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Lavrador JP, Rajwani K, Patel S, Kalaitzoglou D, Soumpasis C, Gullan R, Ashkan K, Bhangoo R, Dell'Acqua F, Vergani F. Ultra-early navigated transcranial magnetic stimulation for perioperative stroke: anatomo-functional report. Cereb Cortex 2024; 34:bhae251. [PMID: 38879808 DOI: 10.1093/cercor/bhae251] [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: 01/22/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
Navigated repetitive transmagnetic stimulation is a non-invasive and safe brain activity modulation technique. When combined with the classical rehabilitation process in stroke patients it has the potential to enhance the overall neurologic recovery. We present a case of a peri-operative stroke, treated with ultra-early low frequency navigated repetitive transmagnetic stimulation over the contralesional hemisphere. The patient received low frequency navigated repetitive transmagnetic stimulation within 12 hours of stroke onset for seven consecutive days and a significant improvement in his right sided weakness was noticed and he was discharge with normal power. This was accompanied by an increase in the number of positive responses evoked by navigated repetitive transmagnetic stimulation and a decrease of the resting motor thresholds at a cortical level. Subcortically, a decrease in the radial, axial, and mean diffusivity were recorded in the ipsilateral corticospinal tract and an increase in fractional anisotropy, axial diffusivity, and mean diffusivity was observed in the interhemispheric fibers of the corpus callosum responsible for the interhemispheric connectivity between motor areas. Our case demonstrates clearly that ultra-early low frequency navigated repetitive transmagnetic stimulation applied to the contralateral motor cortex can lead to significant clinical motor improvement in patients with subcortical stroke.
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Affiliation(s)
- José Pedro Lavrador
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, London, UK
| | - Kapil Rajwani
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, London, UK
| | - Sabina Patel
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, London, UK
| | - Dimitrios Kalaitzoglou
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, London, UK
| | - Christos Soumpasis
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, London, UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, London, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, London, UK
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, London, UK
| | - Flavio Dell'Acqua
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College London, 16 De Crespigny Park, London SE5 8AF, London, UK
| | - Francesco Vergani
- Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, London, UK
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Ismail UN, Yahya N, Manan HA. Investigating functional connectivity related to stroke recovery: A systematic review. Brain Res 2024; 1840:149023. [PMID: 38815644 DOI: 10.1016/j.brainres.2024.149023] [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: 02/03/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024]
Abstract
INTRODUCTION Stroke recovery is a complex process influenced by various factors, including specific neural reorganization. The objective of this systematic review was to identify important functional connectivity (FC) changes in resting-state fMRI data that were often correlated with motor, emotional, and cognitive outcome improvement. METHOD A systematic search using PubMed and SCOPUS databases was conducted to identify relevant studies published between 2010 and 2023. RESULTS A total of 766 studies were identified, of which 20 studies (602 S individuals) met the inclusion criteria. Fourteen studies focussed on motor recovery while six on cognitive recovery. All studies reported interhemispheric FC to be strongly associated with motor and cognitive recovery. The preservation and changes of M1-M1 (eight incidences) and M1-SMA (nine incidences) FC were found to be strongly correlated with motor function improvement. For cognitive recovery, restoration and preservation of FC with and between default mode network (DMN)-related regions were important for the process. CONCLUSIONS This review identified specific patterns of FC that were consistently reported with recovery of motor and cognitive function. The findings may serve in refining future management strategies to enhance patient outcomes.
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Affiliation(s)
- Umi Nabilah Ismail
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56 000 Cheras, Kuala Lumpur, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, Centre of Diagnostic, Therapeutic and Investigative Sciences (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56 000 Cheras, Kuala Lumpur, Malaysia; Department of Radiology and Intervention, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia.
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Esht V, Alshehri MM, Balasubramanian K, Sanjeevi RR, Shaphe MA, Alhowimel A, Alenazi AM, Alqahtani BA, Alhwoaimel N. Transcranial direct current stimulation (tDCS) for neurological disability among subacute stroke survivors to improve multiple domains in health-related quality of life: Randomized controlled trial protocol. Neurophysiol Clin 2024; 54:102976. [PMID: 38663043 DOI: 10.1016/j.neucli.2024.102976] [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: 11/20/2023] [Revised: 03/23/2024] [Accepted: 03/23/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES The primary goal of the current proposal is to fill the gaps in the literature by studying the effectiveness of transcranial direct current stimulation (tDCS) on lifestyle parameters, and physical, behavioral, and cognitive functions among stroke survivors, and understanding the factors that mediate the effects of various domains related to Health-related Quality of life (HRQoL) improvements. METHODS Anticipated 64 volunteer subacute stroke survivors (>7 days to 3 months post stroke) aged 40-75 years with National Institutes of Health stroke scale (NIHSS) score of >10 and Mini-Mental State Examination (MMSE) score between 18 and 23 will be randomly assigned at a ratio of 1:1 to receive either: (1) 20 sessions of anodal tDCS or (2) sham tDCS in addition to conventional rehabilitation. Battery driven tDCS will be applied at 2 mA intensity to the dorsolateral prefrontal cortex and primary motor cortex for 20 minutes. The primary endpoints of study will be 36-Item Short Form Survey (SF-36) post intervention at 4 weeks. The secondary outcomes will include Stroke Specific Quality of Life Scale (SS_QOL), Montreal cognitive assessment (MCA), Beck Anxiety Inventory (BAI), Fugl-Meyer Assessment (FMA), 10 m walk test and Modified Barthel Activities of daily living (ADL) Index. At 0.05 level of significance, data normality, within group and between group actual differences will be analyzed with a moderate scope software. DISCUSSION Our knowledge of this technique and its use is expanding daily as tDCS motor recovery studies-mostly single-center studies-in either single session or many sessions have been completed and shown positive results. The field is prepared for a multi-center, carefully planned, sham-controlled, double-blinded tDCS study to comprehensively examine its feasibility and effectiveness in enhancing outcomes in stroke population. CONCLUSION The function of Transcranial Direct Current Stimulation in aiding stroke recuperation will be ascertained.
