auckland, Auckland, New Zealand, 1142
| | - Bo Sheng
- Shanghai University, Shanghai, 200444, China
| | - Xiaoling Wang
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, 350122, China
| | - Jia Huang
- Fujian University of Traditional Chinese Medicine, Fuzhou, 350122, China.
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, 350122, China.
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Williamson JN, James SA, He D, Li S, Sidorov EV, Yang Y. High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study. Front Hum Neurosci 2023; 17:1286238. [PMID: 37900725 PMCID: PMC10602806 DOI: 10.3389/fnhum.2023.1286238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Previous studies found that post-stroke motor impairments are associated with damage to the lesioned corticospinal tract (CST) and hyperexcitability of the contralesional cortico-reticulospinal tract (CRST). This proof-of-concept study aims to develop a non-invasive brain stimulation protocol that facilitates the lesioned CST and inhibits the contralesional CRST to improve upper extremity rehabilitation in individuals with moderate-to-severe motor impairments post-stroke. Methods Fourteen individuals (minimum 3 months post ischemic stroke) consented. Physician decision of the participants baseline assessment qualified eight to continue in a randomized, double-blind cross-over pilot trial (ClinicalTrials.gov Identifier: NCT05174949) with: (1) anodal high-definition transcranial direct stimulation (HD-tDCS) over the ipsilesional primary motor cortex (M1), (2) cathodal HD-tDCS over contralesional dorsal premotor cortex (PMd), (3) sham stimulation, with a two-week washout period in-between. Subject-specific MR images and computer simulation were used to guide HD-tDCS and verified by Transcranial Magnetic Stimulation (TMS) induced Motor Evoked Potential (MEP). The motor behavior outcome was evaluated by an Fugl-Meyer Upper Extremity score (primary outcome measure) and the excitability of the ipslesoinal CST and contralesional CRST was determined by the change of MEP latencies and amplitude (secondary outcome measures). Results The baseline ipsilesional M1 MEP latency and amplitude were correlated with FM-UE. FM-UE scores were improved post HD-tDCS, in comparison to sham stimulation. Both anodal and cathodal HD-tDCS reduced the latency of the ipsilesional M1 MEP. The contralesional PMd MEP disappeared/delayed after HD-tDCS. Discussion These results suggest that HD-tDCS could improve the function of the lesioned corticospinal tract and reduce the excitability of the contralesional cortico-reticulospinal tract, thus, improving motor function of the upper extremity in more severely impaired individuals.
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Affiliation(s)
- Jordan N. Williamson
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States
| | - Shirley A. James
- University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, OK, United States
| | - Dorothy He
- University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, UT Health Huston, McGovern Medical School, Houston, TX, United States
| | - Evgeny V. Sidorov
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Yuan Yang
- Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Clinical Imaging Research Center, Stephenson Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL, United States
- Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, United States
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
- Department of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Gallogly College of Engineering, Stephenson School of Biomedical Engineering, University of Oklahoma, Oklahoma City, OK, United States
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Zhan J, Yu C, Xiao S, Shen B, Zhang C, Zhou J, Fu W. Effects of high-definition transcranial direct current stimulation on the cortical-muscular functional coupling and muscular activities of ankle dorsi-plantarflexion under running-induced fatigue. Front Physiol 2023; 14:1263309. [PMID: 37841316 PMCID: PMC10570418 DOI: 10.3389/fphys.2023.1263309] [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: 07/21/2023] [Accepted: 09/22/2023] [Indexed: 10/17/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) can improve motor control performance under fatigue. However, the influences of tDCS on factors contributing to motor control (e.g., cortical-muscular functional coupling, CMFC) are unclear. This double-blinded and randomized study examined the effects of high-definition tDCS (HD-tDCS) on muscular activities of dorsiflexors and plantarflexors and CMFC when performing ankle dorsi-plantarflexion under fatigue. Twenty-four male adults were randomly assigned to receive five sessions of 20-min HD-tDCS targeting primary motor cortex (M1) or sham stimulation. Three days before and 1 day after the intervention, participants completed ankle dorsi-plantarflexion under fatigue induced by prolonged running exercise. During the task, electroencephalography (EEG) of M1 (e.g., C1, Cz) and surface electromyography (sEMG) of several muscles (e.g., tibialis anterior [TA]) were recorded synchronously. The corticomuscular coherence (CMC), root mean square (RMS) of sEMG, blood lactate, and maximal voluntary isometric contraction (MVC) of ankle dorsiflexors and plantarflexors were obtained. Before stimulation, greater beta- and gamma-band CMC between M1 and TA were significantly associated with greater RMS of TA (r = 0.460-0.619, p = 0.001-0.024). The beta- and gamma-band CMC of C1-TA and Cz-TA, and RMS of TA and MVC torque of dorsiflexors were significantly higher after HD-tDCS than those at pre-intervention in the HD-tDCS group and post-intervention in the control group (p = 0.002-0.046). However, the HD-tDCS-induced changes in CMC and muscle activities were not significantly associated (r = 0.050-0.128, p = 0.693-0.878). HD-tDCS applied over M1 can enhance the muscular activities of ankle dorsiflexion under fatigue and related CMFC.
