Overactivation of the supplementary motor area in chronic stroke patients

Changes in brain functional connectivity and muscle strength independent of elbow flexor atrophy following upper limb immobilization in young females

Muscle disuse induces a decline in muscle strength that exceeds the rate and magnitude of muscle atrophy, suggesting that factors beyond the muscle contribute to strength loss. The purpose of this study was to characterize changes in the brain and neuromuscular system in addition to muscle size following upper limb immobilization in young females. Using a within-participant, unilateral design, 12 females (age: 20.6 ± 2.1 years) underwent 14 days of upper arm immobilization using an elbow brace and sling. Bilateral measures of muscle strength (isometric and isokinetic dynamometry), muscle size (magnetic resonance imaging), voluntary muscle activation capacity, corticospinal excitability, cortical thickness and resting-state functional connectivity were collected before and after immobilization. Immobilization induced a significant decline in isometric elbow flexion (-21.3 ± 19.2%, interaction: P = 0.0440) and extension (-19.9 ± 15.7%, interaction: P = 0.0317) strength in the immobilized arm only. There was no significant effect of immobilization on elbow flexor cross-sectional area (CSA) (-1.2 ± 2.4%, interaction: P = 0.466), whereas elbow extensor CSA decreased (-2.9 ± 2.9%, interaction: P = 0.0177) in the immobilized arm. Immobilization did not differentially alter voluntary activation capacity, corticospinal excitability, or cortical thickness (P > 0.05); however, there were significant changes in the functional connectivity of brain regions related to movement planning and error detection (P < 0.05). This study reveals that elbow flexor strength loss can occur in the absence of significant elbow flexor muscle atrophy, and that the brain represents a site of functional adaptation in response to upper limb immobilization in young females.

Why is there an error negativity on correct trials? A reappraisal

In healthy subjects, the Error Negativity (Ne) was initially reported on errors and on partial errors, only. Later on, application of the Laplacian transformation to EEG data unmasked a Ne-like wave (Nc) that shares a main generator with the Ne, suggesting that the Nc is just a small Ne. However, the reason why a small Ne would persist on correct responses remains unclear. Now, sometimes, subthreshold EMG activations in the muscles corresponding to correct responses (not strong enough to reach the response threshold) can precede full-blown correct responses. These "partially correct" activities seem to correspond to (force) execution errors, as they evoke a sizeable Ne. Within the frames of the Reward Value and Prediction Model or of the Predicted Response-Outcome model we propose that the action monitoring system evokes a Ne/Nc on correct responses because, even when a correct choice has been made, the accuracy of response (force) execution cannot be fully predicted. If this interpretation is correct, it can be assumed that, once these execution errors have been corrected, the correctness of the (full-blown) correcting response is highly predictable. Consequently, they should evoke a smaller Nc/Ne than "pure" correct responses. We show, that for the response thresholds set in the present experiment, the correcting response of the trials containing a partially correct activation evoke no identifiable Nc at all. Therefore it seems that there usually is an Error Negativity on correct trials because the correctness of response (force) execution cannot be fully predicted.

The Effects of Vestibular Rehabilitation on Poststroke Fatigue: A Randomized Controlled Trial Study

Background

A major complication caused by stroke is poststroke fatigue (PSF), and by causing limitations in doing activities of daily living (ADL), it can lower the quality of life.

Objective

The present study is an attempt to examine the effects of vestibular rehabilitation on BADL (Basic Activities of Daily Living), fatigue, depression, and Lawton Instrumental Activities of Daily Living (IADL) in patients with stroke.

Method

Patients with a history of stroke took part voluntarily in a single-blind clinical trial. The participants were allocated to control and experimental groups randomly. The experimental group attended 24 sessions of vestibular rehabilitation protocol, while the control group received the standard rehabilitation (including three sessions per week each for around 60 min). To measure fatigue, the Fatigue Impact Scale (FIS) and the Fatigue Assessment Scale (FAS) were used. Depression, BADL, and IADL were measured using the Beck Depression Inventory-II (BDI-II), Barthel Index (BI), and Lawton Instrumental Activities of Daily Living, respectively. All changes were measured from the baseline after the intervention.

Results

Significant improvement was found in the experimental group compared to the control group (p < 0.05) in FIS (physical, cognition, and social subscales), FAS, BDI-II, BADL, and IADL. Moreover, the results showed small to medium and large effect sizes for the physical subscale of FIS and FAS scores based on Cohen's d, respectively; however, no significant difference was found in terms of cognition and social subscales of FIS, BDI-II, BADL, and IADL scores.