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Affiliation(s)
- Vandana Esht
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia.
| | - Mohammed M Alshehri
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Karthick Balasubramanian
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ramya R Sanjeevi
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Mohammed A Shaphe
- Physical Therapy Department, College of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Ahmed Alhowimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin University, Jazan 45142, Kingdom of Saudi Arabia
| | - Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin University, Jazan 45142, Kingdom of Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin University, Jazan 45142, Kingdom of Saudi Arabia
| | - Norah Alhwoaimel
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin University, Jazan 45142, Kingdom of Saudi Arabia
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Monaghan AS, Ofori E, Fling BW, Peterson DS. Associating white matter microstructural integrity and improvements in reactive stepping in people with Parkinson's Disease. Brain Imaging Behav 2024:10.1007/s11682-024-00867-w. [PMID: 38530517 DOI: 10.1007/s11682-024-00867-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/28/2024]
Abstract
Reactive steps are rapid responses after balance challenges. People with Parkinson's Disease (PwPD) demonstrate impaired reactive stepping, increasing fall-risk. Although PwPD can improve steps through practice, the neural mechanisms contributing to improved reactive stepping are poorly understood. This study investigated white-matter correlates of responsiveness to reactive step training in PwPD. In an eighteen-week multiple-baseline study, participants (n = 22) underwent baseline assessments (B1 and B2 two-weeks apart), a two-week training protocol, and post-training assessments immediately (P1) and two-months (P2) post-training. Assessments involved three backward reactive step trials, measuring anterior-posterior margin of stability (AP MOS), step length, and step latency. Tract-Based Spatial Statistics correlated white-matter integrity (fractional anisotropy (FA) and radial diffusivity (RD)) with retained (P2-B2) and immediate improvements (P1-B2) in stepping. Significant and sustained improvements in step length and AP MOS were observed. Greater retention of step length improvement correlated with increased FA in the left anterior thalamic radiation (ATR), left posterior thalamic radiation (PTR), left superior longitudinal fasciculus (SLF), and right inferior longitudinal fasciculus (ILF). Step latency retention was associated with lower RD in the left posterior corona radiata and left PTR. Immediate improvements in AP MOS correlated with increased FA of the right ILF, right SLF, and right corticospinal tract. Immediate step length improvements were associated with increased FA in right and left ATR and right SLF. These findings highlight the importance of white-matter microstructural integrity in motor learning and retention processes in PD and could aid in identifying individuals with PD who would benefit most from balance rehabilitation.
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Affiliation(s)
- Andrew S Monaghan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Edward Ofori
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Brett W Fling
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, USA
- Molecular, Cellular and Integrative Neurosciences Program, Colorado State University, Fort Collins, USA
| | - Daniel S Peterson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA.
- Phoenix VA Health Care Center, Phoenix, AZ, USA.
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Illman M, Jaatela J, Vallinoja J, Nurmi T, Mäenpää H, Piitulainen H. Altered excitation-inhibition balance in the primary sensorimotor cortex to proprioceptive hand stimulation in cerebral palsy. Clin Neurophysiol 2024; 157:25-36. [PMID: 38039924 DOI: 10.1016/j.clinph.2023.10.016] [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: 01/19/2023] [Revised: 10/13/2023] [Accepted: 10/27/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Our objective was to clarify the primary sensorimotor (SM1) cortex excitatory and inhibitory alterations in hemiplegic (HP) and diplegic (DP) cerebral palsy (CP) by quantifying SM1 cortex beta power suppression and rebound with magnetoencephalography (MEG). METHODS MEG was recorded from 16 HP and 12 DP adolescents, and their 32 healthy controls during proprioceptive stimulation of the index fingers evoked by a movement actuator. The related beta power changes were computed with Temporal Spectral Evolution (TSE). Peak strengths of beta suppression and rebound were determined from representative channels over the SM1 cortex. RESULTS Beta suppression was stronger contralateral to the stimulus and rebound was weaker ipsilateral to the stimulation in DP compared to controls. Beta modulation strengths did not differ significantly between HP and the control group. CONCLUSIONS The emphasized beta suppression in DP suggests less efficient proprioceptive processing in the SM1 contralateral to the stimulation. Their weak rebound further indicates reduced intra- and/or interhemispheric cortical inhibition, which is a potential neuronal mechanism for their bilateral motor impairments. SIGNIFICANCE The excitation-inhibition balance of the SM1 cortex related to proprioception is impaired in diplegic CP. Therefore, the cortical and behavioral proprioceptive deficits should be better diagnosed and considered to better target individualized effective rehabilitation in CP.
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Affiliation(s)
- Mia Illman
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O.BOX 35, FI-40014 Jyväskylä, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland; Aalto NeuroImaging, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland.
| | - Julia Jaatela
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland
| | - Jaakko Vallinoja
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland
| | - Timo Nurmi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland
| | - Helena Mäenpää
- Pediatric Neurology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Harri Piitulainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O.BOX 35, FI-40014 Jyväskylä, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland; Pediatric Neurology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
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Levin MF, Berman S, Weiss N, Parmet Y, Baniña MC, Frenkel-Toledo S, Soroker N, Solomon JM, Liebermann DG. ENHANCE proof-of-concept three-arm randomized trial: effects of reaching training of the hemiparetic upper limb restricted to the spasticity-free elbow range. Sci Rep 2023; 13:22934. [PMID: 38129527 PMCID: PMC10739929 DOI: 10.1038/s41598-023-49974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
Post-stroke motor recovery processes remain unknown. Timescales and patterns of upper-limb (UL) recovery suggest a major impact of biological factors, with modest contributions from rehabilitation. We assessed a novel impairment-based training motivated by motor control theory where reaching occurs within the spasticity-free elbow range. Patients with subacute stroke (≤ 6 month; n = 46) and elbow flexor spasticity were randomly allocated to a 10-day UL training protocol, either personalized by restricting reaching to the spasticity-free elbow range defined by the tonic stretch reflex threshold (TSRT) or non-personalized (non-restricted) and with/without anodal transcranial direct current stimulation. Outcomes assessed before, after, and 1 month post-intervention were elbow flexor TSRT angle and reach-to-grasp arm kinematics (primary) and stretch reflex velocity sensitivity, clinical impairment, and activity (secondary). Results were analyzed for 3 groups as well as those of the effects of impairment-based training. Clinical measures improved in both groups. Spasticity-free range training resulted in faster and smoother reaches, smaller (i.e., better) arm-plane path length, and closer-to-normal shoulder/elbow movement patterns. Non-personalized training improved clinical scores without improving arm kinematics, suggesting that clinical measures do not account for movement quality. Impairment-based training within a spasticity-free elbow range is promising since it may improve clinical scores together with arm movement quality.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique Identifier: NCT02725853; Initial registration date: 01/04/2016.