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Affiliation(s)
- Jianglong Zhan
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Changxiao Yu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Songlin Xiao
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Bin Shen
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Chuyi Zhang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Junhong Zhou
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Weijie Fu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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Scano A, Guanziroli E, Brambilla C, Amendola C, Pirovano I, Gasperini G, Molteni F, Spinelli L, Molinari Tosatti L, Rizzo G, Re R, Mastropietro A. A Narrative Review on Multi-Domain Instrumental Approaches to Evaluate Neuromotor Function in Rehabilitation. Healthcare (Basel) 2023; 11:2282. [PMID: 37628480 PMCID: PMC10454517 DOI: 10.3390/healthcare11162282] [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: 07/04/2023] [Revised: 08/02/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
In clinical scenarios, the use of biomedical sensors, devices and multi-parameter assessments is fundamental to provide a comprehensive portrait of patients' state, in order to adapt and personalize rehabilitation interventions and support clinical decision-making. However, there is a huge gap between the potential of the multidomain techniques available and the limited practical use that is made in the clinical scenario. This paper reviews the current state-of-the-art and provides insights into future directions of multi-domain instrumental approaches in the clinical assessment of patients involved in neuromotor rehabilitation. We also summarize the main achievements and challenges of using multi-domain approaches in the assessment of rehabilitation for various neurological disorders affecting motor functions. Our results showed that multi-domain approaches combine information and measurements from different tools and biological signals, such as kinematics, electromyography (EMG), electroencephalography (EEG), near-infrared spectroscopy (NIRS), and clinical scales, to provide a comprehensive and objective evaluation of patients' state and recovery. This multi-domain approach permits the progress of research in clinical and rehabilitative practice and the understanding of the pathophysiological changes occurring during and after rehabilitation. We discuss the potential benefits and limitations of multi-domain approaches for clinical decision-making, personalized therapy, and prognosis. We conclude by highlighting the need for more standardized methods, validation studies, and the integration of multi-domain approaches in clinical practice and research.
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Affiliation(s)
- Alessandro Scano
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Eleonora Guanziroli
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Cristina Brambilla
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Caterina Amendola
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.A.); (R.R.)
| | - Ileana Pirovano
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
| | - Giulio Gasperini
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Franco Molteni
- Villa Beretta Rehabilitation Center, Via N. Sauro 17, 23845 Costa Masnaga, Italy; (E.G.); (G.G.); (F.M.)
| | - Lorenzo Spinelli
- Institute for Photonics and Nanotechnology (IFN), Italian National Research Council (CNR), Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Lorenzo Molinari Tosatti
- Institute of Intelligent Industrial Systems and Technologies for Advanced Manufacturing (STIIMA), Italian Council of National Research (CNR), Via A. Corti 12, 20133 Milan, Italy; (C.B.); (L.M.T.)
| | - Giovanna Rizzo
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
| | - Rebecca Re
- Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy; (C.A.); (R.R.)
- Institute for Photonics and Nanotechnology (IFN), Italian National Research Council (CNR), Piazza Leonardo da Vinci 32, 20133 Milan, Italy;
| | - Alfonso Mastropietro
- Institute of Biomedical Technologies (ITB), Italian National Research Council (CNR), Via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (G.R.); (A.M.)
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Zhu F, Li Y, Shi Z, Shi W. TV-NARX and Coiflets WPT based time-frequency Granger causality with application to corticomuscular coupling in hand-grasping. Front Neurosci 2022; 16:1014495. [PMID: 36248661 PMCID: PMC9560889 DOI: 10.3389/fnins.2022.1014495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/12/2022] [Indexed: 11/21/2022] Open
Abstract
The study of the synchronous characteristics and functional connections between the functional cortex and muscles of hand-grasping movements is important in basic research, clinical disease diagnosis and rehabilitation evaluation. The electroencephalogram (EEG) and electromyographic signal (EMG) signals of 15 healthy participants were used to analyze the corticomuscular coupling under grasping movements by holding three different objects, namely, card, ball, and cup by using the time-frequency Granger causality method based on time-varying nonlinear autoregressive with exogenous input (TV-NARX) model and Coiflets wavelet packet transform. The results show that there is a bidirectional coupling between cortex and muscles under grasping movement, and it is mainly reflected in the beta and gamma frequency bands, in which there is a statistically significant difference (p < 0.05) among the different grasping actions during the movement execution period in the beta frequency band, and a statistically significant difference (p < 0.1) among the different grasping actions during the movement preparation period in the gamma frequency band. The results show that the proposed method can effectively characterize the EEG-EMG synchronization features and functional connections in different frequency bands during the movement preparation and execution phases in the time-frequency domain, and reveal the neural control mechanism of sensorimotor system to control the hand-grasping function achievement by regulating the intensity of neuronal synchronization oscillations.
