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Liu X, Li H, Yang S, Xiao Z, Li Q, Zhang F, Ma J. Efficacy of repetitive transcranial magnetic stimulation on post-stroke cognitive impairment: A systematic and a network meta-analysis. Int J Geriatr Psychiatry 2024; 39:e6117. [PMID: 38925887 DOI: 10.1002/gps.6117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES This study aimed to evaluate the efficacy of different repetitive transcranial magnetic stimulation (rTMS) modes in stroke patients with cognitive impairment, and to rank the best option according to the outcome measures. METHODS Literature was searched in PubMed, Cochrane Library, Web of Science, Embase, SinoMed, China National Knowledge Infrastructure, Wanfang Database, and VIP Database, from database inception to September 2023. We included randomized controlled trials (RCTs) investigating the efficacy of all rTMS modes for post-stroke cognitive impairment. The selected studies assessed at least one of the following outcome measures: Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), P300 latency and amplitude, and modified Barthel Index (MBI) or BI. Two researchers independently conducted data extraction. Quality assessment was performed using RevMan 5.3 software based on the Cochrane Collaboration's tool, and statistical analysis was conducted by GeMTC 0.14.3 software and Stata 17.0 software. RESULTS The network meta-analysis included 74 RCTs with a total of 5478 patients. The best probability ranking indicated that intermittent theta burst stimulation (iTBS) was the most effective in enhancing MoCA, MMSE and MBI scores (85%, 54%, 42%, respectively), followed by 10 Hz rTMS (79%, 50%, 39%, respectively), for P300 amplitude, ≤1 Hz rTMS was ranked first (52%). CONCLUSIONS The current limited evidence suggests that iTBS may be the optimal approach for improving cognitive and daily life abilities of stroke patients, followed by 10 Hz rTMS, ≤1 Hz rTMS may be the preferred option for enhancing P300 amplitude. TRAIL REGISTRATION PROSPERO 2023 CRD42023424771 available from: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=424771.
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Affiliation(s)
- Xianying Liu
- Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, China
- Faculty of Graduate Studies, Hebei Medical University, Shijiazhuang, China
| | - Hong Li
- Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Shining Yang
- Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, China
- Physical Education College, Hebei Normal University, Shijiazhuang, China
| | - Zhenghua Xiao
- Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, China
- Physical Education College, Hebei Normal University, Shijiazhuang, China
| | - Qing Li
- Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, China
- Faculty of Graduate Studies, Hebei Medical University, Shijiazhuang, China
| | - Feng Zhang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiang Ma
- Department of Rehabilitation Medicine, Shijiazhuang People's Hospital, Shijiazhuang, China
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Nath D, Singh N, Saini M, Banduni O, Kumar N, Srivastava MVP, Mehndiratta A. Clinical potential and neuroplastic effect of targeted virtual reality based intervention for distal upper limb in post-stroke rehabilitation: a pilot observational study. Disabil Rehabil 2024; 46:2640-2649. [PMID: 37383015 DOI: 10.1080/09638288.2023.2228690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 06/18/2023] [Indexed: 06/30/2023]
Abstract
PURPOSE A library of Virtual Reality (VR) tasks has been developed for targeted post-stroke rehabilitation of distal upper extremities. The objective of this pilot study was to evaluate the clinical potential of the targeted VR-based therapeutic intervention in a small cohort of patients specifically with chronic stroke. Furthermore, our aim was to explore the possible neuronal reorganizations in corticospinal pathways in response to the distal upper limb targeted VR-intervention. METHODOLOGY Five patients with chronic stroke were enrolled in this study and were given VR-intervention of 20 sessions of 45 min each. Clinical Scales, cortical-excitability measures (using Transcranial Magnetic Stimulation): Resting Motor Threshold (RMT), and Motor Evoked Potential (MEP) amplitude, task-specific performance metrics i.e., Time taken to complete the task (TCT), smoothness of trajectory, relative % error were evaluated pre- and post-intervention to evaluate the intervention-induced improvements. RESULTS Pre-to post-intervention improvements were observed in Fugl-Meyer Assessment (both total and wrist/hand component), Modified Barthel Index, Stroke Impact Scale, Motor Assessment Scale, active range of motion at wrist, and task-specific outcome metrics. Pre-to post-intervention ipsilesional RMT reduced (mean ∼9%) and MEP amplitude increased (mean ∼29µV), indicating increased cortical excitability at post-intervention. CONCLUSION VR-training exhibited improved motor outcomes and cortical-excitability in patients with stroke. Neurophysiological changes observed in terms of improved cortical-excitability might be a consequence of plastic reorganization induced by VR-intervention.
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Affiliation(s)
- Debasish Nath
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Neha Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Megha Saini
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Onika Banduni
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
| | - Nand Kumar
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi (IITD), New Delhi, India
- Department of Biomedical Engineering, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Gama G, Conceição Matias MD, de Luiz Vânia M, de Sales Regis T, Peregrino-Filho A, de Sales Tavares J, Amorim M, Melo A. Motor and cognitive response to intensive multidisciplinary therapy: the first reported case of congenital Zika virus syndrome. Physiother Theory Pract 2024; 40:1362-1371. [PMID: 36625893 DOI: 10.1080/09593985.2023.2165887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/27/2022] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To provide a detailed description of the development of the first case of congenital Zika syndrome (CZS) to be reported in the literature worldwide. CASE DESCRIPTION This report describes the case of a child with CZS monitored from pregnancy until four years of age, with periodic evaluations of head circumference, weight, height, motor function according to the Gross Motor Function Measure (GMFM-88), and the occurrence of comorbidities. OUTCOMES The child's birth weight and length were normal (z-score = 1.1 and -1.95, respectively), while head circumference was below the expected value (z-score = -3.15). At 48 months, head circumference reached 43 cm (z-score = -4.48). During daily home physiotherapy sessions, the child achieved developmental milestones, standing unsupported at 17 months, with a GMFM-88x score of 137. With specialist therapy, the child walked independently at 36 months and a total GMFM-66 score of 214 was achieved by 42 months. In the four years of follow-up, the child was hospitalized four times for different reasons. No convulsive seizures occurred. CONCLUSIONS Despite severe neurological impairment, the child's weight and height are adequate for age, with motor and cognitive function improving over the first four years of life.
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Affiliation(s)
- Gabriela Gama
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
| | | | - Mell de Luiz Vânia
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
| | | | | | | | - Melania Amorim
- Instituto de Pesquisa Professor Jpaquim Amorim Neto and Instituto de Medicina Integral Professor Fernando Figueira
| | - Adriana Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), Paraíba, Brazil
- Campina Grande, UNIFACISA University Center, Paraíba, Brazil
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Ribeiro JAM, Oliveira SG, Ocamoto GN, Thommazo-Luporini LD, Mendes RG, Borghi-Silva A, Phillips SA, Billinger SA, Russo TL. Hemispheric lateralization, endothelial function, and arterial compliance in chronic post-stroke individuals: a cross-sectional exploratory study. Int J Neurosci 2024; 134:481-491. [PMID: 36028987 DOI: 10.1080/00207454.2022.2118597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/29/2022] [Accepted: 08/17/2022] [Indexed: 10/15/2022]
Abstract
Purpose/Aim: Cardiovascular function is controlled and regulated by a functional brain-heart axis. Although the exact mechanism is not fully understood, several studies suggest a hemispheric asymmetry in the neural control of cardiovascular function. Thus, the purpose of this study was to examine whether endothelial function and arterial compliance differ between individuals with left- and right-sided strokes.Materials and Methods: This was a cross-sectional exploratory study. Thirty individuals more than 6 months after stroke participated in the study. The endothelial function was assessed by ultrasound-measured flow-mediated dilation of the nonparetic arm brachial artery (baFMD). The arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (cfPWV) and central aortic pulse wave analysis [augmentation index (AIx), augmentation index normalized to a heart rate of 75 bpm (AIx@75) and reflection magnitude (RM)] using applanation tonometry. Results: Participants with right-sided stroke had worse endothelial function than those with left-sided stroke. This difference (baFMD = 2.51%) was significant (p = 0.037), and it represented a medium effect size (r = 0.38). Likewise, they had higher arterial stiffness than those with left-sided stroke. This difference (AIx = 10%; RM = 7%) was significant (p = 0.011; p = 0.012), and it represented a medium effect size (r = 0.48; r = 0.47).Conclusions: Our findings suggest that individuals with right-sided stroke have reduced endothelial function and arterial compliance compared to those with left-sided stroke. These data may indicate that those with right-sided strokes are more susceptible to cardiovascular events.
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Affiliation(s)
| | | | | | | | | | - Audrey Borghi-Silva
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | - Shane A Phillips
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, USA
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Center, Kansas City, USA
- KU Alzheimer's Disease Research Center, Fairway, KS, USA
| | - Thiago Luiz Russo
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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Sarasola-Sanz A, Ray AM, Insausti-Delgado A, Irastorza-Landa N, Mahmoud WJ, Brötz D, Bibián-Nogueras C, Helmhold F, Zrenner C, Ziemann U, López-Larraz E, Ramos-Murguialday A. A hybrid brain-muscle-machine interface for stroke rehabilitation: Usability and functionality validation in a 2-week intensive intervention. Front Bioeng Biotechnol 2024; 12:1330330. [PMID: 38681960 PMCID: PMC11046466 DOI: 10.3389/fbioe.2024.1330330] [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: 10/30/2023] [Accepted: 03/21/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction: The primary constraint of non-invasive brain-machine interfaces (BMIs) in stroke rehabilitation lies in the poor spatial resolution of motor intention related neural activity capture. To address this limitation, hybrid brain-muscle-machine interfaces (hBMIs) have been suggested as superior alternatives. These hybrid interfaces incorporate supplementary input data from muscle signals to enhance the accuracy, smoothness and dexterity of rehabilitation device control. Nevertheless, determining the distribution of control between the brain and muscles is a complex task, particularly when applied to exoskeletons with multiple degrees of freedom (DoFs). Here we present a feasibility, usability and functionality study of a bio-inspired hybrid brain-muscle machine interface to continuously control an upper limb exoskeleton with 7 DoFs. Methods: The system implements a hierarchical control strategy that follows the biologically natural motor command pathway from the brain to the muscles. Additionally, it employs an innovative mirror myoelectric decoder, offering patients a reference model to assist them in relearning healthy muscle activation patterns during training. Furthermore, the multi-DoF exoskeleton enables the practice of coordinated arm and hand movements, which may facilitate the early use of the affected arm in daily life activities. In this pilot trial six chronic and severely paralyzed patients controlled the multi-DoF exoskeleton using their brain and muscle activity. The intervention consisted of 2 weeks of hBMI training of functional tasks with the system followed by physiotherapy. Patients' feedback was collected during and after the trial by means of several feedback questionnaires. Assessment sessions comprised clinical scales and neurophysiological measurements, conducted prior to, immediately following the intervention, and at a 2-week follow-up. Results: Patients' feedback indicates a great adoption of the technology and their confidence in its rehabilitation potential. Half of the patients showed improvements in their arm function and 83% improved their hand function. Furthermore, we found improved patterns of muscle activation as well as increased motor evoked potentials after the intervention. Discussion: This underscores the significant potential of bio-inspired interfaces that engage the entire nervous system, spanning from the brain to the muscles, for the rehabilitation of stroke patients, even those who are severely paralyzed and in the chronic phase.
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Affiliation(s)
- Andrea Sarasola-Sanz
- Health Unit, TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - Andreas M. Ray
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | | | - Nerea Irastorza-Landa
- Health Unit, TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - Wala Jaser Mahmoud
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Doris Brötz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Carlos Bibián-Nogueras
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Florian Helmhold
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Christoph Zrenner
- Department of Neurology and Stroke, University Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
- Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Institute for Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Ulf Ziemann
- Department of Neurology and Stroke, University Tübingen, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | | | - Ander Ramos-Murguialday
- Health Unit, TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
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Caine S, Alaverdashvili M, Colbourne F, Muir GD, Paterson PG. A modified rehabilitation paradigm bilaterally increased rat extensor digitorum communis muscle size but did not improve forelimb function after stroke. PLoS One 2024; 19:e0302008. [PMID: 38603768 PMCID: PMC11008896 DOI: 10.1371/journal.pone.0302008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/26/2024] [Indexed: 04/13/2024] Open
Abstract
Malnutrition after stroke may lessen the beneficial effects of rehabilitation on motor recovery through influences on both brain and skeletal muscle. Enriched rehabilitation (ER), a combination of environmental enrichment and forelimb reaching practice, is used preclinically to study recovery of skilled reaching after stroke. However, the chronic food restriction typically used to motivate engagement in reaching practice is a barrier to using ER to investigate interactions between nutritional status and rehabilitation. Thus, our objectives were to determine if a modified ER program comprised of environmental enrichment and skilled reaching practice motivated by a short fast would enhance post-stroke forelimb motor recovery and preserve forelimb muscle size and metabolic fiber type, relative to a group exposed to stroke without ER. At one week after photothrombotic cortical stroke, male, Sprague-Dawley rats were assigned to modified ER or standard care for 2 weeks. Forelimb recovery was assessed in the Montoya staircase and cylinder task before stroke and on days 5-6, 22-23, and 33-34 after stroke. ER failed to improve forelimb function in either task (p > 0.05). Atrophy of extensor digitorum communis (EDC) and triceps brachii long head (TBL) muscles was not evident in the stroke-targeted forelimb on day 35, but the area occupied by hybrid fibers was increased in the EDC muscle (p = 0.038). ER bilaterally increased EDC (p = 0.046), but not TBL, muscle size; EDC muscle fiber type was unchanged by ER. While the modified ER did not promote forelimb motor recovery, it does appear to have utility for studying the role of skeletal muscle plasticity in post-stroke recovery.