Conclusion

It is possible to improve fatigue, depression, and independence in BADL and IADL using vestibular rehabilitation. Thus, it is an effective intervention in case of stroke, which is also well tolerated.

Structure and function of corticospinal projection originating from supplementary motor area

PURPOSE

The importance of supplementary motor area (SMA) for motor function and compensation for primary motor area (M1) has received increased attention.

METHODS

We used diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS) to evaluate structure and function of corticospinal projection originating from SMA. Fibers of corticospinal projection originating from M1 (CST) and SMA (ACST) were analyzed. ACST originating from mesial SMA area formed separate white matter bundles leaving the anterior part of M1 area, which then entered the posterior limb of the internal capsule. Projection and overlap of both CST and ACST were detected on medulla.

RESULTS

Fibers of contralesional ACST were more than that of ipsilesional ACST in patients with SMA tumors (p<0.05). In patients with SMA tumor, all patients experienced temporary akinesia postoperatively. Seven hundred forty-one fibers of ipsilateral ACST and no fibers of ipsilateral CST were detected in the patient with M1 glioma, while most of contralateral limb movement was preserved. MEP could be evoked by stimulating SMA area as well as M1 area. ACST originated from SMA area and projected to the medial medulla.

CONCLUSION

SMA area and ACST integrity contributed to contralateral motor function and were a compensation for M1 lesion and damaged CST.

Intervention-induced changes in neural connectivity during motor preparation may affect cortical activity at motor execution

Effective interventions have demonstrated the ability to improve motor function by reengaging ipsilesional resources, which appears to be critical and feasible for hand function recovery even in individuals with severe chronic stroke. However, previous studies focus on changes in brain activity related to motor execution. How changes in motor preparation may facilitate these changes at motor execution is still unclear. To address this question, 8 individuals with severe chronic hemiparetic stroke participated in a device-assisted intervention for seven weeks. We then quantified changes in both coupling between regions during motor preparation and changes in topographical cortical activity at motor execution for both hand opening in isolation and together with the shoulder using high-density EEG. We hypothesized that intervention-induced changes in cortico-cortico interactions during motor preparation would lead to changes in activity at motor execution specifically towards an increased reliance on the ipsilesional hemisphere. In agreement with this hypothesis, we found that, following the intervention, individuals displayed a reduction in coupling from ipsilesional M1 to contralesional M1 within gamma frequencies during motor preparation for hand opening. This was followed by a reduction in activity in the contralesional primary sensorimotor cortex during motor execution. Similarly, during lifting and opening, a shift to negative coupling within ipsilesional M1 from gamma to beta frequencies was accompanied by an increase in ipsilesional primary sensorimotor cortex activity following the intervention. Together, these results show that intervention-induced changes in coupling within or between motor regions during motor preparation may affect cortical activity at execution.

Errors and Action Monitoring: Errare Humanum Est Sed Corrigere Possibile

It was recognized long ago by Seneca through his famous "errare humanum est." that the human information processing system is intrinsically fallible. What is newer is the fact that, at least in sensorimotor information processing realized under time pressure, errors are largely dealt with by several (psycho)physiological-specific mechanisms: prevention, detection, inhibition, correction, and, if these mechanisms finally fail, strategic behavioral adjustments following errors. In this article, we review several datasets from laboratory experiments, showing that the human information processing system is well equipped not only to detect and correct errors when they occur but also to detect, inhibit, and correct them even before they fully develop. We argue that these (psycho)physiological mechanisms are important to consider when the brain works in everyday settings in order to render work systems more resilient to human errors and, thus, safer.

The functional role of beta-oscillations in the supplementary motor area during reaching and grasping after stroke: A question of structural damage to the corticospinal tract

Hand motor function is often severely affected in stroke patients. Non-satisfying recovery limits reintegration into normal daily life. Understanding stroke-related network changes and identifying common principles that might underlie recovered motor function is a prerequisite for the development of interventional therapies to support recovery. Here, we combine the evaluation of functional activity (multichannel electroencephalography) and structural integrity (diffusion tensor imaging) in order to explain the degree of residual motor function in chronic stroke patients. By recording neural activity during a reaching and grasping task that mimics activities of daily living, the study focuses on deficit-related neural activation patterns. The study showed that the functional role of movement-related beta desynchronization in the supplementary motor area (SMA) for residual hand motor function in stroke patients depends on the microstructural integrity of the corticospinal tract (CST). In particular, in patients with damaged CST, stronger task-related activity in the SMA was associated with worse residual motor function. Neither CST damage nor functional brain activity alone sufficiently explained residual hand motor function. The findings suggest a central role of the SMA in the motor network during reaching and grasping in stroke patients, the degree of functional relevance of the SMA is depending on CST integrity.