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Affiliation(s)
- Mindy F Levin
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada.
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada.
| | - Sigal Berman
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- The Zlotowski Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Neta Weiss
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yisrael Parmet
- Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Melanie C Baniña
- Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montreal, QC, H3G 1Y5, Canada
- Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, QC, Canada
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dario G Liebermann
- Department of Physical Therapy, Faculty of Medicine, Stanley Steyer School of Health Professions, Tel Aviv University, POB 39040, 61390, Ramat Aviv, Tel Aviv, Israel.
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Kakebeeke TH, Chaouch A, Caflisch J, Eichelberger DA, Wehrle FM, Jenni OG. Comparing neuromotor functions in 45- and 65-year-old adults with 18-year-old adolescents. Front Hum Neurosci 2023; 17:1286393. [PMID: 38034071 PMCID: PMC10684742 DOI: 10.3389/fnhum.2023.1286393] [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: 09/04/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
Aim This cross-sectional analysis investigates how neuromotor functions of two independent cohorts of approximately 45- and 65-year-old individuals are different from 18-year-old adolescents using the Zurich Neuromotor Assessment-2 (ZNA-2). Methods A total of 186 individuals of the Zurich Longitudinal Studies (ZLS) born in the 1950s (mean age 65.1 years, SD = 1.2 year, range of ages 59.0-67.5 years, n = 151, 82 males) and 1970s (mean age 43.6 years, SD = 1.3 year, range of ages 40.8-46.6 years, n = 35, 16 males) were tested with the ZNA-2 on 14 motor tasks combined in 5 motor components: fine motor, pure motor, balance, gross motor, and associated movements. Motor performance measures were converted into standard deviation scores (SDSs) using the normative data for 18-year-old individuals as reference. Results The motor performance of the 45-year-old individuals was remarkably similar to that of the 18-year-olds (SDS from -0.22 to 0.25) apart from associated movements (-0.49 SDS). The 65-year-olds showed lower performance than the 18-year-olds in all components of the ZNA-2, with the smallest difference observed for associated movements (-0.67 SDS) and the largest for gross motor skills (-2.29 SDS). Higher body mass index (BMI) was associated with better performance on gross motor skills for 45-year-olds but with worse performance for 65-year-olds. More educational years had positive effects on gross motor skills for both ages. Interpretation With the exception of associated movements, neuromotor functions as measured with the ZNA-2 are very similar in 45- and 18-year-olds. In contrast, at age 65 years, all neuromotor components show significantly lower function than the norm population at 18 years. Some evidence was found for the last-in-first-out hypothesis: the functions that developed later during adolescence, associated movements and gross motor skills, were the most vulnerable to age-related decline.
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Affiliation(s)
- Tanja H. Kakebeeke
- Child Development Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Aziz Chaouch
- Department of Epidemiology and Health Systems, Quantitative Research, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Jon Caflisch
- Child Development Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | | | - Flavia M. Wehrle
- Child Development Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Department of Neonatology and Intensive Care, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Oskar G. Jenni
- Child Development Center, University Children’s Hospital Zurich, Zurich, Switzerland
- Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Carter AR, Barrett A. Recent advances in treatment of spatial neglect: networks and neuropsychology. Expert Rev Neurother 2023; 23:587-601. [PMID: 37273197 PMCID: PMC10740348 DOI: 10.1080/14737175.2023.2221788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Spatial neglect remains an underdiagnosed and undertreated consequence of stroke that imposes significant disability. A growing appreciation of brain networks involved in spatial cognition is helping us to develop a mechanistic understanding of different therapies under development. AREAS COVERED This review focuses on neuromodulation of brain networks for the treatment of spatial neglect after stroke, using evidence-based approaches including 1) Cognitive strategies that are more likely to impact frontal lobe executive function networks; 2) Visuomotor adaptation, which may depend on the integrity of parietal and parieto- and subcortical-frontal connections and the presence of a particular subtype of neglect labeled Aiming neglect; 3) Non-invasive brain stimulation that may modulate relative levels of activity of the two hemispheres and depend on corpus callosum connectivity; and 4) Pharmacological modulation that may exert its effect primarily via right-lateralized networks more closely involved in arousal. EXPERT OPINION Despite promising results from individual studies, significant methodological heterogeneity between trials weakened conclusions drawn from meta-analyses. Improved classification of spatial neglect subtypes will benefit research and clinical care. Understanding the brain network mechanisms of different treatments and different types of spatial neglect will make possible a precision medicine treatment approach.
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Affiliation(s)
- Alex R. Carter
- Department of Neurology, Department of Orthopedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - A.M. Barrett
- UMass Chan Medical School and UMass Memorial Healthcare, Worcester, MA, USA
- Central Western MA VA Healthcare System, Worcester, MA, USA
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Clael S, David FJ, Brandão E, Bezerra L. Cross-education in people with Parkinson's disease, a short-term randomized controlled trial. J Bodyw Mov Ther 2023; 35:114-120. [PMID: 37330755 DOI: 10.1016/j.jbmt.2023.04.026] [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: 09/09/2021] [Revised: 10/29/2022] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION People with Parkinson's disease usually have a major impairment on one side of the body. It is hypothesized that unilateral resistance training may improve strength on the most affected limb when compared to bilateral resistance training. AIM 1) To confirm that short-term unilateral resistance training improves strength on the most affected limb in people with PD. 2) To investigate if short-term unilateral resistance training reduces asymmetry. METHODS Seventeen individuals with Parkinson's disease were randomly assigned to unilateral resistance group (UTG, n = 9) and bilateral resistance group (BTG, n = 8). Twenty-four sessions of resistance training were performed. The nine-hole peg and box and blocks tests were performed to assess motor control of the upper limbs. The handgrip strength and isokinetic dynamometry were performed to assess the upper and lower limbs strength, respectively. All tests were assessed unilaterally at baseline (T0), during (T12), and at the end of the intervention (T24). Friedman's ANOVA was used to determine within group differences across the three time-points. In the event of significance, post-hoc analyses were performed using the Wilcoxon signed rank test. The U Mann-Whitney was used to determine between group differences at a specific time point. RESULTS The BTG was significantly better than the UTG group at T24 compared to T12 with respect to peak torque at 60°/s and 180°/s (p < 0.05). CONCLUSION Short-term bilateral resistance training is better than unilateral resistance training to improve strength for lower limbs most affected in people with Parkinson's disease.