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Affiliation(s)
- Feifei Zhu
- College of Electrical Engineering and Automation, Fuzhou University, Fuzhou, China
- Fujian Provincial Key Laboratory of Medical Instrument and Pharmaceutical Technology, Fuzhou University, Fuzhou, China
| | - Yurong Li
- College of Electrical Engineering and Automation, Fuzhou University, Fuzhou, China
- Fujian Provincial Key Laboratory of Medical Instrument and Pharmaceutical Technology, Fuzhou University, Fuzhou, China
- *Correspondence: Yurong Li
| | - Zhengyi Shi
- College of Electrical Engineering and Automation, Fuzhou University, Fuzhou, China
- Fujian Provincial Key Laboratory of Medical Instrument and Pharmaceutical Technology, Fuzhou University, Fuzhou, China
| | - Wuxiang Shi
- College of Electrical Engineering and Automation, Fuzhou University, Fuzhou, China
- Fujian Provincial Key Laboratory of Medical Instrument and Pharmaceutical Technology, Fuzhou University, Fuzhou, China
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Hodics T, Cohen LG, Pezzullo JC, Kowalske K, Dromerick AW. Barriers to Enrollment in Post-Stroke Brain Stimulation in a Racially and Ethnically Diverse Population. Neurorehabil Neural Repair 2022; 36:596-602. [PMID: 35925037 DOI: 10.1177/15459683221088861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Brain stimulation is an adjuvant strategy to promote rehabilitation after stroke. Here, we evaluated the influence of inclusion/exclusion criteria on enrollment in a transcranial direct current stimulation (tDCS) trial in the context of a racially/ethnically diverse acute stroke service at University of Texas Southwestern (UTSW). METHODS 3124 (59.7 ± 14.5 years) racially/ethnically diverse (38.4% non-Hispanic white, (W), Hispanic (H) 22%, African American (AA) 33.5%, Asian (A) 2.3%) patients were screened in the acute stroke service at UTSW. Demographics, stroke characteristics, and reasons for exclusion were recorded prospectively. RESULTS 2327 (74.5%) patients had a verified stroke. Only 44 of them (1.9%) were eligible. Causes for exclusion included in order of importance: (1) magnitude of upper extremity (UE) motor impairment, (2) prior strokes (s), (3) hemorrhagic stroke, (4) psychiatric condition or inability to follow instructions, and (5) old age, of these (2) and (4) were more common in AA patients but not in other minorities. 31 of the 44 eligible individuals were enrolled (W 1.68%, H 1.37%, AA .77%, A 3.774%). 90.5% of verified stroke patients did not exhibit contraindications for stimulation. CONCLUSIONS 3 main conclusions emerged: (a) The main limitations for inclusion in brain stimulation trials of motor recovery were magnitude of UE motor impairments and stroke lesion characteristics, (b) most stroke patients could be stimulated with tDCS without safety concerns and (c) carefully tailored inclusion criteria could increase diversity in enrollment.Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique identifier: NCT01007136.
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Affiliation(s)
- Timea Hodics
- Department of Neurology and Neurotherapeutics, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Neurology, 23534Houston Methodist Hospital, Houston, TX, USA
| | - Leonardo G Cohen
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institutes of Health, 35046National Institutes of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - John C Pezzullo
- Department of Medicine, 8368Georgetown University Medical Center, Washington, DC, USA
| | - Karen Kowalske
- Department of Physical Medicine and Rehabilitation, 12334University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexander W Dromerick
- Department of Rehabilitation Medicine and Neurology, MedStar National Rehabilitation Hospital, Washington, DC, USA.,8368Center for Brain Plasticity and Recovery, Departments of Rehabilitation Medicine and Neurology, Georgetown University Medical Center, Washington, DC USA.,Research Division, MedStar National Rehabilitation Hospital, Washington, DC, USA
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Applications of open-source software ROAST in clinical studies: A review. Brain Stimul 2022; 15:1002-1010. [PMID: 35843597 PMCID: PMC9378654 DOI: 10.1016/j.brs.2022.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/09/2022] [Accepted: 07/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background: Transcranial electrical stimulation (TES) is broadly investigated as a therapeutic technique for a wide range of neurological disorders. The electric fields induced by TES in the brain can be estimated by computational models. A realistic and volumetric approach to simulate TES (ROAST) has been recently released as an open-source software package and has been widely used in TES research and its clinical applications. Rigor and reproducibility of TES studies have recently become a concern, especially in the context of computational modeling. Methods: Here we reviewed 94 clinical TES studies that leveraged ROAST for computational modeling. When reviewing each study, we pay attention to details related to the rigor and reproducibility as defined by the locations of stimulation electrodes and the dose of stimulating current. Specifically, we compared across studies the electrode montages, stimulated brain areas, achieved electric field strength, and the relations between modeled electric field and clinical outcomes. Results: We found that over 1800 individual heads have been modeled by ROAST for more than 30 different clinical applications. Similar electric field intensities were found to be reproducible by ROAST across different studies at the same brain area under same or similar stimulation montages. Conclusion: This article reviews the use cases of ROAST and provides an overview of how ROAST has been leveraged to enhance the rigor and reproducibility of TES research and its applications.