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Affiliation(s)
- Sally Caine
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | | | - Frederick Colbourne
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Gillian D. Muir
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Phyllis G. Paterson
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
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Neves LT, Paz LV, Wieck A, Mestriner RG, de Miranda Monteiro VAC, Xavier LL. Environmental Enrichment in Stroke Research: an Update. Transl Stroke Res 2024; 15:339-351. [PMID: 36717476 DOI: 10.1007/s12975-023-01132-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
Environmental enrichment (EE) refers to different forms of stimulation, where the environment is designed to improve the levels of sensory, cognitive, and motor stimuli, inducing stroke recovery in animal models. Stroke is a leading cause of mortality and neurological disability among older adults, hence the importance of developing strategies to improve recovery for such patients. This review provides an update on recent findings, compiling information regarding the parameters affected by EE exposure in both preclinical and clinical studies. During stroke recovery, EE exposure has been shown to improve both the cognitive and locomotor aspects, inducing important neuroplastic alterations, increased angiogenesis and neurogenesis, and modified gene expression, among other effects. There is a need for further research in this field, particularly in those aspects where the evidence is inconclusive. Moreover, it is necessary refine and adapt the EE paradigms for application in human patients.
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Affiliation(s)
- Laura Tartari Neves
- Programa de Pós-Graduação Em Biologia Celular E Molecular, Laboratório deBiologiaCelular ETecidual, Pontifical Catholic University of Rio Grande Do Sul, PUCRS. Escola de Ciências da Saúde E da Vida, Av. Ipiranga 6681, Prédio 12C, Sala 104, Porto Alegre, Rio Grande Do Sul, CEP, 90619-900, Brazil
| | - Lisiê Valéria Paz
- Programa de Pós-Graduação Em Biologia Celular E Molecular, Laboratório deBiologiaCelular ETecidual, Pontifical Catholic University of Rio Grande Do Sul, PUCRS. Escola de Ciências da Saúde E da Vida, Av. Ipiranga 6681, Prédio 12C, Sala 104, Porto Alegre, Rio Grande Do Sul, CEP, 90619-900, Brazil
| | - Andréa Wieck
- Programa de Pós-Graduação Em Biologia Celular E Molecular, Laboratório deBiologiaCelular ETecidual, Pontifical Catholic University of Rio Grande Do Sul, PUCRS. Escola de Ciências da Saúde E da Vida, Av. Ipiranga 6681, Prédio 12C, Sala 104, Porto Alegre, Rio Grande Do Sul, CEP, 90619-900, Brazil
- Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Av. Ipiranga, 6690 - Jardim Botânico, Porto Alegre, RS, 90610-000, Brazil
| | - Régis Gemerasca Mestriner
- Programa de Pós-Graduação Em Biologia Celular E Molecular, Laboratório deBiologiaCelular ETecidual, Pontifical Catholic University of Rio Grande Do Sul, PUCRS. Escola de Ciências da Saúde E da Vida, Av. Ipiranga 6681, Prédio 12C, Sala 104, Porto Alegre, Rio Grande Do Sul, CEP, 90619-900, Brazil
| | - Valentina Aguiar Cardozo de Miranda Monteiro
- Programa de Pós-Graduação Em Biologia Celular E Molecular, Laboratório deBiologiaCelular ETecidual, Pontifical Catholic University of Rio Grande Do Sul, PUCRS. Escola de Ciências da Saúde E da Vida, Av. Ipiranga 6681, Prédio 12C, Sala 104, Porto Alegre, Rio Grande Do Sul, CEP, 90619-900, Brazil
| | - Léder Leal Xavier
- Programa de Pós-Graduação Em Biologia Celular E Molecular, Laboratório deBiologiaCelular ETecidual, Pontifical Catholic University of Rio Grande Do Sul, PUCRS. Escola de Ciências da Saúde E da Vida, Av. Ipiranga 6681, Prédio 12C, Sala 104, Porto Alegre, Rio Grande Do Sul, CEP, 90619-900, Brazil.
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Ti CHE, Hu C, Yuan K, Chu WCW, Tong RKY. Uncovering the Neural Mechanisms of Inter-Hemispheric Balance Restoration in Chronic Stroke Through EMG-Driven Robot Hand Training: Insights From Dynamic Causal Modeling. IEEE Trans Neural Syst Rehabil Eng 2024; 32:1-11. [PMID: 38051622 DOI: 10.1109/tnsre.2023.3339756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
EMG-driven robot hand training can facilitate motor recovery in chronic stroke patients by restoring the interhemispheric balance between motor networks. However, the underlying mechanisms of reorganization between interhemispheric regions remain unclear. This study investigated the effective connectivity (EC) between the ventral premotor cortex (PMv), supplementary motor area (SMA), and primary motor cortex (M1) using Dynamic Causal Modeling (DCM) during motor tasks with the paretic hand. Nineteen chronic stroke subjects underwent 20 sessions of EMG-driven robot hand training, and their Action Reach Arm Test (ARAT) showed significant improvement ( β =3.56, [Formula: see text]). The improvement was correlated with the reduction of inhibitory coupling from the contralesional M1 to the ipsilesional M1 (r=0.58, p=0.014). An increase in the laterality index was only observed in homotopic M1, but not in the premotor area. Additionally, we identified an increase in resting-state functional connectivity (FC) between bilateral M1 ( β =0.11, p=0.01). Inter-M1 FC demonstrated marginal positive relationships with ARAT scores (r=0.402, p=0.110), but its changes did not correlate with ARAT improvements. These findings suggest that the improvement of hand functions brought about by EMG-driven robot hand training was driven explicitly by task-specific reorganization of motor networks. Particularly, the restoration of interhemispheric balance was induced by a reduction in interhemispheric inhibition from the contralesional M1 during motor tasks of the paretic hand. This finding sheds light on the mechanistic understanding of interhemispheric balance and functional recovery induced by EMG-driven robot training.
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Sattin D, Parma C, Lunetta C, Zulueta A, Lanzone J, Giani L, Vassallo M, Picozzi M, Parati EA. An Overview of the Body Schema and Body Image: Theoretical Models, Methodological Settings and Pitfalls for Rehabilitation of Persons with Neurological Disorders. Brain Sci 2023; 13:1410. [PMID: 37891779 PMCID: PMC10605253 DOI: 10.3390/brainsci13101410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Given the widespread debate on the definition of the terms "Body Schema" and "Body Image", this article presents a broad overview of the studies that have investigated the nature of these types of body representations, especially focusing on the innovative information about these two representations that could be useful for the rehabilitation of patients with different neurological disorders with motor deficits (especially those affecting the upper limbs). In particular, we analyzed (i) the different definitions and explicative models proposed, (ii) the empirical settings used to test them and (iii) the clinical and rehabilitative implications derived from the application of interventions on specific case reports. The growing number of neurological diseases with motor impairment in the general population has required the development of new rehabilitation techniques and a new phenomenological paradigm placing body schema as fundamental and intrinsic parts for action in space. In this narrative review, the focus was placed on evidence from the application of innovative rehabilitation techniques and case reports involving the upper limbs, as body parts particularly involved in finalistic voluntary actions in everyday life, discussing body representations and their functional role.
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Affiliation(s)
- Davide Sattin
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Chiara Parma
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department-ALS Unit, Via Camaldoli 64, 20138 Milan, Italy;
| | - Aida Zulueta
- Istituti Clinici Scientifici Maugeri IRCCS, Labion, Via Camaldoli 64, 20138 Milan, Italy;
| | - Jacopo Lanzone
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Luca Giani
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
| | - Marta Vassallo
- Istituti Clinici Scientifici Maugeri IRCCS, Health Directorate, Via Camaldoli 64, 20138 Milan, Italy; (D.S.); (M.V.)
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Mario Picozzi
- Center for Clinical Ethics, Biotechnology and Life Sciences Department, Insubria University, 21100 Varese, Italy;
| | - Eugenio Agostino Parati
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department, Via Camaldoli 64, 20138 Milan, Italy; (J.L.); (L.G.); (E.A.P.)
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10
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Paul T, Wiemer VM, Hensel L, Cieslak M, Tscherpel C, Grefkes C, Grafton ST, Fink GR, Volz LJ. Interhemispheric Structural Connectivity Underlies Motor Recovery after Stroke. Ann Neurol 2023; 94:785-797. [PMID: 37402647 DOI: 10.1002/ana.26737] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVE Although ample evidence highlights that the ipsilesional corticospinal tract (CST) plays a crucial role in motor recovery after stroke, studies on cortico-cortical motor connections remain scarce and provide inconclusive results. Given their unique potential to serve as structural reserve enabling motor network reorganization, the question arises whether cortico-cortical connections may facilitate motor control depending on CST damage. METHODS Diffusion spectrum imaging (DSI) and a novel compartment-wise analysis approach were used to quantify structural connectivity between bilateral cortical core motor regions in chronic stroke patients. Basal and complex motor control were differentially assessed. RESULTS Both basal and complex motor performance were correlated with structural connectivity between bilateral premotor areas and ipsilesional primary motor cortex (M1) as well as interhemispheric M1 to M1 connectivity. Whereas complex motor skills depended on CST integrity, a strong association between M1 to M1 connectivity and basal motor control was observed independent of CST integrity especially in patients who underwent substantial motor recovery. Harnessing the informational wealth of cortico-cortical connectivity facilitated the explanation of both basal and complex motor control. INTERPRETATION We demonstrate for the first time that distinct aspects of cortical structural reserve enable basal and complex motor control after stroke. In particular, recovery of basal motor control may be supported via an alternative route through contralesional M1 and non-crossing fibers of the contralesional CST. Our findings help to explain previous conflicting interpretations regarding the functional role of the contralesional M1 and highlight the potential of cortico-cortical structural connectivity as a future biomarker for motor recovery post-stroke. ANN NEUROL 2023;94:785-797.
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Affiliation(s)
- Theresa Paul
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
| | - Valerie M Wiemer
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
| | - Lukas Hensel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Matthew Cieslak
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Caroline Tscherpel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Scott T Grafton
- Department of Psychological & Brain Sciences, University of California, Santa Barbara, CA
| | - Gereon R Fink
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Research Centre Juelich, Juelich, Germany
| | - Lukas J Volz
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
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Vidaurre C, Irastorza-Landa N, Sarasola-Sanz A, Insausti-Delgado A, Ray AM, Bibián C, Helmhold F, Mahmoud WJ, Ortego-Isasa I, López-Larraz E, Lozano Peiteado H, Ramos-Murguialday A. Challenges of neural interfaces for stroke motor rehabilitation. Front Hum Neurosci 2023; 17:1070404. [PMID: 37789905 PMCID: PMC10543821 DOI: 10.3389/fnhum.2023.1070404] [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: 10/14/2022] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
More than 85% of stroke survivors suffer from different degrees of disability for the rest of their lives. They will require support that can vary from occasional to full time assistance. These conditions are also associated to an enormous economic impact for their families and health care systems. Current rehabilitation treatments have limited efficacy and their long-term effect is controversial. Here we review different challenges related to the design and development of neural interfaces for rehabilitative purposes. We analyze current bibliographic evidence of the effect of neuro-feedback in functional motor rehabilitation of stroke patients. We highlight the potential of these systems to reconnect brain and muscles. We also describe all aspects that should be taken into account to restore motor control. Our aim with this work is to help researchers designing interfaces that demonstrate and validate neuromodulation strategies to enforce a contingent and functional neural linkage between the central and the peripheral nervous system. We thus give clues to design systems that can improve or/and re-activate neuroplastic mechanisms and open a new recovery window for stroke patients.
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Affiliation(s)
- Carmen Vidaurre
- TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
- Ikerbasque Science Foundation, Bilbao, Spain
| | | | | | | | - Andreas M. Ray
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Carlos Bibián
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Florian Helmhold
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Wala J. Mahmoud
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Iñaki Ortego-Isasa
- TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - Eduardo López-Larraz
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Bitbrain, Zaragoza, Spain
| | | | - Ander Ramos-Murguialday
- TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
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12
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Qing W, Nam CY, Shum HMH, Chan MKL, Yu KP, Ng SSW, Yang B, Hu X. The Translation of Mobile-Exoneuromusculoskeleton-Assisted Wrist-Hand Poststroke Telerehabilitation from Laboratory to Clinical Service. Bioengineering (Basel) 2023; 10:976. [PMID: 37627861 PMCID: PMC10451942 DOI: 10.3390/bioengineering10080976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Rehabilitation robots are helpful in poststroke telerehabilitation; however, their feasibility and rehabilitation effectiveness in clinical settings have not been sufficiently investigated. A non-randomized controlled trial was conducted to investigate the feasibility of translating a telerehabilitation program assisted by a mobile wrist/hand exoneuromusculoskeleton (WH-ENMS) into routine clinical services and to compare the rehabilitative effects achieved in the hospital-service-based group (n = 12, clinic group) with the laboratory-research-based group (n = 12, lab group). Both groups showed significant improvements (p ≤ 0.05) in clinical assessments of behavioral motor functions and in muscular coordination and kinematic evaluations after the training and at the 3-month follow-up, with the lab group demonstrating better motor gains than the clinic group (p ≤ 0.05). The results indicated that the WH-ENMS-assisted tele-program was feasible and effective for upper limb rehabilitation when integrated into routine practice, and the quality of patient-operator interactions physically and remotely affected the rehabilitative outcomes.