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Affiliation(s)
- Sacha Clael
- University of Brasilia, Faculty of Physical Education, Distrito Federal, Brasilia, Brazil; Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, IL, USA.
| | - Fabian J David
- Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Chicago, IL, USA
| | - Elaine Brandão
- University of Brasilia, Faculty of Physical Education, Distrito Federal, Brasilia, Brazil
| | - Lídia Bezerra
- University of Brasilia, Faculty of Physical Education, Distrito Federal, Brasilia, Brazil
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Mirdamadi JL, Xu J, Arevalo-Alas KM, Kam LK, Borich MR. State-dependent interhemispheric inhibition reveals individual differences in motor behavior in chronic stroke. Clin Neurophysiol 2023; 149:157-167. [PMID: 36965468 PMCID: PMC10101934 DOI: 10.1016/j.clinph.2023.02.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/05/2023] [Accepted: 02/26/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To investigate state-dependent interhemispheric inhibition (IHI) in chronic stroke survivors compared to neurotypical older adult controls, and test whether abnormal IHI modulation was associated with upper extremity motor behavior. METHODS Dual-coil transcranial magnetic stimulation (TMS) measured IHI bi-directionally, between non-lesioned and lesioned motor cortex (M1) in two activity states: (1) at rest and (2) during contralateral isometric hand muscle contraction. IHI was tested by delivering a conditioning stimulus 8-msec or 50-msec prior to a test stimulus over contralateral M1. Paretic motor behavior was assessed by clinical measures of impairment, strength, and dexterity, and mirroring activity in the non-paretic hand. RESULTS Stroke survivors demonstrated reduced IHI at rest, and less IHI modulation (active - rest) compared to controls. Individual differences in IHI modulation were related to motor behavior differences where greater IHI modulation was associated with greater motor impairment and more mirroring. In contrast, there were no relationships between IHI at rest and motor behavior. CONCLUSIONS Abnormal state-dependent interhemispheric circuit activity may be more sensitive to post-stroke motor deficits than when assessed in a single motor state. SIGNIFICANCE Characterizing state-dependent changes in neural circuitry may enhance models of stroke recovery and inform rehabilitation interventions.
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Affiliation(s)
- Jasmine L Mirdamadi
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jing Xu
- Department of Kinesiology, University of Georgia, Athens, GA, USA
| | - Karla M Arevalo-Alas
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Liana K Kam
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael R Borich
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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11
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Abstract
Swallowing is a complex activity requiring a sophisticated system of neurological control from neurones within the brainstem, cerebral cortices and cerebellum. The cerebellum is a critical part of the brain responsible for the modulation of movements. It receives input from motor cortical and sensory areas and fine tunes these inputs to produce coordinated motor outputs. With respect to swallowing, numerous functional imaging studies have demonstrated increased activity in the cerebellum during the task of swallowing and damage to the cerebellum following differing pathological processes is associated with dysphagia. Single pulses of transcranial magnetic stimulation (TMS) have been applied to the cerebellum and have been shown to evoke motor responses in the pharynx. Moreover, repetitive TMS (rTMS) over the cerebellum can modulate cerebral motor (pharyngeal) cortical activity. Neurostimulation has allowed a better understanding of the connections that exist between the cerebellum and cerebral swallowing motor areas in health and provides a potential treatment for neurogenic dysphagia in illness. In this review we will examine what is currently known about the role of the cerebellum in the control of swallowing, explore new findings from neurostimulatory and imaging studies and provide an overview of the future clinical applications of cerebellar stimulation for treating dysphagia.
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Affiliation(s)
- Ayodele Sasegbon
- Gastrointestinal (GI) Sciences, Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Salford, UK.
| | - Shaheen Hamdy
- Gastrointestinal (GI) Sciences, Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, University of Manchester, Salford Royal Hospital (part of the Manchester Academic Health Sciences Center (MAHSC)), Salford, UK
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12
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Wang B, Sun H, Pan X, Ma W, Dong L, Wang Q, Meng P. The effects of intermittent theta burst stimulation of the unilateral cerebellar hemisphere on swallowing-related brain regions in healthy subjects. Front Hum Neurosci 2023; 17:1100320. [PMID: 37063103 PMCID: PMC10097892 DOI: 10.3389/fnhum.2023.1100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/13/2023] [Indexed: 03/31/2023] Open
Abstract
ObjectiveWe aimed to investigate the effects and mechanisms of swallowing-related brain regions using resting-state functional magnetic resonance imaging (rs-fMRI) in healthy subjects who underwent intermittent theta burst stimulation (iTBS) on dominant or non-dominant cerebellar hemispheres.MethodsThirty-nine healthy subjects were randomized into three groups that completed different iTBS protocols (dominant cerebellum group, non-dominant cerebellum group and sham group). Before iTBS, the resting motor threshold (rMT) was measured by single-pulse transcranial magnetic stimulation (sTMS) on the cerebellar representation of the suprahyoid muscles, and the dominant cerebellar hemisphere for swallowing was determined. Forty-eight hours after elution, iTBS protocols were completed: in the dominant cerebellum group, iTBS was administered to the dominant cerebellar hemisphere, and the non-dominant cerebellar hemisphere was given sham stimulation; in the non-dominant cerebellum group, iTBS was administered to the non-dominant cerebellar hemisphere, and sham stimulation was delivered to the dominant cerebellar hemisphere; in the sham group, sham stimulation was applied to the cerebellum bilaterally. Rs-fMRI was performed before and after iTBS stimulation to observe changes in the fractional amplitude of low-frequency fluctuation (fALFF) in the whole brain.ResultsCompared with baseline, the dominant cerebellum group showed increased fALFF in the ipsilateral cerebellum, and decreased fALFF in the ipsilateral middle temporal gyrus and contralateral precuneus after iTBS; the iTBS of the non-dominant cerebellum group induced increased fALFF in the ipsilateral superior frontal gyrus, the calcarine fissure and the surrounding cortex, and the contralateral inferior parietal lobule; and in the sham group, there was no significant difference in fALFF. Exploring the effects induced by iTBS among groups, the dominant cerebellum group showed decreased fALFF in the contralateral calcarine fissure, and surrounding cortex compared with the sham group.ConclusionIntermittent theta burst stimulation of the dominant cerebellar hemisphere for swallowing excited the ipsilateral cerebellum, and stimulation of the non-dominant cerebellar hemisphere increased the spontaneous neural activity of multiple cerebrocortical areas related to swallowing. In conclusion, regardless of which side of the cerebellum is stimulated, iTBS can facilitate part of the brain neural network related to swallowing. Our findings provide supporting evidence that cerebellar iTBS can be used as a potential method to modulate human swallowing movement.