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Lee G, Lee J, Kim J, Kim H, Chang WH, Kim YH. Whole Brain Hemodynamic Response Based on Synchrony Analysis of Brain Signals for Effective Application of HD-tDCS in Stroke Patients: An fNIRS Study. J Pers Med 2022; 12:jpm12030432. [PMID: 35330432 PMCID: PMC8949719 DOI: 10.3390/jpm12030432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/28/2022] [Accepted: 03/08/2022] [Indexed: 01/27/2023] Open
Abstract
In this study, the effective application of high-definition transcranial direct current stimulation (HD-tDCS) based on the whole brain hemodynamic response in stroke patients was investigated using functional near-infrared spectroscopy (fNIRS). The intrahemispheric and interhemispheric synchronization and cortical activity based on the time during 1 mA HD-tDCS were examined in 26 chronic cerebrovascular disease patients. At the beginning of HD-tDCS, the synchronization and brain activity in the whole brain increased rapidly and decreased after 5 min. In the middle of tDCS, the synchronization began to increase again, and strong synchronic connections were formed around the desired stimulation area. After tDCS, strong cortical activation was observed in the stimulation area, indicating that the baseline of the oxyhemoglobin (HbO) signal increased in the desired stimulation area. Therefore, the results of this study indicate that HD-tDCS can be applied efficiently to enhance the effect of tDCS. This stimulation method with tDCS can be explored clinically for more neurorehabilitation of patients with degenerative brain diseases.
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Affiliation(s)
- Gihyoun Lee
- Department of Health Sciences and Technology, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06351, Korea; (G.L.); (J.K.); (H.K.)
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Jungsoo Lee
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi 39177, Korea;
| | - Jinuk Kim
- Department of Health Sciences and Technology, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06351, Korea; (G.L.); (J.K.); (H.K.)
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Heegoo Kim
- Department of Health Sciences and Technology, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06351, Korea; (G.L.); (J.K.); (H.K.)
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Yun-Hee Kim
- Department of Health Sciences and Technology, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06351, Korea; (G.L.); (J.K.); (H.K.)
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
- Department of Medical Device Management & Research, Department of Digital Health, The Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06351, Korea
- Correspondence:
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Guo Z, Zhou S, Ji K, Zhuang Y, Song J, Nam C, Hu X, Zheng Y. Corticomuscular integrated representation of voluntary motor effort in robotic control for wrist-hand rehabilitation after stroke. J Neural Eng 2022; 19. [PMID: 35193124 DOI: 10.1088/1741-2552/ac5757] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/22/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The central-to-peripheral voluntary motor effort (VME) in physical practice of the paretic limb is a dominant force for driving functional neuroplasticity on motor restoration post-stroke. However, current rehabilitation robots isolated the central and peripheral involvements in the control design, resulting in limited rehabilitation effectiveness. The purpose of this study was to design a corticomuscular coherence (CMC) and electromyography (EMG)-driven (CMC-EMG-driven) system with central-and-peripheral integrated representation of VME for wrist-hand rehabilitation after stroke. APPROACH The CMC-EMG-driven control was developed in a neuromuscular electrical stimulation (NMES)-robot system, i.e., CMC-EMG-driven NMES-robot system, to instruct and assist the wrist-hand extension and flexion in persons after stroke. A pilot single-group trial of 20 training sessions was conducted with the developed system to assess the feasibility for wrist-hand practice on the chronic strokes (n=16). The rehabilitation effectiveness was evaluated through clinical assessments, CMC, and EMG activation levels. MAIN RESULTS The trigger success rate and laterality index (LI) of CMC were significantly increased in wrist-hand extension across training sessions (p<0.05). After the training, significant improvements in the target wrist-hand joints and suppressed compensation from the proximal shoulder-elbow joints were observed through the clinical scores and EMG activation levels (p<0.05). The central-to-peripheral VME distribution across upper extremity (UE) muscles was also significantly improved, as revealed by the CMC values (p<0.05). SIGNIFICANCE Precise wrist-hand rehabilitation was achieved by the developed system, presenting suppressed cortical and muscular compensation from the contralesional hemisphere and the proximal UE, and improved distribution of the central-and-peripheral VME on UE muscles.