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Affiliation(s)
- Wanyi Qing
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Ching-Yi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Harvey Man-Hok Shum
- Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong
| | - Marko Ka-Leung Chan
- Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong
| | - King-Pong Yu
- Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong
| | - Serena Sin-Wah Ng
- Community Rehabilitation Service Support Centre, Queen Elizabeth Hospital, Hong Kong
| | - Bibo Yang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
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13
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Das N, Endo S, Patel S, Krewer C, Hirche S. Online detection of compensatory strategies in human movement with supervised classification: a pilot study. Front Neurorobot 2023; 17:1155826. [PMID: 37520678 PMCID: PMC10382178 DOI: 10.3389/fnbot.2023.1155826] [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: 01/31/2023] [Accepted: 06/19/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Stroke survivors often compensate for the loss of motor function in their distal joints by altered use of more proximal joints and body segments. Since this can be detrimental to the rehabilitation process in the long-term, it is imperative that such movements are indicated to the patients and their caregiver. This is a difficult task since compensation strategies are varied and multi-faceted. Recent works that have focused on supervised machine learning methods for compensation detection often require a large training dataset of motions with compensation location annotations for each time-step of the recorded motion. In contrast, this study proposed a novel approach that learned a linear classifier from energy-based features to discriminate between healthy and compensatory movements and identify the compensating joints without the need for dense and explicit annotations. Methods Six healthy physiotherapists performed five different tasks using healthy movements and acted compensations. The resulting motion capture data was transformed into joint kinematic and dynamic trajectories. Inspired by works in bio-mechanics, energy-based features were extracted from this dataset. Support vector machine (SVM) and logistic regression (LR) algorithms were then applied for detection of compensatory movements. For compensating joint identification, an additional condition enforcing the independence of the feature calculation for each observable degree of freedom was imposed. Results Using leave-one-out cross validation, low values of mean brier score (<0.15), mis-classification rate (<0.2) and false discovery rate (<0.2) were obtained for both SVM and LR classifiers. These methods were found to outperform deep learning classifiers that did not use energy-based features. Additionally, online classification performance by our methods were also shown to outperform deep learning baselines. Furthermore, qualitative results obtained from the compensation joint identification experiment indicated that the method could successfully identify compensating joints. Discussion Results from this study indicated that including prior bio-mechanical information in the form of energy based features can improve classification performance even when linear classifiers are used, both for offline and online classification. Furthermore, evaluation compensation joint identification algorithm indicated that it could potentially provide a straightforward and interpretable way of identifying compensating joints, as well as the degree of compensation being performed.
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Affiliation(s)
- Neha Das
- Information-Oriented Control, TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Satoshi Endo
- Information-Oriented Control, TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
| | - Sabrina Patel
- Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
| | - Carmen Krewer
- Human Movement Science, Department of Sports and Health Sciences, Technical University of Munich, Munich, Germany
- Department of Neurology, Research Group, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Sandra Hirche
- Information-Oriented Control, TUM School of Computation, Information and Technology, Technical University of Munich, Munich, Germany
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14
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Yüksel MM, Sun S, Latchoumane C, Bloch J, Courtine G, Raffin EE, Hummel FC. Low-Intensity Focused Ultrasound Neuromodulation for Stroke Recovery: A Novel Deep Brain Stimulation Approach for Neurorehabilitation? IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:300-318. [PMID: 38196977 PMCID: PMC10776095 DOI: 10.1109/ojemb.2023.3263690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 01/11/2024] Open
Abstract
Stroke as the leading cause of adult long-term disability and has a significant impact on patients, society and socio-economics. Non-invasive brain stimulation (NIBS) approaches such as transcranial magnetic stimulation (TMS) or transcranial electrical stimulation (tES) are considered as potential therapeutic options to enhance functional reorganization and augment the effects of neurorehabilitation. However, non-invasive electrical and magnetic stimulation paradigms are limited by their depth focality trade-off function that does not allow to target deep key brain structures critically important for recovery processes. Transcranial ultrasound stimulation (TUS) is an emerging approach for non-invasive deep brain neuromodulation. Using non-ionizing, ultrasonic waves with millimeter-accuracy spatial resolution, excellent steering capacity and long penetration depth, TUS has the potential to serve as a novel non-invasive deep brain stimulation method to establish unprecedented neuromodulation and novel neurorehabilitation protocols. The purpose of the present review is to provide an overview on the current knowledge about the neuromodulatory effects of TUS while discussing the potential of TUS in the field of stroke recovery, with respect to existing NIBS methods. We will address and discuss critically crucial open questions and remaining challenges that need to be addressed before establishing TUS as a new clinical neurorehabilitation approach for motor stroke recovery.
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Affiliation(s)
- Mahmut Martin Yüksel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1201Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
| | - Shiqi Sun
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1011Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1011Switzerland
| | - Charles Latchoumane
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1011Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1011Switzerland
| | - Jocelyne Bloch
- Neuro-X Institute and Brain Mind Institute, School of Life SciencesSwiss Federal Institute of Technology (EPFL)Lausanne1015Switzerland
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1015Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1015Switzerland
- Department of NeurosurgeryLausanne University HospitalLausanne1011Switzerland
| | - Gregoire Courtine
- Department of Clinical NeuroscienceLausanne University Hospital (CHUV) and the University of Lausanne (UNIL)Lausanne1015Switzerland
- Defitech Center for Interventional Neurotherapies (NeuroRestore)EPFL/CHUV/UNILLausanne1015Switzerland
- Department of NeurosurgeryLausanne University HospitalLausanne1011Switzerland
| | - Estelle Emeline Raffin
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1201Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
| | - Friedhelm Christoph Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de LausanneGeneva1202Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute and Brain Mind InstituteÉcole Polytechnique Fédérale de Lausanne Valais, Clinique Romande de Réadaptation Sion1951Switzerland
- Clinical NeuroscienceUniversity of Geneva Medical SchoolGeneva1211Switzerland
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Sánchez-Cuesta FJ, González-Zamorano Y, Arroyo-Ferrer A, Moreno-Verdú M, Romero-Muñoz JP. Repetitive Transcranial Magnetic Stimulation of Primary Motor Cortex for stroke upper limb motor sequelae rehabilitation: A systematic review. NeuroRehabilitation 2023; 52:329-348. [PMID: 37005900 DOI: 10.3233/nre-220306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND: Repetitive Transcranial Magnetic Stimulation (rTMS) over the primary motor cortex (M1) has been used to treat stroke motor sequelae regulating cortical excitability. Early interventions are widely recommended, but there is also evidence showing interventions in subacute or chronic phases are still useful. OBJECTIVE: To synthetize the evidence of rTMS protocols to improve upper limb motor function in people with subacute and/or chronic stroke. METHODS: Four databases were searched in July 2022. Clinical trials investigating the effectiveness of different rTMS protocols on upper limb motor function in subacute or chronic phases post-stroke were included. PRISMA guidelines and PEDro scale were used. RESULTS: Thirty-two studies representing 1137 participants were included. Positive effects of all types of rTMS protocols on upper limb motor function were found. These effects were heterogeneous and not always clinically relevant or related to neurophysiological changes but produced evident changes if evaluated with functional tests. CONCLUSION: rTMS interventions over M1 are effective for improving upper limb motor function in people with subacute and chronic stroke. When rTMS protocols were priming physical rehabilitation better effects were achieved. Studies considering minimal clinical differences and different dosing will help to generalize the use of these protocols in clinical practice.
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Affiliation(s)
- Francisco José Sánchez-Cuesta
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
| | - Yeray González-Zamorano
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, King Juan Carlos University, Alcorcón, Spain
| | - Aída Arroyo-Ferrer
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
| | - Marcos Moreno-Verdú
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
| | - Juan Pablo Romero-Muñoz
- Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
- Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain
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Parikh V, Medley A, Chung YC, Goh HT. Optimal timing and neural loci: a scoping review on the effect of non-invasive brain stimulation on post-stroke gait and balance recovery. Top Stroke Rehabil 2023; 30:84-100. [PMID: 34859744 DOI: 10.1080/10749357.2021.1990467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the optimal timing and neural loci for applying noninvasive brain stimulation (NIBS) to promote gait and balance recovery after stroke. OBJECTIVE To identify the optimal timing and neural loci of NIBS for gait and balance recovery after stroke. METHODS We performed a PubMed search using keywords of stroke, transcranial magnetic stimulation, transcranial direct current stimulation, NIBS, balance, and gait. Interventional trials with various designs published in English were selected. Both flowcharts and tables were used for the result presentation. RESULTS The majority of selected 31 studies included individuals with chronic stroke and primary motor cortex (M1) stimulation. Studies' quality ranged from 4 to 10 (max = 10) on the Pedro scale. NIBS led to improvements in gait and balance in individuals with chronic and subacute stroke, yet the evidence for the acute phase of stroke is limited. Further, stimulation over the ipsilesional M1 resulted in improvement in gait and balanced performance. Stimulation over non-motor regions such as the cerebellum has been limitedly explored. CONCLUSION Current evidence supports the use of NIBS to the M1 in conjunction with behavioral training to improve gait and balance performance in individuals with subacute and chronic stroke. Future research is recommended to evaluate the effect of NIBS during acute stroke and over neural loci other than M1, and to implement a more rigorous method.
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Affiliation(s)
- Vyoma Parikh
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
| | - Ann Medley
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
| | - Yu-Chen Chung
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hui-Ting Goh
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
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17
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The pericontused cortex can support function early after TBI but it remains functionally isolated from normal afferent input. Exp Neurol 2023; 359:114260. [PMID: 36404463 DOI: 10.1016/j.expneurol.2022.114260] [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: 04/16/2022] [Revised: 09/01/2022] [Accepted: 10/25/2022] [Indexed: 12/30/2022]
Abstract
Traumatically injured brain functional connectivity (FC) is altered in a region-dependent manner with some regions functionally disconnected while others are hyperconnected after experimental TBI. Remote, homotopic cortical regions become hyperexcitable after injury, and we hypothesize that this results in increased trans-hemispheric cortical inhibition, preventing reorganization of the primary injured hemisphere. Previously we have shown that temporary silencing the contralesional cortex at 1wk normalizes affected forelimb behavioral use, but not at 4wks. To investigate the potential mechanism for this and to determine whether this occurs due to restoration of afferent pathway FC, and/or reorganization of brain circuits, we probed forelimb circuit function with sensorimotor task-evoked-fMRI, resting state fMRI seed-based analysis, and exploratory structural equation modelling (SEM) of directed causal connections due to forelimb task at 1 and 4wks post-injury after temporary, contralateral silencing with intraparenchymal injection of muscimol versus vehicle, as well as from sham rats. As predicted, silencing at 1wk and 4wks post-injury decimated the contralesional cortical forelimb map evoked by stimulation of the opposite, unaffected forelimb compared to vehicle-injected injured rats indicating the success of the intervention. Surprisingly however, this also resulted in activation of the pericontused cortex ipsilateral to the stimulated forelimb at 1wk, yet this same region could not be activated by directly stimulating the opposite, injury-affected forelimb. Underpinning this were significant increases in interhemispheric FC at the level of the cortex but decreases within subcortical regions. Causal SEM analysis confirmed increased corticothalamic connectivity and suggested changes from and to bilateral thalamus are important for the effect. At 4wks post-injury only cortical increases in FC were found in response to silencing indicating a less flexible brain, and ipsilesional cortex evoked activity was mostly absent. The absence of a reinstatement of ipsilesional evoked activity through normal pathways by temporary neuromodulation despite prior data showing behavioral improvements under the same conditions, indicates that while the pericontused cortex does retain function initially after injury, it is too functionally disconnected to be controlled by normal afferent input. More significant alterations in cross-brain FC during neuromodulation at 1wk compared to 4wk post-injury, suggest that more distributed brain activity accounts for prior behavior improvements in sensorimotor function, and that hemispheric imbalance in function is causally involved in early loss of sensorimotor function in this TBI model.
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18
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Dai J, Wu F, Li J, Yu M, Liao C, Shou Y. Surface electromyography analysis of mirror movements under unilateral movement in stroke patients: A retrospective study. Front Hum Neurosci 2022; 16:1079596. [PMID: 36606247 PMCID: PMC9807621 DOI: 10.3389/fnhum.2022.1079596] [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: 10/25/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Objective Mirror movements (MMs) are common abnormal motor performance in patients with poststroke hemiparesis. The study aimed to utilize the Electromyography (EMG) characterization of MMs in stroke patients and explore the relationship between MMs and the motor function of affected limbs. Methods Sixty patients with stroke who had used to undergo clinical assessment and surface Electromyography (sEMG) were selected in this study. We investigated the standardized net excitation (SNE) and overflow percentage (OF) as a measure of mirror activities on bilateral muscles of stroke patients. Results In stroke patients, mirror activities occurred in both affected and unaffected muscles during maximal contractions. We found that OF at unilateral contraction on the affected side (UCA) was significantly greater than that at unilateral contraction on the unaffected side (UCU). Additionally, a negative correlation between OF at UCA and Brunnstrom stages on admission and discharge. However, there were no significant correlations between OF and disease duration, Barthel Index, or the degree of improvement in all clinical evaluations. We still found a positive correlation between SNE at UCA and the improvement of the Brunnstrom stage of the hand. But we could not find any significant correlation between SNE and other clinical evaluation scores. Conclusion In conclusion, the study found mirror activities in both affected and unaffected muscles, confirming an asymmetry between them. Although the mechanisms are still unclear, we confirmed a significant correlation between MMs at UCA and the motor function of the affected upper extremity, which might provide further evidences for understanding MMs in stroke patients and a new research direction on evaluation for motor function and outcomes of stroke patients.