The Way We Do the Things We Do: How Cognitive Contexts Shape the Neural Dynamics of Motor Areas in Humans

In spontaneously triggered movements the nature of the executed response has a prominent effect on the intensity and the dynamics of motor areas recruitment. Under time pressure, the time course of motor areas recruitment is necessarily shorter than that of spontaneously triggered movements because RTs may be extremely short. Moreover, different classes of RT tasks allow examining the nature and the dynamics of motor areas activation in different cognitive contexts. In the present article, we review experimental results obtained from high temporal resolution methods (mainly, but not exclusively EEG ones), during voluntary movements; these results indicate that the activity of motor areas not only depends on the nature of the executed movement but also on the cognitive context in which these movements have to be executed.

Frequency-specific alterations of regional homogeneity in subcortical stroke patients with different outcomes in hand function

Emerging evidence has suggested that abnormalities in regional spontaneous brain activity following stroke may be detected by intrinsic low-frequency oscillations (LFO) in resting-state functional MRI (R-fMRI). However, the relationship between hand function outcomes following stroke and local LFO synchronization in different frequency bands is poorly understood. In this study, we performed R-fMRI to examine the regional homogeneity (ReHo) at three different frequency bands (slow-5: .01-.027 Hz; slow-4: .027-.08 Hz; and typical band: .01-.1 Hz) in 26 stroke patients with completely paralyzed hands (CPH) and 26 matched patients with partially paralyzed hands (PPH). Compared to the PPH group, decreased ReHo in the bilateral cerebellum posterior lobes and the contralesional cerebellum anterior lobe was observed in the slow-5 band and the slow-4 band in the CPH group, respectively. The mean ReHo values in these regions were positively correlated with the Fugl-Meyer assessment (FMA) scores. In contrast, increased ReHo in the contralesional supplementary motor area and the contralesional superior temporal gyrus was observed in the slow-4 band and the slow-5 band, respectively. The mean ReHo values in these regions were negatively correlated with the FMA scores. Importantly, significant interactions were identified between the frequency bands and the subgroups of patients in the contralesional precentral gyrus and middle frontal gyrus. These findings indicate that frequency-dependent R-fMRI patterns may serve as potential biomarkers of the neural substrates associated with hand function outcomes following stroke.

Auditory Target and Novelty Processing in Patients with Unilateral Hippocampal Sclerosis: A Current-Source Density Study

The capacity to respond to novel events is crucial for adapting to the constantly changing environment. Here, we recorded 29-channel Event Related Brain Potentials (ERPs) during an active auditory novelty oddball paradigm and used for the first time Current Source Density-transformed Event Related Brain Potentials and associated time-frequency spectra to study target and novelty processing in a group of epileptic patients with unilateral damage of the hippocampus (N = 18) and in healthy matched control participants (N = 18). Importantly, we used Voxel-Based Morphometry to ensure that our group of patients had a focal unilateral damage restricted to the hippocampus and especially its medial part. We found a clear deficit for target processing at the behavioral level. In addition, compared to controls, our group of patients presented (i) a reduction of theta event-related synchronization (ERS) for targets and (ii) a reduction and delayed P3a source accompanied by reduced theta and low-beta ERS and alpha event-related synchronization (ERD) for novel stimuli. These results suggest that the integrity of the hippocampus might be crucial for the functioning of the complex cortico-subcortical network involved in the detection of novel and target stimuli.

Issues and considerations for using the scalp surface Laplacian in EEG/ERP research: A tutorial review

Despite the recognition that the surface Laplacian may counteract adverse effects of volume conduction and recording reference for surface potential data, electrophysiology as a discipline has been reluctant to embrace this approach for data analysis. The reasons for such hesitation are manifold but often involve unfamiliarity with the nature of the underlying transformation, as well as intimidation by a perceived mathematical complexity, and concerns of signal loss, dense electrode array requirements, or susceptibility to noise. We revisit the pitfalls arising from volume conduction and the mandated arbitrary choice of EEG reference, describe the basic principle of the surface Laplacian transform in an intuitive fashion, and exemplify the differences between common reference schemes (nose, linked mastoids, average) and the surface Laplacian for frequently-measured EEG spectra (theta, alpha) and standard event-related potential (ERP) components, such as N1 or P3. We specifically review common reservations against the universal use of the surface Laplacian, which can be effectively addressed by employing spherical spline interpolations with an appropriate selection of the spline flexibility parameter and regularization constant. We argue from a pragmatic perspective that not only are these reservations unfounded but that the continued predominant use of surface potentials poses a considerable impediment on the progress of EEG and ERP research.