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Affiliation(s)
- Ziqi Guo
- The Hong Kong Polytechnic University, Rm S107a, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Kowloon, Nil, HONG KONG
| | - Sa Zhou
- The Hong Kong Polytechnic University, Rm S107a, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Hong Kong, Kowloon, HONG KONG
| | - Kailai Ji
- The Hong Kong Polytechnic University, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Kowloon, Hong Kong, HONG KONG
| | - Yongqi Zhuang
- Biomedical Engineering, Hong Kong Polytechnic University, BME PolyU, Kowloon, HONG KONG
| | - Jie Song
- The Hong Kong Polytechnic University, Rm S107a, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Hong Kong, Kowloon, Nil, HONG KONG
| | - Chingyi Nam
- The Hong Kong Polytechnic University, Rm S107a, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Hong Kong, Kowloon, Nil, HONG KONG
| | - Xiaoling Hu
- Biomedical Engineering, Hong Kong Polytechnic University, Rm ST420, Dept. of BME, PolyU, Hung H, Hung Hom, Kowloon, Hong Kong, Kowloon, HONG KONG
| | - Yongping Zheng
- Biomedical Engineering, The Hong Kong Polytechnic University, BME PolyU, Hong Kong, Nil, CHINA
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Brambilla C, Pirovano I, Mira RM, Rizzo G, Scano A, Mastropietro A. Combined Use of EMG and EEG Techniques for Neuromotor Assessment in Rehabilitative Applications: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:7014. [PMID: 34770320 PMCID: PMC8588321 DOI: 10.3390/s21217014] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/22/2022]
Abstract
Electroencephalography (EEG) and electromyography (EMG) are widespread and well-known quantitative techniques used for gathering biological signals at cortical and muscular levels, respectively. Indeed, they provide relevant insights for increasing knowledge in different domains, such as physical and cognitive, and research fields, including neuromotor rehabilitation. So far, EEG and EMG techniques have been independently exploited to guide or assess the outcome of the rehabilitation, preferring one technique over the other according to the aim of the investigation. More recently, the combination of EEG and EMG started to be considered as a potential breakthrough approach to improve rehabilitation effectiveness. However, since it is a relatively recent research field, we observed that no comprehensive reviews available nor standard procedures and setups for simultaneous acquisitions and processing have been identified. Consequently, this paper presents a systematic review of EEG and EMG applications specifically aimed at evaluating and assessing neuromotor performance, focusing on cortico-muscular interactions in the rehabilitation field. A total of 213 articles were identified from scientific databases, and, following rigorous scrutiny, 55 were analyzed in detail in this review. Most of the applications are focused on the study of stroke patients, and the rehabilitation target is usually on the upper or lower limbs. Regarding the methodological approaches used to acquire and process data, our results show that a simultaneous EEG and EMG acquisition is quite common in the field, but it is mostly performed with EMG as a support technique for more specific EEG approaches. Non-specific processing methods such as EEG-EMG coherence are used to provide combined EEG/EMG signal analysis, but rarely both signals are analyzed using state-of-the-art techniques that are gold-standard in each of the two domains. Future directions may be oriented toward multi-domain approaches able to exploit the full potential of combined EEG and EMG, for example targeting a wider range of pathologies and implementing more structured clinical trials to confirm the results of the current pilot studies.
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Affiliation(s)
- Cristina Brambilla
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy; (C.B.); (R.M.M.); (A.S.)
| | - Ileana Pirovano
- Istituto di Tecnologie Biomediche (ITB), Consiglio Nazionale delle Ricerche (CNR), via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (A.M.)
| | - Robert Mihai Mira
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy; (C.B.); (R.M.M.); (A.S.)
| | - Giovanna Rizzo
- Istituto di Tecnologie Biomediche (ITB), Consiglio Nazionale delle Ricerche (CNR), via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (A.M.)
| | - Alessandro Scano
- Istituto di Sistemi e Tecnologie Industriali Intelligenti per il Manifatturiero Avanzato (STIIMA), Consiglio Nazionale delle Ricerche (CNR), Via Previati 1/E, 23900 Lecco, Italy; (C.B.); (R.M.M.); (A.S.)
| | - Alfonso Mastropietro
- Istituto di Tecnologie Biomediche (ITB), Consiglio Nazionale delle Ricerche (CNR), via Fratelli Cervi 93, 20054 Segrate, Italy; (I.P.); (A.M.)