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Affiliation(s)
- Jie Dai
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Fangchao Wu
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jianhua Li
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Mengjie Yu
- Department of Rehabilitation Medicine, Hospital of Zhejiang Chinese Armed Police Force, Hangzhou, Zhejiang, China
| | - Chen Liao
- Department of Rehabilitation Medicine, The Third Hospital of Quzhou, Quzhou, Zhejiang, China
| | - Yiqun Shou
- Department of Rehabilitation Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,*Correspondence: Yiqun Shou,
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Leng Y, Lo WLA, Mao YR, Bian R, Zhao JL, Xu Z, Li L, Huang DF. The Impact of Cognitive Function on Virtual Reality Intervention for Upper Extremity Rehabilitation of Patients With Subacute Stroke: Prospective Randomized Controlled Trial With 6-Month Follow-up. JMIR Serious Games 2022; 10:e33755. [PMID: 35802415 PMCID: PMC9308068 DOI: 10.2196/33755] [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: 09/22/2021] [Revised: 03/28/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Stroke is among the leading causes of long-term disability worldwide. Motor impairments after stroke not only impact the individuals quality of life but also lay substantial burdens on the society. Motor planning is a key component of cognitive function that impacts motor control. Hand movements such as grasping or reaching to grasp require the application of correct force and the coordination of multiple limb segments. Successful completion of hand motor task requires a certain degree of cognitive function to anticipate the requirement of the task. Cognitive function may thus be a confounding factor to rehabilitation outcomes. Objective This study aims to explore the impact of cognitive function on functional outcomes in people with subacute stroke after VR intervention. Methods Patients with stroke were first stratified into cognitively normal (CN) and cognitively impaired (CI), followed by allocation to the VR or control group (CG). Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Barthel Index (BI), and Instrumental Activities of Daily Living (IADL) were recorded at baseline, 3 weeks after the intervention, and 3 and 6 months after the intervention. The between-group and within-group differences were assessed by repeated-measures analysis of variance (ANOVA). Results The between-group comparison indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) scores improved significantly in both groups after the intervention. Repeated-measures ANOVA indicated that FMA-UE, BI, and IADL (time effect P<.001 for all) were significantly different in each subgroup after the intervention. For BI score, the ANOVA results showed obvious interaction effects (treatment × time × cognitive effect, P=.04). Conclusions VR intervention was as effective as traditional conventional therapy in improving upper limb function regardless of the cognitive functional level. Patients with stroke with impaired cognitive function may gain more improvement in upper limb function and independency in performing activities of daily living after a VR-based intervention. Trial Registration Chinese Clinical Trial Registry ChiCTR-IOC-15006064; https://tinyurl.com/4c9vkrrn
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Affiliation(s)
- Yan Leng
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China.,Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Sun Yat-sen University, Guangzhou, China
| | - Yu Rong Mao
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Sun Yat-sen University, Guangzhou, China.,Department of Rehabilitation Medicine, Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, China
| | - Ruihao Bian
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Jiang Li Zhao
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Zhiqin Xu
- Department of Rehabilitation Medicine, First Affiliated Hospital Sun Yat-sen University, Guangzhou, China
| | - Le Li
- Institute of Medical Research, Northwestern Polytechnical University, Xi'an, China
| | - Dong Feng Huang
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, Sun Yat-sen University, Guangzhou, China.,Department of Rehabilitation Medicine, Seventh Affiliated Hospital Sun Yat-sen University, Shenzhen, China
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20
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Remsik AB, van Kan PLE, Gloe S, Gjini K, Williams L, Nair V, Caldera K, Williams JC, Prabhakaran V. BCI-FES With Multimodal Feedback for Motor Recovery Poststroke. Front Hum Neurosci 2022; 16:725715. [PMID: 35874158 PMCID: PMC9296822 DOI: 10.3389/fnhum.2022.725715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/26/2022] [Indexed: 01/31/2023] Open
Abstract
An increasing number of research teams are investigating the efficacy of brain-computer interface (BCI)-mediated interventions for promoting motor recovery following stroke. A growing body of evidence suggests that of the various BCI designs, most effective are those that deliver functional electrical stimulation (FES) of upper extremity (UE) muscles contingent on movement intent. More specifically, BCI-FES interventions utilize algorithms that isolate motor signals-user-generated intent-to-move neural activity recorded from cerebral cortical motor areas-to drive electrical stimulation of individual muscles or muscle synergies. BCI-FES interventions aim to recover sensorimotor function of an impaired extremity by facilitating and/or inducing long-term motor learning-related neuroplastic changes in appropriate control circuitry. We developed a non-invasive, electroencephalogram (EEG)-based BCI-FES system that delivers closed-loop neural activity-triggered electrical stimulation of targeted distal muscles while providing the user with multimodal sensory feedback. This BCI-FES system consists of three components: (1) EEG acquisition and signal processing to extract real-time volitional and task-dependent neural command signals from cerebral cortical motor areas, (2) FES of muscles of the impaired hand contingent on the motor cortical neural command signals, and (3) multimodal sensory feedback associated with performance of the behavioral task, including visual information, linked activation of somatosensory afferents through intact sensorimotor circuits, and electro-tactile stimulation of the tongue. In this report, we describe device parameters and intervention protocols of our BCI-FES system which, combined with standard physical rehabilitation approaches, has proven efficacious in treating UE motor impairment in stroke survivors, regardless of level of impairment and chronicity.
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Affiliation(s)
- Alexander B. Remsik
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- School of Medicine and Public Health, Institute for Clinical and Translational Research, University of Wisconsin–Madison, Madison, WI, United States
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Peter L. E. van Kan
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, United States
- Neuroscience Training Program, University of Wisconsin–Madison, Madison, WI, United States
| | - Shawna Gloe
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Klevest Gjini
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurology, University of Wisconsin–Madison, Madison, WI, United States
| | - Leroy Williams
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Educational Psychology, University of Wisconsin–Madison, Madison, WI, United States
| | - Veena Nair
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Kristin Caldera
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
| | - Justin C. Williams
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Neuroscience Training Program, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
- Medical Scientist Training Program, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
- Department of Psychology, University of Wisconsin–Madison, Madison, WI, United States
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21
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Cleland BT, Madhavan S. Motor overflow in the lower limb after stroke: insights into mechanisms. Eur J Neurosci 2022; 56:4455-4468. [PMID: 35775788 PMCID: PMC9380181 DOI: 10.1111/ejn.15753] [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: 01/19/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Motor overflow (involuntary muscle activation) is common after stroke, particularly in the non-paretic upper limb. Two potential cortical mechanisms are: 1) the contralesional hemisphere controls both limbs, and 2) inhibition from the ipsilesional to the contralesional hemisphere is diminished. Few studies have differentiated between these hypotheses or investigated motor overflow in the lower limb after stroke. To investigate these potential mechanisms, individuals with chronic stroke performed unilateral isometric and dynamic dorsiflexion. Motor overflow was quantified in the contralateral, resting (non-target) ankle. Transcranial magnetic stimulation was applied, and responses were measured in both legs. Relations between motor overflow, excitability of ipsilateral motor pathways, and interhemispheric inhibition were assessed. Non-target muscle activity (motor overflow) was greater during isometric and dynamic conditions than rest in both legs (p≤0.001) and was higher in the non-paretic than the paretic leg (p=0.03). Some participants (25%) had motor overflow >4SD above the group mean in the non-paretic leg. Greater motor overflow in the non-paretic leg was associated with lesser inhibition from the ipsilesional to the contralesional hemisphere (p=0.04). In both legs, non-target TMS responses were greater during the isometric and dynamic than the rest condition (p≤0.01), but not when normalized to background muscle activity. Overall, motor overflow occurred in both legs after stroke, suggesting a common bilateral mechanism. Our correlational results suggest that alterations in interhemispheric inhibition may contribute to motor overflow. Furthermore, the lack of differences in non-target MEPs between rest, isometric, and dynamic conditions, suggests that subcortical and/or spinal pathways may contribute to motor overflow.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
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22
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Zhao Q, Jia G, Jia L, Wang Y, Jiang W, Feng Y, Jiang H, Yu L, Yu J, Tan B. Effects of Electromyography Bridge on Upper Limb Motor Functions in Stroke Participants: An Exploratory Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12070870. [PMID: 35884677 PMCID: PMC9312916 DOI: 10.3390/brainsci12070870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/25/2022] [Accepted: 06/28/2022] [Indexed: 01/27/2023] Open
Abstract
The electromyography bridge (EMGB) plays an important role in promoting the recovery of wrist joint function in stroke patients. We investigated the effects of the EMGB on promoting the recovery of upper limb function in hemiplegia. Twenty-four stroke patients with wrist dorsal extension dysfunction were recruited. Participants were randomized to undergo EMGB treatment or neuromuscular electrical stimulation (NMES). Treatments to wrist extensors were conducted for 25 min, twice a day, 5 days per week, for 1 month. Outcome measures: active range of motion (AROM) of wrist dorsal extension; Fugl-Meyer assessment for upper extremity (FMA-UE); Barthel index (BI); and muscle strength of wrist extensors. After interventions, patients in the NMES group had significantly greater improvement in the AROM of wrist dorsal extension at the 4th week and 1st month follow-up (p < 0.05). However, patients in the EMGB group had a statistically significant increase in AROM only at the follow-up assessment. No significant differences were observed in the AROM between the EMGB group and the NMES group (p > 0.05). For secondary outcomes in the EMGB group, compared to baseline measurements, FMA-UE, BI, extensor carpi radialis and extensor carpi ulnaris muscle strength were significantly different as early as the 4th week (p < 0.05). The muscle strength of the extensor digitorum communis muscle showed significant differences at the follow-up (p < 0.05). There were no statistically significant differences between patients in the two groups in any of the parameters evaluated (p > 0.05). The combination of EMGB or NMES with conventional treatment had similar effects on the improvement of the hemiplegic upper limb as assessed by wrist dorsal extension, FMA-UE, and activities of daily living. The improvement in both groups was maintained until 1 month after the intervention.
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Affiliation(s)
- Qin Zhao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Gongwei Jia
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Lang Jia
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Yule Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Wei Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Yali Feng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Hang Jiang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Lehua Yu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
| | - Jing Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou 510630, China
- Correspondence: (J.Y.); (B.T.)
| | - Botao Tan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China; (Q.Z.); (G.J.); (L.J.); (Y.W.); (W.J.); (Y.F.); (H.J.); (L.Y.)
- Correspondence: (J.Y.); (B.T.)
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23
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Hacene S, Le Friec A, Desmoulin F, Robert L, Colitti N, Fitremann J, Loubinoux I, Cirillo C. Present and future avenues of cell-based therapy for brain injury: The enteric nervous system as a potential cell source. Brain Pathol 2022; 32:e13105. [PMID: 35773942 PMCID: PMC9425017 DOI: 10.1111/bpa.13105] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/09/2022] [Indexed: 01/01/2023] Open
Abstract
Cell therapy is a promising strategy in the field of regenerative medicine; however, several concerns limit the effective clinical use, namely a valid cell source. The gastrointestinal tract, which contains a highly organized network of nerves called the enteric nervous system (ENS), is a valuable reservoir of nerve cells. Together with neurons and neuronal precursor cells, it contains glial cells with a well described neurotrophic potential and a newly identified neurogenic one. Recently, enteric glia is looked at as a candidate for cell therapy in intestinal neuropathies. Here, we present the therapeutic potential of the ENS as cell source for brain repair, too. The example of stroke is introduced as a brain injury where cell therapy appears promising. This disease is the first cause of handicap in adults. The therapies developed in recent years allow a partial response to the consequences of the disease. The only prospect of recovery in the chronic phase is currently based on rehabilitation. The urgency to offer other treatments is therefore tangible. In the first part of the review, some elements of stroke pathophysiology are presented. An update on the available therapeutic strategies is provided, focusing on cell‐ and biomaterial‐based approaches. Following, the ENS is presented with its anatomical and functional characteristics, focusing on glial cells. The properties of these cells are depicted, with particular attention to their neurotrophic and, recently identified, neurogenic properties. Finally, preliminary data on a possible therapeutic approach combining ENS‐derived cells and a biomaterial are presented.
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Affiliation(s)
- Sirine Hacene
- National Veterinary School of Toulouse, University of Toulouse, Toulouse, France.,Toulouse NeuroImaging Center (ToNIC), Inserm, University of Toulouse-Paul Sabatier, Toulouse, France
| | - Alice Le Friec
- Toulouse NeuroImaging Center (ToNIC), Inserm, University of Toulouse-Paul Sabatier, Toulouse, France.,Department of Biological and Chemical Engineering-Medical Biotechnology, Aarhus University, Aarhus, Denmark
| | - Franck Desmoulin
- Toulouse NeuroImaging Center (ToNIC), Inserm, University of Toulouse-Paul Sabatier, Toulouse, France
| | - Lorenne Robert
- Toulouse NeuroImaging Center (ToNIC), Inserm, University of Toulouse-Paul Sabatier, Toulouse, France
| | - Nina Colitti
- Toulouse NeuroImaging Center (ToNIC), Inserm, University of Toulouse-Paul Sabatier, Toulouse, France
| | - Juliette Fitremann
- Laboratoire des IMRCP, CNRS UMR 5623, University of Toulouse-Paul Sabatier, Toulouse, France
| | - Isabelle Loubinoux
- Toulouse NeuroImaging Center (ToNIC), Inserm, University of Toulouse-Paul Sabatier, Toulouse, France
| | - Carla Cirillo
- Toulouse NeuroImaging Center (ToNIC), Inserm, University of Toulouse-Paul Sabatier, Toulouse, France
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24
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Orendáčová M, Kvašňák E. Possible Mechanisms Underlying Neurological Post-COVID Symptoms and Neurofeedback as a Potential Therapy. Front Hum Neurosci 2022; 16:837972. [PMID: 35431842 PMCID: PMC9010738 DOI: 10.3389/fnhum.2022.837972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
Theoretical considerations related to neurological post-COVID complications have become a serious issue in the COVID pandemic. We propose 3 theoretical hypotheses related to neurological post-COVID complications. First, pathophysiological processes responsible for long-term neurological complications caused by COVID-19 might have 2 phases: (1) Phase of acute Sars-CoV-2 infection linked with the pathogenesis responsible for the onset of COVID-19-related neurological complications and (2) the phase of post-acute Sars-CoV-2 infection linked with the pathogenesis responsible for long-lasting persistence of post-COVID neurological problems and/or exacerbation of another neurological pathologies. Second, post-COVID symptoms can be described and investigated from the perspective of dynamical system theory exploiting its fundamental concepts such as system parameters, attractors and criticality. Thirdly, neurofeedback may represent a promising therapy for neurological post-COVID complications. Based on the current knowledge related to neurofeedback and what is already known about neurological complications linked to acute COVID-19 and post-acute COVID-19 conditions, we propose that neurofeedback modalities, such as functional magnetic resonance-based neurofeedback, quantitative EEG-based neurofeedback, Othmer's method of rewarding individual optimal EEG frequency and heart rate variability-based biofeedback, represent a potential therapy for improvement of post-COVID symptoms.