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Affiliation(s)
- Bingyan Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hui Sun
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaona Pan
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Wenshuai Ma
- Department of Radiology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Linghui Dong
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qiang Wang
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Qiang Wang,
| | - Pingping Meng
- Department of Rehabilitation Medicine, Affiliated Hospital of Qingdao University, Qingdao, China
- Pingping Meng,
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13
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Van Malderen S, Hehl M, Verstraelen S, Swinnen SP, Cuypers K. Dual-site TMS as a tool to probe effective interactions within the motor network: a review. Rev Neurosci 2023; 34:129-221. [PMID: 36065080 DOI: 10.1515/revneuro-2022-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/02/2022] [Indexed: 02/07/2023]
Abstract
Dual-site transcranial magnetic stimulation (ds-TMS) is well suited to investigate the causal effect of distant brain regions on the primary motor cortex, both at rest and during motor performance and learning. However, given the broad set of stimulation parameters, clarity about which parameters are most effective for identifying particular interactions is lacking. Here, evidence describing inter- and intra-hemispheric interactions during rest and in the context of motor tasks is reviewed. Our aims are threefold: (1) provide a detailed overview of ds-TMS literature regarding inter- and intra-hemispheric connectivity; (2) describe the applicability and contributions of these interactions to motor control, and; (3) discuss the practical implications and future directions. Of the 3659 studies screened, 109 were included and discussed. Overall, there is remarkable variability in the experimental context for assessing ds-TMS interactions, as well as in the use and reporting of stimulation parameters, hindering a quantitative comparison of results across studies. Further studies examining ds-TMS interactions in a systematic manner, and in which all critical parameters are carefully reported, are needed.
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Affiliation(s)
- Shanti Van Malderen
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Melina Hehl
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Stefanie Verstraelen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Stephan P Swinnen
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Koen Cuypers
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
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14
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Bharti K, Conte G, Tommasin S, Giannì C, Suppa A, Mirabella G, Cardona F, Pantano P. White matter alterations in drug-naïve children with Tourette syndrome and obsessive-compulsive disorder. Front Neurol 2022; 13:960979. [PMID: 36262836 PMCID: PMC9575657 DOI: 10.3389/fneur.2022.960979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Tourette syndrome (TS) and early-onset obsessive-compulsive disorder (OCD) are frequently associated and conceptualized as distinct phenotypes of a common disease spectrum. However, the nature of their relationship is still largely unknown on a pathophysiological level. In this study, early structural white matter (WM) changes investigated through diffusion tensor imaging (DTI) were compared across four groups of drug-naïve children: TS-pure (n = 16), TS+OCD (n = 14), OCD (n = 10), and 11 age-matched controls. We analyzed five WM tracts of interest, i.e., cortico-spinal tract (CST), anterior thalamic radiations (ATR), inferior longitudinal fasciculus (ILF), corpus callosum (CC), and cingulum and evaluated correlations of DTI changes to symptom severity. Compared to controls, TS-pure and TS+OCD showed a comparable pattern of increased fractional anisotropy (FA) in CST, ATR, ILF and CC, with FA changes displaying negative correlation to tic severity. Conversely, in OCD, FA decreased in all WM tracts (except for the cingulum) compared to controls and negatively correlated to symptoms. We demonstrate different early WM microstructural alterations in children with TS-pure/TS+OCD as opposed to OCD. Our findings support the conceptualization of TS+OCD as a subtype of TS while suggesting that OCD is characterized by independent pathophysiological mechanisms affecting WM development.
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Affiliation(s)
- Komal Bharti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Giulia Conte
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- *Correspondence: Giulia Conte
| | - Silvia Tommasin
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Costanza Giannì
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Isernia, Italy
| | - Antonio Suppa
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Isernia, Italy
| | - Giovanni Mirabella
- Department of Clinical and Experimental Sciences Section, Brescia University, Brescia, Italy
| | - Francesco Cardona
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Patrizia Pantano
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Isernia, Italy
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15
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A Literature Review of High-Tech Physiotherapy Interventions in the Elderly with Neurological Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159233. [PMID: 35954587 PMCID: PMC9368072 DOI: 10.3390/ijerph19159233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/28/2022]
Abstract
Neurological physiotherapy adopts a problem-based approach for each patient as determined by a thorough evaluation of the patient’s physical and mental well-being. Τhis work aims to provide a literature review of physical therapy interventions in the elderly with neurological diseases (NDs) and discuss physiotherapy procedures and methods that utilize cutting-edge technologies for which clinical studies are available. Hence, the review focuses on acute NDs (stroke), deteriorating NDs (Parkinson’s disease), and age-related cognitive impairment. The most used physiotherapy procedures on which clinical data are available are balance and gait training (robot-assisted or not), occupational therapy, classical physiotherapy, walking and treadmill training, and upper limb robot-assisted therapy. Respectively, the most often-used equipment are types of treadmills, robotic-assisted equipment (Lokomat® and Gait Trainer GT1), and portable walkway systems (GAITRite®), along with state-of-the-art technologies of virtual reality, virtual assistants, and smartphones. The findings of this work summarize the core standard tools and procedures, but more importantly, provide a glimpse of the new era in physiotherapy with the utilization of innovative equipment tools for advanced patient monitoring and empowerment.