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12
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Bao SC, Chen C, Yuan K, Yang Y, Tong RKY. Disrupted cortico-peripheral interactions in motor disorders. Clin Neurophysiol 2021; 132:3136-3151. [PMID: 34749233 DOI: 10.1016/j.clinph.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/08/2021] [Accepted: 09/19/2021] [Indexed: 11/15/2022]
Abstract
Motor disorders may arise from neurological damage or diseases at different levels of the hierarchical motor control system and side-loops. Altered cortico-peripheral interactions might be essential characteristics indicating motor dysfunctions. By integrating cortical and peripheral responses, top-down and bottom-up cortico-peripheral coupling measures could provide new insights into the motor control and recovery process. This review first discusses the neural bases of cortico-peripheral interactions, and corticomuscular coupling and corticokinematic coupling measures are addressed. Subsequently, methodological efforts are summarized to enhance the modeling reliability of neural coupling measures, both linear and nonlinear approaches are introduced. The latest progress, limitations, and future directions are discussed. Finally, we emphasize clinical applications of cortico-peripheral interactions in different motor disorders, including stroke, neurodegenerative diseases, tremor, and other motor-related disorders. The modified interaction patterns and potential changes following rehabilitation interventions are illustrated. Altered coupling strength, modified coupling directionality, and reorganized cortico-peripheral activation patterns are pivotal attributes after motor dysfunction. More robust coupling estimation methodologies and combination with other neurophysiological modalities might more efficiently shed light on motor control and recovery mechanisms. Future studies with large sample sizes might be necessary to determine the reliabilities of cortico-peripheral interaction measures in clinical practice.
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Affiliation(s)
- Shi-Chun Bao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Cheng Chen
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Kai Yuan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong
| | - Yuan Yang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Tulsa, OK, USA; Laureate Institute for Brain Research, Tulsa, OK, USA; Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Raymond Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong.
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13
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Cortico-muscular interaction to monitor the effects of neuromuscular electrical stimulation pedaling training in chronic stroke. Comput Biol Med 2021; 137:104801. [PMID: 34481180 DOI: 10.1016/j.compbiomed.2021.104801] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/21/2022]
Abstract
Neuromuscular electrical stimulation (NMES) has been widely utilized in post-stroke motor restoration. However, its impact on the closed-loop sensorimotor control process remains largely unclear. This is the first study to investigate the directional changes in cortico-muscular interactions after repetitive rehabilitation training by measuring the noninvasive electroencephalogram (EEG) and electromyography (EMG) signals. In this study, 10 subjects with chronic stroke received 20 sessions of NMES-pedaling interventions, and each training session included three 10-min NMES-driven pedaling trials. In addition, pre- and post-intervention assessments of lower limb isometric contraction were conducted before and after the whole NMES-pedaling interventions. The EEG (128 channels) and EMG (3 bilateral lower limb sensors) signals were collected during the isometric contraction tasks for the paretic and non-paretic lower limbs. Both the cortico-muscular coherence (CMC) and generalized partial directed coherence (GPDC) values were analyzed between eight selected EEG channels in the central primary motor cortex and EMG channels. The results revealed significant clinical improvements. Additionally, rehabilitation training facilitated cortico-muscular interaction of the ipsilesional brain and paretic lower limbs (p = 0.004). Moreover, both the descending and ascending cortico-muscular pathways were altered after NMES-training (p = 0.001, p < 0.001). Therefore, the results implied potential applications of EEG-EMG in understanding neuromuscular changes during the post-stroke motor rehabilitation process.
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Wang T, Kleiven S, Li X. Electroosmosis Based Novel Treatment Approach for Cerebral Edema. IEEE Trans Biomed Eng 2021; 68:2645-2653. [PMID: 33338011 DOI: 10.1109/tbme.2020.3045916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Cerebral edema characterized as an abnormal accumulation of interstitial fluid has not been treated effectively. We propose a novel edema treatment approach to drive edematous fluid out of the brain by direct current utilizing brain tissue's electroosmotic property. METHODS A finite element (FE) head model is developed and employed to assess the feasibility of the approach. First, the capacity of the model for electric field prediction is validated against human experiments. Second, two electrode configurations (S and D-montage) are designed to evaluate the distribution of the electric field, electroosmotic flow (EOF), current density, and temperature across the brain under an applied direct current. RESULTS The S-montage is shown to induce an average EOF velocity of 7e-4 mm/s underneath the anode by a voltage of 15 V, and the D-montage induces a velocity of 9e-4 mm/s by a voltage of 5 V. Meanwhile, the brain temperature in both configurations is below 38 °C, which is within the safety range. Further, the magnitude of EOF is proportional to the electric field, and the EOF direction follows the current flow from anode to cathode. The EOF velocity in the white matter is significantly higher than that in the gray matter under the anode where the fluid is to be drawn out. CONCLUSION The proposed electroosmosis based approach allows alleviating brain edema within the critical time window by direct current. SIGNIFICANCE The approach may be further developed as a new treatment solely or as a complement to existing conventional treatments of edema.