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Affiliation(s)
- Mária Orendáčová
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Eugen Kvašňák
- Department of Medical Biophysics and Medical Informatics, Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
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25
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Sarasola-Sanz A, López-Larraz E, Irastorza-Landa N, Rossi G, Figueiredo T, McIntyre J, Ramos-Murguialday A. Real-Time Control of a Multi-Degree-of-Freedom Mirror Myoelectric Interface During Functional Task Training. Front Neurosci 2022; 16:764936. [PMID: 35360179 PMCID: PMC8962619 DOI: 10.3389/fnins.2022.764936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/07/2022] [Indexed: 12/03/2022] Open
Abstract
Motor learning mediated by motor training has in the past been explored for rehabilitation. Myoelectric interfaces together with exoskeletons allow patients to receive real-time feedback about their muscle activity. However, the number of degrees of freedom that can be simultaneously controlled is limited, which hinders the training of functional tasks and the effectiveness of the rehabilitation therapy. The objective of this study was to develop a myoelectric interface that would allow multi-degree-of-freedom control of an exoskeleton involving arm, wrist and hand joints, with an eye toward rehabilitation. We tested the effectiveness of a myoelectric decoder trained with data from one upper limb and mirrored to control a multi-degree-of-freedom exoskeleton with the opposite upper limb (i.e., mirror myoelectric interface) in 10 healthy participants. We demonstrated successful simultaneous control of multiple upper-limb joints by all participants. We showed evidence that subjects learned the mirror myoelectric model within the span of a five-session experiment, as reflected by a significant decrease in the time to execute trials and in the number of failed trials. These results are the necessary precursor to evaluating if a decoder trained with EMG from the healthy limb could foster learning of natural EMG patterns and lead to motor rehabilitation in stroke patients.
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Affiliation(s)
- Andrea Sarasola-Sanz
- Neurotechnology Unit, TECNALIA, Basque Research and Technology Alliance, Donostia-San Sebastian, Spain
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- *Correspondence: Andrea Sarasola-Sanz,
| | - Eduardo López-Larraz
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Bitbrain Technologies, Zaragoza, Spain
| | - Nerea Irastorza-Landa
- Neurotechnology Unit, TECNALIA, Basque Research and Technology Alliance, Donostia-San Sebastian, Spain
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Giulia Rossi
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Thiago Figueiredo
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Joseph McIntyre
- Neurotechnology Unit, TECNALIA, Basque Research and Technology Alliance, Donostia-San Sebastian, Spain
| | - Ander Ramos-Murguialday
- Neurotechnology Unit, TECNALIA, Basque Research and Technology Alliance, Donostia-San Sebastian, Spain
- Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
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26
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Muffel T, Shih PC, Kalloch B, Nikulin V, Villringer A, Sehm B. Differential effects of anodal and dual tDCS on sensorimotor functions in chronic hemiparetic stroke patients. Brain Stimul 2022; 15:509-522. [DOI: 10.1016/j.brs.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
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27
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Zhao M, Wang G, Wang A, Cheng LJ, Lau Y. Robot-assisted distal training improves upper limb dexterity and function after stroke: a systematic review and meta-regression. Neurol Sci 2022; 43:1641-1657. [PMID: 35089447 DOI: 10.1007/s10072-022-05913-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/23/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stroke is one of the top 10 causes of death worldwide, and more than half of stroke patients face distal upper extremity dysfunction. Considering that robot-assisted training may be effective in improving distal upper extremity function, the review evaluated the effect of robot-assisted distal training on motor function, hand dexterity, and spasticity after stroke. METHODS Eleven databases were systematically searched for randomised controlled trials (RCTs) from inception until Aug 28, 2021. Meta-analysis and meta-regression were performed to investigate the overall effect and source of heterogeneity, respectively. RESULTS Twenty-two trials involving 758 participants were included in this systematic review. The overall effect of robot-assisted distal training on the motor function of the wrists and hands was significant improvement (MD = 3.92; 95% CI, 3.04-4.80; P < 0.001). The robot-assisted training had a significantly beneficial effect on other motor functions (MD = 2.84; 95% CI, 1.54-4.14; P < 0.001); dexterity (MD = 9.01; 95% CI, -12.07--5.95; P < 0.001), spasticity, upper extremity strength (SMD = 0.42; 95% CI, 0.07-0.78; P = 0.02) and activities of daily living (SMD = 0.70; 95% CI, 0.29-1.23; P < 0.001). A series of subgroup analyses showed preferable design and effective regime of training. Meta-regression indicated the statistically significant effect of the year of trial, country, and duration on the effectiveness of training. CONCLUSION Robot-assisted distal training has a significant effect on motor function, dexterity and spasticity of the upper extremity, compared to conventional therapy.
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Affiliation(s)
- Menglu Zhao
- The Affiliated Hospital of Qingdao University, Shandong, Qingdao, China
| | | | - Aimin Wang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
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28
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Barak Ventura R, Stewart Hughes K, Nov O, Raghavan P, Ruiz Marín M, Porfiri M. Data-Driven Classification of Human Movements in Virtual Reality-Based Serious Games: Preclinical Rehabilitation Study in Citizen Science. JMIR Serious Games 2022; 10:e27597. [PMID: 35142629 PMCID: PMC8874800 DOI: 10.2196/27597] [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: 01/29/2021] [Revised: 06/14/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Sustained engagement is essential for the success of telerehabilitation programs. However, patients’ lack of motivation and adherence could undermine these goals. To overcome this challenge, physical exercises have often been gamified. Building on the advantages of serious games, we propose a citizen science–based approach in which patients perform scientific tasks by using interactive interfaces and help advance scientific causes of their choice. This approach capitalizes on human intellect and benevolence while promoting learning. To further enhance engagement, we propose performing citizen science activities in immersive media, such as virtual reality (VR). Objective This study aims to present a novel methodology to facilitate the remote identification and classification of human movements for the automatic assessment of motor performance in telerehabilitation. The data-driven approach is presented in the context of a citizen science software dedicated to bimanual training in VR. Specifically, users interact with the interface and make contributions to an environmental citizen science project while moving both arms in concert. Methods In all, 9 healthy individuals interacted with the citizen science software by using a commercial VR gaming device. The software included a calibration phase to evaluate the users’ range of motion along the 3 anatomical planes of motion and to adapt the sensitivity of the software’s response to their movements. During calibration, the time series of the users’ movements were recorded by the sensors embedded in the device. We performed principal component analysis to identify salient features of movements and then applied a bagged trees ensemble classifier to classify the movements. Results The classification achieved high performance, reaching 99.9% accuracy. Among the movements, elbow flexion was the most accurately classified movement (99.2%), and horizontal shoulder abduction to the right side of the body was the most misclassified movement (98.8%). Conclusions Coordinated bimanual movements in VR can be classified with high accuracy. Our findings lay the foundation for the development of motion analysis algorithms in VR-mediated telerehabilitation.
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Affiliation(s)
- Roni Barak Ventura
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Kora Stewart Hughes
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Oded Nov
- Department of Technology Management and Innovation, New York University Tandon School of Engineering, Brooklyn, NY, United States
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Manuel Ruiz Marín
- Department of Quantitative Methods, Law and Modern Languages, Technical University of Cartagena, Cartagena, Spain.,Murcia Bio-Health Institute (IMIB-Arrixaca), Health Science Campus, Cartagena, Spain
| | - Maurizio Porfiri
- Department of Mechanical and Aerospace Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States.,Center for Urban Science and Progress, New York University, Brooklyn, NY, United States.,Department of Biomedical Engineering, New York University Tandon School of Engineering, Brooklyn, NY, United States
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Hildesheim FE, Silver AN, Dominguez-Vargas AU, Andrushko JW, Edwards JD, Dancause N, Thiel A. Predicting Individual Treatment Response to rTMS for Motor Recovery After Stroke: A Review and the CanStim Perspective. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:795335. [PMID: 36188894 PMCID: PMC9397689 DOI: 10.3389/fresc.2022.795335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022]
Abstract
Background Rehabilitation is critical for reducing stroke-related disability and improving quality-of-life post-stroke. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique used as stand-alone or adjunct treatment to physiotherapy, may be of benefit for motor recovery in subgroups of stroke patients. The Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim) seeks to advance the use of these techniques to improve post-stroke recovery through clinical trials and pre-clinical studies using standardized research protocols. Here, we review existing clinical trials for demographic, clinical, and neurobiological factors which may predict treatment response to identify knowledge gaps which need to be addressed before implementing these parameters for patient stratification in clinical trial protocols. Objective To provide a review of clinical rTMS trials of stroke recovery identifying factors associated with rTMS response in stroke patients with motor deficits and develop research perspectives for pre-clinical and clinical studies. Methods A literature search was performed in PubMed, using the Boolean search terms stroke AND repetitive transcranial magnetic stimulation OR rTMS AND motor for studies investigating the use of rTMS for motor recovery in stroke patients at any recovery phase. A total of 1,676 articles were screened by two blinded raters, with 26 papers identified for inclusion in this review. Results Multiple possible factors associated with rTMS response were identified, including stroke location, cortical thickness, brain-derived neurotrophic factor (BDNF) genotype, initial stroke severity, and several imaging and clinical factors associated with a relatively preserved functional motor network of the ipsilesional hemisphere. Age, sex, and time post-stroke were generally not related to rTMS response. Factors associated with greater response were identified in studies of both excitatory ipsilesional and inhibitory contralesional rTMS. Heterogeneous study designs and contradictory data exemplify the need for greater protocol standardization and high-quality controlled trials. Conclusion Clinical, brain structural and neurobiological factors have been identified as potential predictors for rTMS response in stroke patients with motor impairment. These factors can inform the design of future clinical trials, before being considered for optimization of individual rehabilitation therapy for stroke patients. Pre-clinical models for stroke recovery, specifically developed in a clinical context, may accelerate this process.
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Affiliation(s)
- Franziska E. Hildesheim
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Alexander N. Silver
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
| | - Adan-Ulises Dominguez-Vargas
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Justin W. Andrushko
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jodi D. Edwards
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- University of Ottawa Heart Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Numa Dancause
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Centre interdisciplinaire de recherche sur le cerveau et l'apprentissage (CIRCA), Université de Montréal, Montréal, QC, Canada
- Département de Neurosciences, Faculté de Médecine, Université de Montréal, Montréal, QC, Canada
| | - Alexander Thiel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
- Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim), Montréal, QC, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada
- *Correspondence: Alexander Thiel
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King JT, John AR, Wang YK, Shih CK, Zhang D, Huang KC, Lin CT. Brain Connectivity Changes During Bimanual and Rotated Motor Imagery. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 10:2100408. [PMID: 35492507 PMCID: PMC9041539 DOI: 10.1109/jtehm.2022.3167552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/24/2022] [Accepted: 04/03/2022] [Indexed: 11/10/2022]
Abstract
Motor imagery-based brain-computer interface (MI-BCI) currently represents a new trend in rehabilitation. However, individual differences in the responsive frequency bands and a poor understanding of the communication between the ipsilesional motor areas and other regions limit the use of MI-BCI therapy. Objective: Bimanual training has recently attracted attention as it achieves better outcomes as compared to repetitive one-handed training. This study compared the effects of three MI tasks with different visual feedback. Methods: Fourteen healthy subjects performed single hand motor imagery tasks while watching single static hand (traditional MI), single hand with rotation movement (rmMI), and bimanual coordination with a hand pedal exerciser (bcMI). Functional connectivity is estimated by Transfer Entropy (TE) analysis for brain information flow. Results: Brain connectivity of conducting three MI tasks showed that the bcMI demonstrated increased communications from the parietal to the bilateral prefrontal areas and increased contralateral connections between motor-related zones and spatial processing regions. Discussion/Conclusion: The results revealed bimanual coordination operation events increased spatial information and motor planning under the motor imagery task. And the proposed bimanual coordination MI-BCI (bcMI-BCI) can also achieve the effect of traditional motor imagery tasks and promotes more effective connections with different brain regions to better integrate motor-cortex functions for aiding the development of more effective MI-BCI therapy. Clinical and Translational Impact Statement The proposed bcMI-BCI provides more effective connections with different brain areas and integrates motor-cortex functions to promote motor imagery rehabilitation for patients’ impairment.
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Affiliation(s)
- Jung-Tai King
- Brain Research Center, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Alka Rachel John
- CIBCI Laboratory, Australian AI Institute, FEIT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Yu-Kai Wang
- CIBCI Laboratory, Australian AI Institute, FEIT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Chun-Kai Shih
- Brain Research Center, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Dingguo Zhang
- Department of Electronic and Electrical Engineering, University of Bath, Bath, U.K
| | - Kuan-Chih Huang
- Brain Research Center, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chin-Teng Lin
- Brain Research Center, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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CABRAL DF, FRIED P, KOCH S, RICE J, RUNDEK T, PASCUAL-LEONE A, SACCO R, WRIGHT CB, GOMES-OSMAN J. Efficacy of mechanisms of neuroplasticity after a stroke. Restor Neurol Neurosci 2022; 40:73-84. [PMID: 35570503 PMCID: PMC11032207 DOI: 10.3233/rnn-211227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The sequelae of stoke, including the loss and recovery of function, are strongly linked to the mechanisms of neuroplasticity. Rehabilitation and non-invasive brain stimulation (NIBS) paradigms have shown promise in modulating corticomotor neuroplasticity to promote functional recovery in individuals post-stroke. However, an important limitation to these approaches is that while stroke recovery depends on the mechanisms of neuroplasticity, those mechanisms may themselves be altered by a stroke. OBJECTIVE Compare Transcranial Magnetic Stimulation (TMS)-based assessments of efficacy of mechanism of neuroplasticity between individuals post-stroke and age-matched controls. METHODS Thirty-two participants (16 post-stroke, 16 control) underwent an assessment of mechanisms of neuroplasticity, measured by the change in amplitude of motor evoked potentials elicited by single-pulse TMS 10-20 minutes following intermittent theta-burst stimulation (iTBS), and dual-task effect (DTE) reflecting cognitive-motor interference (CMI). In stroke participants, we further collected: time since stroke, stroke type, location, and Stroke Impact Scale 16 (SIS-16). RESULTS Although there was no between-group difference in the efficacy of TMS-iTBS neuroplasticity mechanism (p = 0.61, η2 = 0.01), the stroke group did not exhibit the expected facilitation to TMS-iTBS (p = 0.60, η2 = 0.04) that was shown in the control group (p = 0.016, η2 = 0.18). Sub-cohort analysis showed a trend toward a difference between those in the late-stage post-stroke and the control group (p = 0.07, η2 = 0.12). Within the post-stroke group, we found significant relationships between TMS-iTBS neuroplasticity and time since stroke onset, physical function (SIS-16), and CMI (all rs > |0.53| and p-values < 0.05). CONCLUSIONS In this proof-of-principle study, our findings suggested altered mechanisms of neuroplasticity in post-stroke patients which were dependent on time since stroke and related to motor function. TMS-iTBS neuroplasticity assessment and its relationship with clinical functional measures suggest that TMS may be a useful tool to study post-stroke recovery. Due to insufficient statistical power and high variability of the data, generalization of the findings will require replication of the results in a larger, better-characterized cohort.