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16
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Gerges AN, Hordacre B, Pietro FD, Moseley GL, Berryman C. Do Adults with Stroke have Altered Interhemispheric Inhibition? A Systematic Review with Meta-Analysis. J Stroke Cerebrovasc Dis 2022; 31:106494. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/29/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022] Open
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17
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From Hemispheric Asymmetry through Sensorimotor Experiences to Cognitive Outcomes in Children with Cerebral Palsy. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent neuroimaging studies allowed us to explore abnormal brain structures and interhemispheric connectivity in children with cerebral palsy (CP). Behavioral researchers have long reported that children with CP exhibit suboptimal performance in different cognitive domains (e.g., receptive and expressive language skills, reading, mental imagery, spatial processing, subitizing, math, and executive functions). However, there has been very limited cross-domain research involving these two areas of scientific inquiry. To stimulate such research, this perspective paper proposes some possible neurological mechanisms involved in the cognitive delays and impairments in children with CP. Additionally, the paper examines the ways motor and sensorimotor experience during the development of these neural substrates could enable more optimal development for children with CP. Understanding these developmental mechanisms could guide more effective interventions to promote the development of both sensorimotor and cognitive skills in children with CP.
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18
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Wilkerson GB, Colston MA, Grillo AN, Rogers AJ, Perry T, Acocello SN. A Neuro-Integrative Assessment of Perceptual-Motor Performance and Wellness in ROTC Cadets. Percept Mot Skills 2022; 129:289-306. [PMID: 35081817 DOI: 10.1177/00315125211067359] [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: 11/16/2022]
Abstract
Resting heart rate variability (HRV) may be a useful index of both brain-based executive function and general health. Our purpose in this study was to quantify relationships among HRV, perceptual-motor performance metrics, and wellness survey responses. A cohort of 32 male Reserve Officer Training Corp (ROTC) cadets completed a dual-task upper extremity reaction time (UERT) test, two tests of whole-body reactive agility, and a 10-item wellness survey that produced a 0-100 Overall Wellness Index (OWI). We averaged participants' resting HRV measurements twice per week over 10 weeks to derive an intra-individual grand mean (HRV-IIGM) and over a series of days we calculated an intra-individual coefficient of variation (HRV-IICV). We used median values for the two HRV metrics (HRV-IIGM and HRV-IICV) to separate the cadets into equal-sized high and low HRV groups to form the dependent variable for logistic regression analyses. We found a significant inverse relationship between HRV-IIGM and HRV-IICV (r = -0.723, p < .001). Differences in UERT in the left versus right visual hemifields (L-R Diff) and OWI scores were strongly related to both HRV-IIGM ≤ 4.49 and HRV-IICV ≥ 6.95%. Logistic regression models that included L-R Diff and OWI showed 71% classification accuracy for HRV-IIGM (Model χ2 [2] = 12.47, p = .002, Nagelkerke R2 = 0.430) and 81% classification accuracy for HRV-IICV (Model χ2 [2] = 14.88, p = .001, Nagelkerke R2 = 0.496). These findings suggest that resting HRV, perceptual-motor efficiency, and overall wellness are highly interrelated, supporting a multi-factor biopsychosocial assessment to guide the design and implementation of interventions to maximize operational effectiveness for ROTC cadets and other military personnel.
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Affiliation(s)
- Gary B Wilkerson
- 14733Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, TN, USA.,Department of Health and Human Performance, 14733University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Marisa A Colston
- 14733Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, TN, USA.,Department of Health and Human Performance, 14733University of Tennessee at Chattanooga, Chattanooga, TN, USA
| | - Ashley N Grillo
- Sports Medicine, 32722United States Naval Academy, Annapolis, MD, USA
| | - Abigail J Rogers
- 14716Intercollegiate Athletics, University of Missouri, Columbia, MO, USA
| | - Tyler Perry
- Orthopaedics and Sports Medicine, 14730Emory Healthcare, Smyrna, GA, USA
| | - Shellie N Acocello
- 14733Graduate Athletic Training Program, University of Tennessee at Chattanooga, Chattanooga, TN, USA.,Department of Health and Human Performance, 14733University of Tennessee at Chattanooga, Chattanooga, TN, USA
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19
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Riedel D, Fellerhoff T, Mierau A, Strüder H, Wolf D, Fischer F, Fellgiebel A, Tüscher O, Kollmann B, Knaepen K. The impact of aging on interhemispheric transfer time and respective sex differences. AGING BRAIN 2022; 2:100040. [PMID: 36908886 PMCID: PMC9997169 DOI: 10.1016/j.nbas.2022.100040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/17/2022] Open
Abstract
Age-related cognitive decline has been attributed to degeneration of the corpus callosum (CC), which allows for interhemispheric integration and information processing [22,69]. Along with decreased structural integrity, altered functional properties of the CC may cause impaired cognitive performance in older adults, yet this aspect of age-related decline remains insufficiently researched [59]. In this context, potential sex-related differences have been proposed [31,58]. A promising parameter, which has been suggested to estimate functional properties of the CC is the interhemispheric transfer time (IHTT), which is ideally obtained from event-related potentials (ERP) evoked by lateralized stimuli [45]. To examine the possible functional consequences of aging with regards to the CC, the present study investigated the IHTT of 107 older (67.69 ± 5.18y) as well as of 23 younger participants (25.09 ± 2.59y). IHTT was obtained using an established letter matching task and targeting early N170 ERP components at posterior electrode sites. The results revealed significantly elongated IHTT in older compared to younger participants, but no significant sex differences. Furthermore, there was a significant positive correlation between IHTT and age, predominantly driven by the female participants. The present findings add support to the notion, that IHTT is subject to age-related elongation reflecting impaired interhemispheric transmission. Age-related decline in women appears to occur at a different age range compared to men.