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15
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Yang D, Shin YI, Hong KS. Systemic Review on Transcranial Electrical Stimulation Parameters and EEG/fNIRS Features for Brain Diseases. Front Neurosci 2021; 15:629323. [PMID: 33841079 PMCID: PMC8032955 DOI: 10.3389/fnins.2021.629323] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/25/2021] [Indexed: 01/09/2023] Open
Abstract
Background Brain disorders are gradually becoming the leading cause of death worldwide. However, the lack of knowledge of brain disease’s underlying mechanisms and ineffective neuropharmacological therapy have led to further exploration of optimal treatments and brain monitoring techniques. Objective This study aims to review the current state of brain disorders, which utilize transcranial electrical stimulation (tES) and daily usable noninvasive neuroimaging techniques. Furthermore, the second goal of this study is to highlight available gaps and provide a comprehensive guideline for further investigation. Method A systematic search was conducted of the PubMed and Web of Science databases from January 2000 to October 2020 using relevant keywords. Electroencephalography (EEG) and functional near-infrared spectroscopy were selected as noninvasive neuroimaging modalities. Nine brain disorders were investigated in this study, including Alzheimer’s disease, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, epilepsy, Parkinson’s disease, stroke, schizophrenia, and traumatic brain injury. Results Sixty-seven studies (1,385 participants) were included for quantitative analysis. Most of the articles (82.6%) employed transcranial direct current stimulation as an intervention method with modulation parameters of 1 mA intensity (47.2%) for 16–20 min (69.0%) duration of stimulation in a single session (36.8%). The frontal cortex (46.4%) and the cerebral cortex (47.8%) were used as a neuroimaging modality, with the power spectrum (45.7%) commonly extracted as a quantitative EEG feature. Conclusion An appropriate stimulation protocol applying tES as a therapy could be an effective treatment for cognitive and neurological brain disorders. However, the optimal tES criteria have not been defined; they vary across persons and disease types. Therefore, future work needs to investigate a closed-loop tES with monitoring by neuroimaging techniques to achieve personalized therapy for brain disorders.
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Affiliation(s)
- Dalin Yang
- School of Mechanical Engineering, Pusan National University, Busan, South Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan-si, South Korea
| | - Keum-Shik Hong
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan-si, South Korea
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16
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Workman CD, Fietsam AC, Rudroff T. Different Effects of 2 mA and 4 mA Transcranial Direct Current Stimulation on Muscle Activity and Torque in a Maximal Isokinetic Fatigue Task. Front Hum Neurosci 2020; 14:240. [PMID: 32714170 PMCID: PMC7344304 DOI: 10.3389/fnhum.2020.00240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/02/2020] [Indexed: 12/13/2022] Open
Abstract
Studies investigating the effects of transcranial direct current stimulation (tDCS) on fatigue and muscle activity have elicited measurable improvements using stimulation intensities ≤2 mA and submaximal effort tasks. The purpose of this study was to determine the effects of 2 mA and 4 mA anodal tDCS over the primary motor cortex (M1) on performance fatigability and electromyographic (EMG) activity of the leg muscles during a maximal isokinetic task in healthy young adults. A double-blind, randomized, sham-controlled crossover study design was applied. Twenty-seven active young adults completed four sessions, each spaced by 5-8 days. During session 1, dominance was verified with isokinetic strength testing, and subjects were familiarized with the fatigue task (FT). The FT protocol included 40 continuous maximum isokinetic contractions of the knee extensors and flexors (120°/s, concentric/concentric). During Sessions 2-4, tDCS was applied for 20 min with one of three randomly assigned intensities (sham, 2 mA or 4 mA) and the FT was repeated. The anode and cathode of the tDCS device were placed over C3 and the contralateral supraorbital area, respectively. A wireless EMG system collected muscle activity during the FT. The 2 mA tDCS condition had significantly less torque (65.9 ± 32.7 Nm) during the FT than both the sham (68.4 ± 33.9 Nm, p < 0.001) and 4 mA conditions (68.4 ± 33.9 Nm, p = 0.001). Furthermore, the 2 mA condition (33.8 ± 11.7%) had significantly less EMG activity during the FT than both the sham (39.7 ± 10.6%, p < 0.001) and 4 mA conditions (40.5 ± 13.4%, p = 0.001). Contrary to previous submaximal isometric fatigue investigations, the 2 mA tDCS condition significantly reduced torque production and EMG activity of the leg extensors during a maximal isokinetic FT compared with the sham and 4 mA conditions. Also, torque production and EMG activity in the 4 mA condition were not significantly different from sham. Thus, the effects of tDCS, and the underlying mechanisms, might not be the same for different tasks and warrants more investigation.