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Affiliation(s)
- Danylo F. CABRAL
- Department of Physical Therapy, University of Miami, Coral Gables, FL, USA
| | - Peter FRIED
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Sebastian KOCH
- Department of Neurology, University of Miami, Miami, USA
| | - Jordyn RICE
- Department of Physical Therapy, University of Miami, Coral Gables, FL, USA
| | - Tatjana RUNDEK
- Department of Neurology, University of Miami, Miami, USA
- Evelyn McKnight Brain Institute, University of Miami, Miami, USA
| | - Alvaro PASCUAL-LEONE
- Department of Neurology, Harvard Medical School, Boston MA, USA
- Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health, Hebrew SeniorLife, Rosindale, MA, USA
- Guttmann Brain Health Institute, Barcelona, Spain
| | - Ralph SACCO
- Department of Neurology, University of Miami, Miami, USA
- Evelyn McKnight Brain Institute, University of Miami, Miami, USA
| | - Clinton B. WRIGHT
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Joyce GOMES-OSMAN
- Department of Physical Therapy, University of Miami, Coral Gables, FL, USA
- Department of Neurology, University of Miami, Miami, USA
- Evelyn McKnight Brain Institute, University of Miami, Miami, USA
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Lustenhouwer R, Cameron IGM, Wolfs E, van Alfen N, Toni I, Geurts ACH, van Engelen BGM, Groothuis JT, Helmich RC. OUP accepted manuscript. Brain Commun 2022; 4:fcac034. [PMID: 35233524 PMCID: PMC8882006 DOI: 10.1093/braincomms/fcac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 12/03/2021] [Accepted: 02/14/2022] [Indexed: 11/14/2022] Open
Abstract
Neuralgic amyotrophy is a common peripheral nerve disorder caused by autoimmune inflammation of the brachial plexus, clinically characterized by acute pain and weakness of the shoulder muscles, followed by motor impairment. Despite recovery of the peripheral nerves, patients often have residual motor dysfunction of the upper extremity, leading to persistent pain related to altered biomechanics of the shoulder region. Building on clinical signs that suggest a role for cerebral mechanisms in these residual complaints, here we show and characterize cerebral alterations following neuralgic amyotrophy. Neuralgic amyotrophy patients often develop alternative motor strategies, which suggests that (mal)adaptations may occur in somatomotor and/or visuomotor brain areas. Here, we tested where changes in cerebral sensorimotor representations occur in neuralgic amyotrophy, while controlling for altered motor execution due to peripheral neuropathy. We additionally explore the relation between potential cerebral alterations in neuralgic amyotrophy and clinical symptoms. During functional MRI scanning, 39 neuralgic amyotrophy patients with persistent, lateralized symptoms in the right upper extremity and 23 matched healthy participants solved a hand laterality judgement task that can activate sensorimotor representations of the upper extremity, across somatomotor and visuomotor brain areas. Behavioural and cerebral responses confirmed the involvement of embodied, sensorimotor processes across groups. Compared with healthy participants, neuralgic amyotrophy patients were slower in hand laterality judgement and had decreased cerebral activity specific to their affected limb in two higher-order visual brain regions: the right extrastriate cortex and the parieto-occipital sulcus. Exploratory analyses revealed that across patients, extrastriate activity specific to the affected limb decreased as persistent pain increased, and affected limb-related parieto-occipital activity decreased as imagery performance of the affected limb became slower. These findings suggest that maladaptive cerebral plasticity in visuomotor areas involved in sensorimotor integration plays a role in residual motor dysfunction and subsequent persistent pain in neuralgic amyotrophy. Rehabilitation interventions that apply visuomotor strategies to improve sensorimotor integration may help to treat neuralgic amyotrophy patients.
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Affiliation(s)
- Renee Lustenhouwer
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Ian G. M. Cameron
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Donders Centre for Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, PO BOX 217, 7500 AE Enschede, The Netherlands
| | - Elze Wolfs
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, The Netherlands
| | - Nens van Alfen
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Baziel G. M. van Engelen
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Jan T. Groothuis
- Department of Rehabilitation, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Rick C. Helmich
- Donders Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Correspondence to: Rick Helmich Department of Neurology, Radboud University Medical Center PO Box 9101, 6500 HB Nijmegen, The Netherlands E-mail:
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Gutierrez-Martinez J, Mercado-Gutierrez JA, Carvajal-Gámez BE, Rosas-Trigueros JL, Contreras-Martinez AE. Artificial Intelligence Algorithms in Visual Evoked Potential-Based Brain-Computer Interfaces for Motor Rehabilitation Applications: Systematic Review and Future Directions. Front Hum Neurosci 2021; 15:772837. [PMID: 34899220 PMCID: PMC8656949 DOI: 10.3389/fnhum.2021.772837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Brain-Computer Interface (BCI) is a technology that uses electroencephalographic (EEG) signals to control external devices, such as Functional Electrical Stimulation (FES). Visual BCI paradigms based on P300 and Steady State Visually Evoked potentials (SSVEP) have shown high potential for clinical purposes. Numerous studies have been published on P300- and SSVEP-based non-invasive BCIs, but many of them present two shortcomings: (1) they are not aimed for motor rehabilitation applications, and (2) they do not report in detail the artificial intelligence (AI) methods used for classification, or their performance metrics. To address this gap, in this paper the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was applied to prepare a systematic literature review (SLR). Papers older than 10 years, repeated or not related to a motor rehabilitation application, were excluded. Of all the studies, 51.02% referred to theoretical analysis of classification algorithms. Of the remaining, 28.48% were for spelling, 12.73% for diverse applications (control of wheelchair or home appliances), and only 7.77% were focused on motor rehabilitation. After the inclusion and exclusion criteria were applied and quality screening was performed, 34 articles were selected. Of them, 26.47% used the P300 and 55.8% the SSVEP signal. Five applications categories were established: Rehabilitation Systems (17.64%), Virtual Reality environments (23.52%), FES (17.64%), Orthosis (29.41%), and Prosthesis (11.76%). Of all the works, only four performed tests with patients. The most reported machine learning (ML) algorithms used for classification were linear discriminant analysis (LDA) (48.64%) and support vector machine (16.21%), while only one study used a deep learning algorithm: a Convolutional Neural Network (CNN). The reported accuracy ranged from 38.02 to 100%, and the Information Transfer Rate from 1.55 to 49.25 bits per minute. While LDA is still the most used AI algorithm, CNN has shown promising results, but due to their high technical implementation requirements, many researchers do not justify its implementation as worthwile. To achieve quick and accurate online BCIs for motor rehabilitation applications, future works on SSVEP-, P300-based and hybrid BCIs should focus on optimizing the visual stimulation module and the training stage of ML and DL algorithms.
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Affiliation(s)
- Josefina Gutierrez-Martinez
- División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Jorge A. Mercado-Gutierrez
- División de Investigación en Ingeniería Médica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
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Giulia L, Adolfo V, Julie C, Quentin D, Simon B, Fleury M, Leveque-Le Bars E, Bannier E, Lécuyer A, Barillot C, Bonan I. The impact of neurofeedback on effective connectivity networks in chronic stroke patients: an exploratory study. J Neural Eng 2021; 18. [PMID: 34551403 DOI: 10.1088/1741-2552/ac291e] [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: 02/10/2021] [Accepted: 09/22/2021] [Indexed: 11/12/2022]
Abstract
Objective.In this study, we assessed the impact of electroencephalography-functional magnetic resonance imaging (EEG-fMRI) neurofeedback (NF) on connectivity strength and direction in bilateral motor cortices in chronic stroke patients. Most of the studies using NF or brain computer interfaces for stroke rehabilitation have assessed treatment effects focusing on successful activation of targeted cortical regions. However, given the crucial role of brain network reorganization for stroke recovery, our broader aim was to assess connectivity changes after an NF training protocol targeting localized motor areas.Approach.We considered changes in fMRI connectivity after a multisession EEG-fMRI NF training targeting ipsilesional motor areas in nine stroke patients. We applied the dynamic causal modeling and parametric empirical Bayes frameworks for the estimation of effective connectivity changes. We considered a motor network including both ipsilesional and contralesional premotor, supplementary and primary motor areas.Main results.Our results indicate that NF upregulation of targeted areas (ipsilesional supplementary and primary motor areas) not only modulated activation patterns, but also had a more widespread impact on fMRI bilateral motor networks. In particular, inter-hemispheric connectivity between premotor and primary motor regions decreased, and ipsilesional self-inhibitory connections were reduced in strength, indicating an increase in activation during the NF motor task.Significance.To the best of our knowledge, this is the first work that investigates fMRI connectivity changes elicited by training of localized motor targets in stroke. Our results open new perspectives in the understanding of large-scale effects of NF training and the design of more effective NF strategies, based on the pathophysiology underlying stroke-induced deficits.
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Affiliation(s)
- Lioi Giulia
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France.,IMT Atlantique, Lab-STICC, UMR CNRS 6285, Brest, F-29238, France
| | - Veliz Adolfo
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
| | | | - Duché Quentin
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France.,Department of Physical and Rehabilitation Medicine, CHU Rennes, Rennes, France
| | - Butet Simon
- Department of Physical and Rehabilitation Medicine, CHU Rennes, Rennes, France
| | - Mathis Fleury
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
| | | | - Elise Bannier
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France.,Department of Radiology, CHU Rennes, Rennes, France
| | | | | | - Isabelle Bonan
- Department of Physical and Rehabilitation Medicine, CHU Rennes, Rennes, France
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Kitai K, Odagiri M, Yamauchi R, Kodama T. Evaluation of Intervention Effectiveness of Sensory Compensatory Training with Tactile Discrimination Feedback on Sensorimotor Dysfunction of the Hand after Stroke. Brain Sci 2021; 11:brainsci11101314. [PMID: 34679379 PMCID: PMC8534145 DOI: 10.3390/brainsci11101314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/30/2021] [Indexed: 12/04/2022] Open
Abstract
We investigated the intervention effect of training using a feedback-type tactile discrimination system on sensorimotor dysfunction of the hand after a stroke. A human male subject with sensorimotor dysfunction in his left hand after a stroke was asked to perform peg manipulation practice, a building block stacking task, and a material identification task for 10 min each for six weeks. During the activities, a tactile discrimination feedback system was used. The system is a device that detects the vibration information generated when touching an object with a hand and that feeds back the captured information in real time as vibration information. After the intervention, in addition to the reorganization of the sensorimotor areas, the deep sensation, sense of agency, numbness, amount of use, and quality of the left-hand movement improved. Our results suggest that training with the use of a feedback system could be a new form of rehabilitation for sensorimotor dysfunction of the hand.
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Affiliation(s)
- Ken Kitai
- Department of Rehabilitation, Maizuru Red Cross Hospital, Kyoto 624-0906, Japan;
| | - Masashi Odagiri
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (M.O.); (R.Y.)
| | - Ryosuke Yamauchi
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (M.O.); (R.Y.)
| | - Takayuki Kodama
- Department of Physical Therapy, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto 607-8175, Japan; (M.O.); (R.Y.)
- Correspondence: ; Tel.: +81-075-574-4312
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Zhou S, Guo Z, Wong K, Zhu H, Huang Y, Hu X, Zheng YP. Pathway-specific cortico-muscular coherence in proximal-to-distal compensation during fine motor control of finger extension after stroke. J Neural Eng 2021; 18. [PMID: 34428752 DOI: 10.1088/1741-2552/ac20bc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022]
Abstract
Objective.Proximal-to-distal compensation is commonly observed in the upper extremity (UE) after a stroke, mainly due to the impaired fine motor control in hand joints. However, little is known about its related neural reorganization. This study investigated the pathway-specific corticomuscular interaction in proximal-to-distal UE compensation during fine motor control of finger extension post-stroke by directed corticomuscular coherence (dCMC).Approach.We recruited 14 chronic stroke participants and 11 unimpaired controls. Electroencephalogram (EEG) from the sensorimotor area was concurrently recorded with electromyography (EMG) from extensor digitorum (ED), flexor digitorum (FD), triceps brachii (TRI) and biceps brachii (BIC) muscles in both sides of the stroke participants and in the dominant (right) side of the controls during the unilateral isometric finger extension at 20% maximal voluntary contractions. The dCMC was analyzed in descending (EEG → EMG) and ascending pathways (EMG → EEG) via the directed coherence. It was also analyzed in stable (segments with higher EMG stability) and less-stable periods (segments with lower EMG stability) subdivided from the whole movement period to investigate the fine motor control. Finally, the corticomuscular conduction time was estimated by dCMC phase delay.Main results.The affected limb had significantly lower descending dCMC in distal UE (ED and FD) than BIC (P< 0.05). It showed the descending dominance (significantly higher descending dCMC than the ascending,P< 0.05) in proximal UE (BIC and TRI) rather than the distal UE as in the controls. In the less-stable period, the affected limb had significantly lower EMG stability but higher ascending dCMC (P< 0.05) in distal UE than the controls. Furthermore, significantly prolonged descending conduction time (∼38.8 ms) was found in ED in the affected limb than the unaffected (∼26.94 ms) and control limbs (∼25.74 ms) (P< 0.05).Significance.The proximal-to-distal UE compensation in fine motor control post-stroke exhibited altered descending dominance from the distal to proximal UE, increased ascending feedbacks from the distal UE for fine motor control, and prolonged descending conduction time in the agonist muscle.