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Affiliation(s)
- David Riedel
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Tim Fellerhoff
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Andreas Mierau
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.,Department of Exercise and Sport Science, LUNEX International University of Health, Exercise and Sports, 50, avenue du Parc des Sports L-4671 Differdange, Luxembourg
| | - Heiko Strüder
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Dominik Wolf
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Florian Fischer
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
| | - Andreas Fellgiebel
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.,Center for Mental Health in Old Age, Landeskrankenhaus (AöR), Hartmühlenweg 2-4, 55122 Mainz, Germany
| | - Oliver Tüscher
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.,Leibniz Institute for Resilience Research, Wallstraße 7, 55122 Mainz, Germany
| | - Bianca Kollmann
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Str. 8, 55131 Mainz, Germany.,Leibniz Institute for Resilience Research, Wallstraße 7, 55122 Mainz, Germany
| | - Kristel Knaepen
- Institute of Movement and Neurosciences, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
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20
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Levin MF, Demers M. Motor learning in neurological rehabilitation. Disabil Rehabil 2021; 43:3445-3453. [PMID: 32320305 DOI: 10.1080/09638288.2020.1752317] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/14/2020] [Accepted: 04/02/2020] [Indexed: 12/27/2022]
Abstract
While most upper limb training interventions in neurological rehabilitation are based on established principles of motor learning and neural plasticity, recovery potential may be improved if the focus includes remediating an individual's specific motor impairment within the framework of a motor control theory. This paper reviews current theories of motor control and motor learning and describes how they can be incorporated into training programs to enhance sensorimotor recovery in patients with neurological lesions. An emphasis is placed on dynamical systems theory and the use of new technologies such as virtual, augmented and mixed reality applications for rehabilitation to facilitate learning.Implications for RehabilitationKinematic abundance allows the healthy nervous system to produce different combinations of joint rotations to perform a desired task.The structure of practice to improve the movement repertoire in rehabilitation should take into account the kinematic abundance of the system.Learning can be enhanced by varied practice with feedback about key movement elements.Virtual reality environments provide opportunities to manipulate the structure and schedule of practice and feedback.
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Affiliation(s)
- Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
| | - Marika Demers
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Feil and Oberfeld Research Center, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Canada
- USA Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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21
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Bruce SL, Wilkerson GB. Whole-Body Reactive Agility Metrics to Identify Football Players With a Core and Lower Extremity Injury Risk. Front Sports Act Living 2021; 3:733567. [PMID: 34746776 PMCID: PMC8564038 DOI: 10.3389/fspor.2021.733567] [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: 06/30/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Clinical prediction models are useful in addressing several orthopedic conditions with various cohorts. American football provides a good population for attempting to predict injuries due to their relatively high injury rate. Physical performance can be assessed a variety of ways using an assortment of different tests to assess a diverse set of metrics, which may include reaction time, speed, acceleration, and deceleration. Asymmetry, the difference between right and left performance has been identified as a possible risk factor for injury. The purpose of this study was to determine the whole-body reactive agility metrics that would identify Division I football players who were at elevated risk for core, and lower extremity injuries (CLEI). This cohort study utilized 177 Division I football players with a total of 57 CLEI suffered who were baseline tested prior to the season. Single-task and dual-task whole-body reactive agility movements in lateral and diagonal direction reacting to virtual reality targets were analyzed separately. Receiver operator characteristic (ROC) analyses narrowed the 34 original predictor variables to five variables. Logistic regression analysis determined the three strongest predictors of CLEI for this cohort to be: lateral agility acceleration asymmetry, lateral flanker deceleration asymmetry, and diagonal agility reaction time average. Univariable analysis found odds ratios to range from 1.98 to 2.75 for these predictors of CLEI. ROC analysis had an area under the curve of 0.702 for any combination of two or more risk factors produced an odds ratio of 5.5 for risk of CLEI. These results suggest an asymmetry of 8-15% on two of the identified metrics or a slowed reaction time of ≥0.787 s places someone at increased risk of injury. Sixty-three percent (36/57) of the players who sustained an injury had ≥2 positive predictors In spite of the recognized limitation, these finding support the belief that whole-body reactive agility performance can identify Division I football players who are at elevated risk for CLEI.
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Affiliation(s)
- Scott L Bruce
- Masters of Athletic Training Program, Arkansas State University, Jonesboro, AR, United States
| | - Gary B Wilkerson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
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22
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Wilkerson GB, Nabhan DC, Perry TS. A Novel Approach to Assessment of Perceptual-Motor Efficiency and Training-Induced Improvement in the Performance Capabilities of Elite Athletes. Front Sports Act Living 2021; 3:729729. [PMID: 34661098 PMCID: PMC8517233 DOI: 10.3389/fspor.2021.729729] [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: 06/23/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Standard clinical assessments of mild traumatic brain injury are inadequate to detect subtle abnormalities that can be revealed by sophisticated diagnostic technology. An association has been observed between sport-related concussion (SRC) and subsequent musculoskeletal injury, but the underlying neurophysiological mechanism is not currently understood. A cohort of 16 elite athletes (10 male, 6 female), which included nine individuals who reported a history of SRC (5 male, 4 female) that occurred between 4 months and 8 years earlier, volunteered to participate in a 12-session program for assessment and training of perceptual-motor efficiency. Performance metrics derived from single- and dual-task whole-body lateral and diagonal reactive movements to virtual reality targets in left and right directions were analyzed separately and combined in various ways to create composite representations of global function. Intra-individual variability across performance domains demonstrated very good SRC history classification accuracy for the earliest 3-session phase of the program (Reaction Time Dispersion AUC = 0.841; Deceleration Dispersion AUC = 0.810; Reaction Time Discrepancy AUC = 0.825, Deceleration Discrepancy AUC = 0.794). Good earliest phase discrimination was also found for Composite Asymmetry between left and right movement directions (AUC = 0.778) and Excursion Average distance beyond the minimal body displacement necessary for virtual target deactivation (AUC = 0.730). Sensitivity derived from Youden's Index for the 6 global factors ranged from 67 to 89% and an identical specificity value of 86% for all of them. Median values demonstrated substantial improvement from the first 3-session phase to the last 3-session phase for Composite Asymmetry and Excursion Average. The results suggest that a Composite Asymmetry value ≥ 0.15 and an Excursion Average value ≥ 7 m, provide reasonable qualitative approximations for clinical identification of suboptimal perceptual-motor performance. Despite acknowledged study limitations, the findings support a hypothesized relationship between whole-body reactive agility performance and functional connectivity among brain networks subserving sensory perception, cognitive decision-making, and motor execution. A complex systems approach appears to perform better than traditional data analysis methods for detection of subtle perceptual-motor impairment, which has the potential to advance both clinical management of SRC and training for performance enhancement.