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Affiliation(s)
- Craig David Workman
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, United States
| | - Alexandra C Fietsam
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, United States
| | - Thorsten Rudroff
- Department of Health and Human Physiology, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA, United States.,Department of Neurology, Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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17
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Bao SC, Khan A, Song R, Kai-yu Tong R. Rewiring the Lesioned Brain: Electrical Stimulation for Post-Stroke Motor Restoration. J Stroke 2020; 22:47-63. [PMID: 32027791 PMCID: PMC7005350 DOI: 10.5853/jos.2019.03027] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/06/2023] Open
Abstract
Electrical stimulation has been extensively applied in post-stroke motor restoration, but its treatment mechanisms are not fully understood. Stimulation of neuromotor control system at multiple levels manipulates the corresponding neuronal circuits and results in neuroplasticity changes of stroke survivors. This rewires the lesioned brain and advances functional improvement. This review addresses the therapeutic mechanisms of different stimulation modalities, such as noninvasive brain stimulation, peripheral electrical stimulation, and other emerging techniques. The existing applications, the latest progress, and future directions are discussed. The use of electrical stimulation to facilitate post-stroke motor recovery presents great opportunities in terms of targeted intervention and easy applicability. Further technical improvements and clinical studies are required to reveal the neuromodulatory mechanisms and to enhance rehabilitation therapy efficiency in stroke survivors and people with other movement disorders.
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Affiliation(s)
- Shi-chun Bao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Ahsan Khan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Rong Song
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Raymond Kai-yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
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18
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Bao SC, Leung WC, K Cheung VC, Zhou P, Tong KY. Pathway-specific modulatory effects of neuromuscular electrical stimulation during pedaling in chronic stroke survivors. J Neuroeng Rehabil 2019; 16:143. [PMID: 31744520 PMCID: PMC6862792 DOI: 10.1186/s12984-019-0614-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/24/2019] [Indexed: 12/25/2022] Open
Abstract
Background Neuromuscular electrical stimulation (NMES) is extensively used in stroke motor rehabilitation. How it promotes motor recovery remains only partially understood. NMES could change muscular properties, produce altered sensory inputs, and modulate fluctuations of cortical activities; but the potential contribution from cortico-muscular couplings during NMES synchronized with dynamic movement has rarely been discussed. Method We investigated cortico-muscular interactions during passive, active, and NMES rhythmic pedaling in healthy subjects and chronic stroke survivors. EEG (128 channels), EMG (4 unilateral lower limb muscles) and movement parameters were measured during 3 sessions of constant-speed pedaling. Sensory-level NMES (20 mA) was applied to the muscles, and cyclic stimulation patterns were synchronized with the EMG during pedaling cycles. Adaptive mixture independent component analysis was utilized to determine the movement-related electro-cortical sources and the source dipole clusters. A directed cortico-muscular coupling analysis was conducted between representative source clusters and the EMGs using generalized partial directed coherence (GPDC). The bidirectional GPDC was compared across muscles and pedaling sessions for post-stroke and healthy subjects. Results Directed cortico-muscular coupling of NMES cycling was more similar to that of active pedaling than to that of passive pedaling for the tested muscles. For healthy subjects, sensory-level NMES could modulate GPDC of both ascending and descending pathways. Whereas for stroke survivors, NMES could modulate GPDC of only the ascending pathways. Conclusions By clarifying how NMES influences neuromuscular control during pedaling in healthy and post-stroke subjects, our results indicate the potential limitation of sensory-level NMES in promoting sensorimotor recovery in chronic stroke survivors.
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Affiliation(s)
- Shi-Chun Bao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing-Cheong Leung
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C K Cheung
- School of Biomedical Sciences, and The Gerald Choa Neuroscience Centre, The Chinese University of Hong Kong, Hong Kong, China.,The KIZ-CUHK Joint Laboratory of Bioresources and Molecular Research of Common Diseases, The Chinese University of Hong Kong, Hong Kong, China
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, Houston, 77030, TX, USA.,TIRR Memorial Hermann Research Center, Houston, 77030, TX, USA
| | - Kai-Yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China. .,Brain and Mind Institute, The Chinese University of Hong Kong, Hong Kong, China.
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