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Affiliation(s)
- Sa Zhou
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Ziqi Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Kiufung Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Hanlin Zhu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, People's Republic of China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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Nam C, Zhang B, Chow T, Ye F, Huang Y, Guo Z, Li W, Rong W, Hu X, Poon W. Home-based self-help telerehabilitation of the upper limb assisted by an electromyography-driven wrist/hand exoneuromusculoskeleton after stroke. J Neuroeng Rehabil 2021; 18:137. [PMID: 34526058 PMCID: PMC8442816 DOI: 10.1186/s12984-021-00930-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most stroke survivors have sustained upper limb impairment in their distal joints. An electromyography (EMG)-driven wrist/hand exoneuromusculoskeleton (WH-ENMS) was developed previously. The present study investigated the feasibility of a home-based self-help telerehabilitation program assisted by the aforementioned EMG-driven WH-ENMS and its rehabilitation effects after stroke. METHODS Persons with chronic stroke (n = 11) were recruited in a single-group trial. The training progress, including the training frequency and duration, was telemonitored. The clinical outcomes were evaluated using the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Functional Independence Measure (FIM), and Modified Ashworth Scale (MAS). Improvement in muscle coordination was investigated in terms of the EMG activation level and the Co-contraction Index (CI) of the target muscles, including the abductor pollicis brevis (APB), flexor carpi radialis-flexor digitorum (FCR-FD), extensor carpi ulnaris-extensor digitorum (ECU-ED), biceps brachii (BIC), and triceps brachii (TRI). The movement smoothness and compensatory trunk movement were evaluated in terms of the following two kinematic parameters: number of movement units (NMUs) and maximal trunk displacement (MTD). The above evaluations were conducted before and after the training. RESULTS All of the participants completed the home-based program with an intensity of 63.0 ± 1.90 (mean ± SD) min/session and 3.73 ± 0.75 (mean ± SD) sessions/week. After the training, motor improvements in the entire upper limb were found, as indicated by the significant improvements (P < 0.05) in the FMA, ARAT, WMFT, and MAS; significant decreases (P < 0.05) in the EMG activation levels of the APB and FCR-FD; significant decreases (P < 0.05) in the CI of the ECU-ED/FCR-FD, ECU-ED/BIC, FCR-FD/APB, FCR-FD/BIC, FCR-FD/TRI, APB/BIC and BIC/TRI muscle pairs; and significant reductions (P < 0.05) in the NMUs and MTD. CONCLUSIONS The results suggested that the home-based self-help telerehabilitation program assisted by EMG-driven WH-ENMS is feasible and effective for improving the motor function of the paretic upper limb after stroke. Trial registration ClinicalTrials.gov. NCT03752775; Date of registration: November 20, 2018.
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Affiliation(s)
- Chingyi Nam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Bingbing Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tszying Chow
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Fuqiang Ye
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ziqi Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Waiming Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wei Rong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China. .,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, 518034, China.
| | - Waisang Poon
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Hu Y, Wu J, Zhang X, Tian J, Lu Y, Guo T. Effects of Paired Associative Stimulation on Metabolites in Ischemia Stroke Rats Model as Studied by Nuclear Magnetic Resonance Spectrum. Neurochem Res 2021; 46:2495-2504. [PMID: 34231112 DOI: 10.1007/s11064-021-03388-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 11/30/2022]
Abstract
Paired associated stimulation (PAS) has been confirmed to play a role in motor recovery after stroke, but the underlying mechanism has not been fully elucidated. In this study, we employed a comprehensive battery of measurements, including behavioral test, electrophysiology and 1H-NMR approaches, to investigate the therapeutic effects of PAS in rat model of cerebral ischemia and its underlying mechanism. Rats were randomly divided into a transient middle cerebral artery occlusion group (tMCAO group), a tMCAO + PAS group (PAS group), and a sham group. PAS was applied over 7 consecutive days in PAS group. The behavioral function of rats was evaluated by modified Garcia Scores and Rota-rod test. Electrophysiological changes were measured by motor evoked potentials (MEP). Metabolic changes of ischemic penumbra were detected by 1H-NMR. After PAS intervention, the performances on Rota-rod test and Garcia test improved and the amplitude of MEP increased significantly. The gamma-aminobutyric acid (GABA) in penumbra cortex was decreased significantly, whereas the glutamate showed the opposite changes. The results suggested that post-stroke recovery promoted by PAS may be related to the metabolites alteration in ischemic penumbra and also regulate the excitability of motor cortex.
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Affiliation(s)
- Yan Hu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Qiaokou District, Wuhan City, 430000, Hubei Province, China
| | - Jinfeng Wu
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan, 430071, China
| | - Xiangyu Zhang
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Qiaokou District, Wuhan City, 430000, Hubei Province, China
| | - Jun Tian
- Department of Rehabilitation Medicine, Zhongnan Hospital, Wuhan University, Wuhan, 430000, China
| | - Yinshan Lu
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Qiaokou District, Wuhan City, 430000, Hubei Province, China
| | - Tiecheng Guo
- Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, No. 1095, Jiefang Avenue, Qiaokou District, Wuhan City, 430000, Hubei Province, China.
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Tok S, Ahnaou A, Drinkenburg W. Functional Neurophysiological Biomarkers of Early-Stage Alzheimer's Disease: A Perspective of Network Hyperexcitability in Disease Progression. J Alzheimers Dis 2021; 88:809-836. [PMID: 34420957 PMCID: PMC9484128 DOI: 10.3233/jad-210397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Network hyperexcitability (NH) has recently been suggested as a potential neurophysiological indicator of Alzheimer’s disease (AD), as new, more accurate biomarkers of AD are sought. NH has generated interest as a potential indicator of certain stages in the disease trajectory and even as a disease mechanism by which network dysfunction could be modulated. NH has been demonstrated in several animal models of AD pathology and multiple lines of evidence point to the existence of NH in patients with AD, strongly supporting the physiological and clinical relevance of this readout. Several hypotheses have been put forward to explain the prevalence of NH in animal models through neurophysiological, biochemical, and imaging techniques. However, some of these hypotheses have been built on animal models with limitations and caveats that may have derived NH through other mechanisms or mechanisms without translational validity to sporadic AD patients, potentially leading to an erroneous conclusion of the underlying cause of NH occurring in patients with AD. In this review, we discuss the substantiation for NH in animal models of AD pathology and in human patients, as well as some of the hypotheses considering recently developed animal models that challenge existing hypotheses and mechanisms of NH. In addition, we provide a preclinical perspective on how the development of animal models incorporating AD-specific NH could provide physiologically relevant translational experimental data that may potentially aid the discovery and development of novel therapies for AD.
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Affiliation(s)
- Sean Tok
- Department of Neuroscience, Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium.,Groningen Institute for Evolutionary Life Sciences, Faculty of Science and Engineering, University of Groningen, The Netherlands
| | - Abdallah Ahnaou
- Department of Neuroscience, Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Wilhelmus Drinkenburg
- Department of Neuroscience, Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium.,Groningen Institute for Evolutionary Life Sciences, Faculty of Science and Engineering, University of Groningen, The Netherlands
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40
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Al-Whaibi RM, Al-Jadid MS, ElSerougy HR, Badawy WM. Effectiveness of virtual reality-based rehabilitation versus conventional therapy on upper limb motor function of chronic stroke patients: a systematic review and meta-analysis of randomized controlled trials. Physiother Theory Pract 2021; 38:2402-2416. [PMID: 34315320 DOI: 10.1080/09593985.2021.1941458] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To systematically review the available randomized controlled trials in the literature concerning the application of virtual reality (VR) rehabilitation interventions compared to conventional physical therapy, in regaining the upper limb motor function among patients with chronic stroke. Methods: A systematic electronic database search was conducted for related studies published from inauguration and until June 25, 2020 in nine databases. Another new search was done on February 1, 2021 and no new studies were identified. Results: Six studies were included in the analysis. Significant improvement was seen following the VR therapy in patients with chronic stroke, compared to their scores prior to it (SMD = 0.28; 95% CI = 0.03-0.53; p = .03). There was neither heterogeneity (I2 = 0% and P = .5) nor a risk of bias (P = .8) among the included studies. VR interventions produced a comparable effectiveness to that of the conventional rehabilitation, with no statistically significant difference (SMD = 0.15; 95% CI = -0.14-0.44; P = .3). There was neither heterogeneity (I2 = 40% and P = .1) nor a risk of bias (P = .5) among the included studies. Conclusions: The upper limb motor function of patients with chronic stroke who underwent VR-based rehabilitative intervention showed significant improvement as compared to the pre-treatment state. Our analysis also revealed no superiority of VR interventions over conservative therapies; however, the difference observed did not accomplish statistical significance.
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Affiliation(s)
- Reem M Al-Whaibi
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Maher S Al-Jadid
- Rehabilitation Medicine Department, Prince Sultan Military Medical School, Riyadh, Saudi Arabia
| | - Hager R ElSerougy
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | - Wanees M Badawy
- Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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41
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Stulin ID, Tardov MV, Damulin IV. [Tinnitus: clinical and pathogenetic aspects]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:100-105. [PMID: 34283538 DOI: 10.17116/jnevro2021121061100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article discusses the pathogenetic and clinical features of tinnitus. It is emphasized that various causes contribute to the appearance of tinnitus, including somatic diseases, excess body weight, iatrogenies, otological diseases with an outcome in hearing loss. The anatomical and physiological features of the structure of the central part of the auditory system are considered. It is suggested that the occurrence of tinnitus is associated with the processes of maladaptive neuroplasticity caused by pathological changes in the neuronal activity of cortical structures of the CNS, and not with changes in the peripheral part of the auditory analyzer - the structures of the cochlea. The results of recent studies, including those using functional neuroimaging methods, indicate the significance of cortical connection disorders (human connectome) in patients with tinnitus. In patients with tinnitus, there are changes in regional neuronal activity and connections not only in the auditory cortex, but also in areas not directly related to the analysis of auditory afferentation. Thus, tinnitus can be considered as one of the variants of dysfunction of the human connectome, triggered primarily from the «auditory input».
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Affiliation(s)
- I D Stulin
- Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - M V Tardov
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - I V Damulin
- Medical Institute of Russian Peoples' Friendship University, Moscow, Russia.,Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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42
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Saeed S, Khan QU. The Pathological Mechanisms and Treatments of Tinnitus. Discoveries (Craiova) 2021; 9:e137. [PMID: 35350720 PMCID: PMC8956333 DOI: 10.15190/d.2021.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/21/2021] [Accepted: 09/30/2021] [Indexed: 11/22/2022] Open
Abstract
Tinnitus is defined as the ringing, hissing, clicking or roaring sounds an individual consciously perceives in the absence of an external auditory stimulus. Currently, the literature on the mechanism of tinnitus pathology is multifaceted, ranging from tinnitus generation at the cellular level to its perception at the system level. Cellular level mechanisms include increased neuronal synchrony, neurotransmission changes and maladaptive plasticity. At the system level, the role of auditory structures, non-auditory structures, changes in the functional connectivities in higher regions and tinnitus networks have been investigated. The exploration of all these mechanisms creates a holistic view on understanding the changes the pathophysiology of tinnitus undertakes. Although tinnitus percept may start at the level of cochlear nerve deafferentation, the neuronal changes in the central auditory system to the neuronal and connectivity changes in non-auditory regions, such as the limbic system, become cardinal in chronic tinnitus generation. At the present moment, some tinnitus generation mechanisms are well established (e.g., increased neuronal synchrony) whereas other mechanisms have gained more traction recently (e.g., tinnitus networks, tinnitus-distress networks) and therefore, require additional investigation to solidify their role in tinnitus pathology.
The treatments and therapeutics designed for tinnitus are numerous, with varied levels of success. They are generally two-fold: some treatments focus on tinnitus cessation (including cochlear implants, deep brain stimulation, transcranial direct current stimulation and transcranial magnetic stimulation) whereas the other set focuses on tinnitus reduction or masking (including hearing aids, sound therapy, cognitive behavioral therapy, tinnitus retraining therapy, and tailor made notched musical training). Tinnitus management has focused on implementing tinnitus masking/reducing therapies more than tinnitus cessation, since cessation treatments are still lacking in streamlined treatment protocols and long-term sustainability and efficacy of the treatment.
This review will focus on concisely exploring the current and most relevant tinnitus pathophysiology mechanisms, treatments and therapeutics.
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Affiliation(s)
- Sana Saeed
- CMH Lahore Medical College & Institute of Dentistry, Lahore, Pakistan
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43
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Zeiger WA, Marosi M, Saggi S, Noble N, Samad I, Portera-Cailliau C. Barrel cortex plasticity after photothrombotic stroke involves potentiating responses of pre-existing circuits but not functional remapping to new circuits. Nat Commun 2021; 12:3972. [PMID: 34172735 PMCID: PMC8233353 DOI: 10.1038/s41467-021-24211-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 06/01/2021] [Indexed: 01/14/2023] Open
Abstract
Recovery after stroke is thought to be mediated by adaptive circuit plasticity, whereby surviving neurons assume the roles of those that died. However, definitive longitudinal evidence of neurons changing their response selectivity after stroke is lacking. We sought to directly test whether such functional “remapping” occurs within mouse primary somatosensory cortex after a stroke that destroys the C1 barrel. Using in vivo calcium imaging to longitudinally record sensory-evoked activity under light anesthesia, we did not find any increase in the number of C1 whisker-responsive neurons in the adjacent, spared D3 barrel after stroke. To promote plasticity after stroke, we also plucked all whiskers except C1 (forced use therapy). This led to an increase in the reliability of sensory-evoked responses in C1 whisker-responsive neurons but did not increase the number of C1 whisker-responsive neurons in spared surround barrels over baseline levels. Our results argue against remapping of functionality after barrel cortex stroke, but support a circuit-based mechanism for how rehabilitation may improve recovery. Definitive evidence for functional remapping after stroke remains lacking. Here, the authors performed in vivo intrinsic signal imaging and two-photon calcium imaging of sensory-evoked responses before and after photothrombotic stroke and found no evidence of remapping of lost functionalities to new circuits in peri-infarct cortex.
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Affiliation(s)
- William A Zeiger
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Máté Marosi
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,Department of Pharmacology and Toxicology, University of Texas Medical Branch, Galveston, TX, USA
| | - Satvir Saggi
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Natalie Noble
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Isa Samad
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Carlos Portera-Cailliau
- Department of Neurology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA. .,Department of Neurobiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
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44
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Russo S, Pigorini A, Mikulan E, Sarasso S, Rubino A, Zauli FM, Parmigiani S, d'Orio P, Cattani A, Francione S, Tassi L, Bassetti CLA, Lo Russo G, Nobili L, Sartori I, Massimini M. Focal lesions induce large-scale percolation of sleep-like intracerebral activity in awake humans. Neuroimage 2021; 234:117964. [PMID: 33771696 DOI: 10.1016/j.neuroimage.2021.117964] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/15/2021] [Accepted: 03/08/2021] [Indexed: 11/26/2022] Open
Abstract
Focal cortical lesions are known to result in large-scale functional alterations involving distant areas; however, little is known about the electrophysiological mechanisms underlying these network effects. Here, we addressed this issue by analysing the short and long distance intracranial effects of controlled structural lesions in humans. The changes in Stereo-Electroencephalographic (SEEG) activity after Radiofrequency-Thermocoagulation (RFTC) recorded in 21 epileptic subjects were assessed with respect to baseline resting wakefulness and sleep activity. In addition, Cortico-Cortical Evoked Potentials (CCEPs) recorded before the lesion were employed to interpret these changes with respect to individual long-range connectivity patterns. We found that small structural ablations lead to the generation and large-scale propagation of sleep-like slow waves within the awake brain. These slow waves match those recorded in the same subjects during sleep, are prevalent in perilesional areas, but can percolate up to distances of 60 mm through specific long-range connections, as predicted by CCEPs. Given the known impact of slow waves on information processing and cortical plasticity, demonstrating their intrusion and percolation within the awake brain add key elements to our understanding of network dysfunction after cortical injuries.
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Affiliation(s)
- S Russo
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - A Pigorini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - E Mikulan
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - S Sarasso
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - A Rubino
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - F M Zauli
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - S Parmigiani
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - P d'Orio
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy; Institute of Neuroscience, CNR, via Volturno 39E, 43125 Parma, Italy
| | - A Cattani
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA
| | - S Francione
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - L Tassi
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - C L A Bassetti
- Department of Neurology, Inselspital, University of Bern, Switzerland
| | - G Lo Russo
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - L Nobili
- Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genova 16147, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - I Sartori
- "C. Munari" Epilepsy Surgery Centre, Department of Neuroscience, Niguarda Hospital, Milan 20162, Italy
| | - M Massimini
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy; IRCCS, Fondazione Don Carlo Gnocchi, Milan 20148, Italy; Azrieli Program in Brain, Mind and Consciousness, Canadian Institute for Advanced Research, Toronto, Canada.
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45
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Thomas SM, Delanni E, Christophe B, Connolly ES. Systematic review of novel technology-based interventions for ischemic stroke. Neurol Sci 2021; 42:1705-1717. [PMID: 33604762 DOI: 10.1007/s10072-021-05126-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify novel technologies pertinent to the prevention, diagnosis, treatment, and rehabilitation of ischemic stroke, and recommend the technologies that show the most promise in advancing ischemic stroke care. METHOD A systematic literature search on PubMed and Medscape was performed. Articles were assessed based on pre-determined criteria. Included journal articles were evaluated for specific characteristics and reviewed according to a structured paradigm. A search on www.clinicaltrials.gov was performed to identify pre-clinical ischemic stroke technological interventions. All clinical trial results were included. An additional search on PubMed was conducted to identify studies on robotic neuroendovascular procedures. RESULTS Thirty journal articles and five clinical trials were analyzed. Articles were categorized as follows: six studies pertinent to pre-morbidity and prevention of ischemic stroke, three studies relevant to the diagnosis of ischemic stroke, 16 studies about post-ischemic stroke rehabilitation, and five studies on robotic neuroendovascular interventions. CONCLUSIONS Novel technologies across the spectrum of ischemic stroke care were identified, and the ones that appear to have the most clinical utility are recommended. Future investigation of the feasibility and long-term efficacy of the recommended technologies in clinical settings is warranted.
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Affiliation(s)
- Steven Mulackal Thomas
- Department of Neurological Surgery, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA.
| | - Ellie Delanni
- Department of Neurological Surgery, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Brandon Christophe
- Department of Neurological Surgery, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
| | - Edward Sander Connolly
- Department of Neurological Surgery, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA
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46
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Zyuz'kov GN, Miroshnichenko LAE, Simanina EV, Stavrova LA, Polykova TYE. Intracellular signaling molecules of nerve tissue progenitors as pharmacological targets for treatment of ethanol-induced neurodegeneration. J Basic Clin Physiol Pharmacol 2021; 33:305-315. [PMID: 33559456 DOI: 10.1515/jbcpp-2020-0317] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/25/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES The development of approaches to the treatment of neurodegenerative diseases caused by alcohol abuse by targeted pharmacological regulation of intracellular signaling transduction of progenitor cells of nerve tissue is promising. We studied peculiarities of participation of NF-кB-, сАМР/РКА-, JAKs/STAT3-, ERK1/2-, p38-pathways in the regulation of neural stem cells (NSC) and neuronal-committed progenitors (NCP) in the simulation of ethanol-induced neurodegeneration in vitro and in vivo. METHODS In vitro, the role of signaling molecules (NF-кB, сАМР, РКА, JAKs, STAT3, ERK1/2, p38) in realizing the growth potential of neural stem cells (NSC) and neuronal-committed progenitors (NCP) in ethanol-induced neurodegeneration modeled in vitro and in vivo was studied. To do this, the method of the pharmacological blockade with the use of selective inhibitors of individual signaling molecules was used. RESULTS Several of fundamental differences in the role of certain intracellular signaling molecules (SM) in proliferation and specialization of NSC and NCP have been revealed. It has been shown that the effect of ethanol on progenitors is accompanied by the formation of a qualitatively new pattern of signaling pathways. Data have been obtained on the possibility of stimulation of nerve tissue regeneration in ethanol-induced neurodegeneration by NF-кB and STAT3 inhibitors. It has been found that the blockage of these SM stimulates NSC and NCP in conditions of ethanol intoxication and does not have a «negative» effect on the realization of the growth potential of intact progenitors (which will appear de novo during therapy). CONCLUSIONS The results may serve as a basis for the development of fundamentally new drugs to the treatment of alcoholic encephalopathy and other diseases of the central nervous system associated with alcohol abuse.
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Affiliation(s)
- Gleb Nikolaevich Zyuz'kov
- Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Larisa Arkad Evna Miroshnichenko
- Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Elena Vladislavovna Simanina
- Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Larisa Alexandrovna Stavrova
- Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Tatyana Yur Evna Polykova
- Goldberg Research Institute of Pharmacology and Regenerative Medicine, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
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47
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Gamma frequency activation of inhibitory neurons in the acute phase after stroke attenuates vascular and behavioral dysfunction. Cell Rep 2021; 34:108696. [PMID: 33535035 DOI: 10.1016/j.celrep.2021.108696] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/06/2020] [Accepted: 01/06/2021] [Indexed: 11/24/2022] Open
Abstract
Alterations in gamma oscillations occur in several neurological disorders, and the entrainment of gamma oscillations has been recently proposed as a treatment for neurodegenerative disease. Optogenetic stimulation enhances recovery in models of stroke when applied weeks after injury; however, the benefits of acute brain stimulation have not been investigated. Here, we report beneficial effects of gamma-frequency modulation in the acute phase, within 1 h, after stroke. Transgenic VGAT-ChR2 mice are subject to awake photothrombotic stroke in an area encompassing the forelimb sensory and motor cortex. Optogenetic stimulation at 40 Hz in the peri-infarct zone recovers neuronal activity 24 h after stroke in motor and parietal association areas, as well as blood flow over the first week after stroke. Stimulation significantly reduces lesion volume and improves motor function. Our results suggest that acute-phase modulation of cortical oscillatory dynamics may serve as a target for neuroprotection against stroke.
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Kilmarx J, Oblak E, Sulzer J, Lewis-Peacock J. Towards a common template for neural reinforcement of finger individuation. Sci Rep 2021; 11:1065. [PMID: 33441742 PMCID: PMC7806844 DOI: 10.1038/s41598-020-80166-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/14/2020] [Indexed: 12/04/2022] Open
Abstract
The inability to individuate finger movements is a common impairment following stroke. Conventional physical therapy ignores underlying neural changes with recovery, leaving it unclear why sensorimotor function often remains impaired. Functional MRI neurofeedback can monitor neural activity and reinforce it towards a healthy template to restore function. However, identifying an individualized training template may not be possible depending on the severity of impairment. In this study, we investigated the use of functional alignment of brain data across healthy participants to create an idealized neural template to be used as a training target for new participants. We employed multi-voxel pattern analyses to assess the prediction accuracy and robustness to missing data of pre-trained functional templates corresponding to individual finger presses. We found a significant improvement in classification accuracy (p < 0.001) of individual finger presses when group data was aligned based on function (88%) rather than anatomy (46%). Importantly, we found no significant drop in performance when aligning a new participant to a pre-established template as compared to including this new participant in the creation of a new template. These results indicate that functionally aligned templates could provide an effective surrogate training target for patients following neurological injury.
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Affiliation(s)
- Justin Kilmarx
- Department of Mechanical Engineering, The University of Texas at Austin, 2501 Wichita St, Austin, TX, 78712, USA.
| | - Ethan Oblak
- Department of Mechanical Engineering, The University of Texas at Austin, 2501 Wichita St, Austin, TX, 78712, USA
| | - James Sulzer
- Department of Mechanical Engineering, The University of Texas at Austin, 2501 Wichita St, Austin, TX, 78712, USA
| | - Jarrod Lewis-Peacock
- Department of Psychology, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX, 78712, USA
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Lee HC, Kuo FL, Lin YN, Liou TH, Lin JC, Huang SW. Effects of Robot-Assisted Rehabilitation on Hand Function of People With Stroke: A Randomized, Crossover-Controlled, Assessor-Blinded Study. Am J Occup Ther 2021; 75:7501205020p1-7501205020p11. [PMID: 33399050 DOI: 10.5014/ajot.2021.038232] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The effects of robot-assisted task-oriented training with tangible objects among patients with stroke remain unknown. OBJECTIVE To investigate the effects of robot-assisted therapy (RT) with a Gloreha device on sensorimotor and hand function and ability to perform activities of daily living (ADLs) among patients with stroke. DESIGN Randomized, crossover-controlled, assessor-blinded study. SETTING Rehabilitation clinic. PARTICIPANTS Patients (N = 24) with moderate motor and sensory deficits. INTERVENTION Patients participated in 12 RT sessions and 12 conventional therapy (CT) sessions, with order counterbalanced, for 6 wk, with a 1-mo washout period. OUTCOMES AND MEASURES Performance was assessed four times: before and after RT and before and after CT. Outcomes were measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Box and Block Test, electromyography of the extensor digitorum communis (EDC) and brachioradialis, and a grip dynamometer for motor function; Semmes-Weinstein hand monofilament and the Revised Nottingham Sensory Assessment for sensory function; and the Modified Barthel Index (MBI) for ADL ability. RESULTS RT resulted in significantly improved FMA-UE proximal (p = .038) and total (p = .046) and MBI (p = .030) scores. Participants' EDC muscles exhibited higher efficacy during the small-block grasping task of the Box and Block Test after RT than after CT (p = .050). CONCLUSIONS AND RELEVANCE RT with the Gloreha device can facilitate whole-limb function, leading to beneficial effects on arm motor function, EDC muscle recruitment efficacy, and ADL ability for people with subacute and chronic stroke. WHAT THIS ARTICLE ADDS The evidence suggests that a task-oriented approach combined with the Gloreha device can facilitate engagement in whole-limb active movement and efficiently promote functional recovery.
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Affiliation(s)
- Hsin-Chieh Lee
- Hsin-Chieh Lee, MS, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Fen-Ling Kuo
- Fen-Ling Kuo, MS, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yen-Nung Lin
- Yen-Nung Lin, MD, MS, is Physiatrist, Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, and Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei City, Taiwan
| | - Tsan-Hon Liou
- Tsan-Hon Liou, MD, PhD, is Physiatrist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, and Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jui-Chi Lin
- Jui-Chi Lin, MS, is Occupational Therapist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan;
| | - Shih-Wei Huang
- Shih-Wei Huang, MD, is Physiatrist, Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, and Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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50
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Brown AR, Coughlin GM, Teskey GC. Seizures Alter Cortical Representations for Complex Movements. Neuroscience 2020; 449:134-146. [DOI: 10.1016/j.neuroscience.2020.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 01/31/2023]
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