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Affiliation(s)
- Gary B Wilkerson
- Department of Health and Human Performance, University of Tennessee at Chattanooga, Chattanooga, TN, United States
| | - Dustin C Nabhan
- Oslo Sports Trauma Research Center, Norwegian School of Sport Science, Oslo, Norway
| | - Tyler S Perry
- Orthopedics and Sports Medicine, Emory Healthcare, Atlanta, GA, United States
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23
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Takeuchi N, Izumi SI. Motor Learning Based on Oscillatory Brain Activity Using Transcranial Alternating Current Stimulation: A Review. Brain Sci 2021; 11:1095. [PMID: 34439714 PMCID: PMC8392205 DOI: 10.3390/brainsci11081095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022] Open
Abstract
Developing effective tools and strategies to promote motor learning is a high-priority scientific and clinical goal. In particular, motor-related areas have been investigated as potential targets to facilitate motor learning by noninvasive brain stimulation (NIBS). In addition to shedding light on the relationship between motor function and oscillatory brain activity, transcranial alternating current stimulation (tACS), which can noninvasively entrain oscillatory brain activity and modulate oscillatory brain communication, has attracted attention as a possible technique to promote motor learning. This review focuses on the use of tACS to enhance motor learning through the manipulation of oscillatory brain activity and its potential clinical applications. We discuss a potential tACS-based approach to ameliorate motor deficits by correcting abnormal oscillatory brain activity and promoting appropriate oscillatory communication in patients after stroke or with Parkinson's disease. Interpersonal tACS approaches to manipulate intra- and inter-brain communication may result in pro-social effects and could promote the teaching-learning process during rehabilitation sessions with a therapist. The approach of re-establishing oscillatory brain communication through tACS could be effective for motor recovery and might eventually drive the design of new neurorehabilitation approaches based on motor learning.
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Affiliation(s)
- Naoyuki Takeuchi
- Department of Physical Therapy, Akita University Graduate School of Health Sciences 1-1-1, Hondo, Akita 010-8543, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai 980-8575, Japan;
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Zhong Y, Fan J, Wang H, He R. Simultaneously stimulating both brain hemispheres by rTMS in patients with unilateral brain lesions decreases interhemispheric asymmetry. Restor Neurol Neurosci 2021; 39:409-418. [PMID: 34334435 DOI: 10.3233/rnn-211172] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Interhemispheric asymmetry caused by brain lesions is an adverse factor in the recovery of patients with neurological deficits. Repetitive transcranial magnetic stimulation (rTMS) has been shown to modulate cortical oscillation and proposed as an approach to rebalance the symmetry, which has not been documented well. OBJECTIVE In this study, we investigated the influence of repetitive transcranial magnetic stimulation (rTMS) on EEG power in patients with unilateral brain lesions by simultaneously stimulating both brain hemispheres and to elucidate asymmetrical changes in rTMS-induced neurophysiological activity. METHODS Fourteen patients with unilateral brain lesions were treated with one active and one sham session of 10 Hz rTMS over the vertex (Cz position). Resting-state EEGs were recorded before and immediately after rTMS. The brain symmetry index (BSI), calculated from a fast Fourier transform, was employed to quantify the power asymmetry in both hemispheres and paired channels over the entire range and five frequency bands (delta, theta, alpha, beta and gamma bands). RESULTS Comparison between active and sham sessions demonstrated rTMS-induced EEG after-effects. rTMS in the active session significantly reduced the BSI in patients with unilateral brain lesions over the entire frequency range (t = 2.767, P = 0.016). Among the five frequency bands, rTMS only induced a noticeable decrease in the BSI in the delta band (t = 2.254, P = 0.042). Furthermore, analysis of different brain regions showed that significant changes in the BSI of the alpha band were only demonstrated in the posterior parietal lobe. In addition, EEG topographic mapping showed a decreased power of delta oscillations in the ipsilesional hemisphere, whereas distinct cortical oscillations were observed in the alpha band around the parietal-occipital lobe in the contralesional hemisphere. CONCLUSIONS When both brain hemispheres were simultaneously activated, rTMS decreased interhemispheric asymmetry primarily via reducing the delta band in the lesioned hemisphere.
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Affiliation(s)
- Yuhua Zhong
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianzhong Fan
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Huijuan Wang
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Renhong He
- Department of Rehabilitation Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Aune MA, Lorås H, Nynes A, Aune TK. Bilateral Interference in Motor Performance in Homologous vs. Non-homologous Proximal and Distal Effectors. Front Psychol 2021; 12:680268. [PMID: 34322064 PMCID: PMC8310955 DOI: 10.3389/fpsyg.2021.680268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/16/2021] [Indexed: 12/20/2022] Open
Abstract
Performance of bimanual motor actions requires coordinated and integrated bilateral communication, but in some bimanual tasks, neural interactions and crosstalk might cause bilateral interference. The level of interference probably depends on the proportions of bilateral interneurons connecting homologous areas of the motor cortex in the two hemispheres. The neuromuscular system for proximal muscles has a higher number of bilateral interneurons connecting homologous areas of the motor cortex compared to distal muscles. Based on the differences in neurophysiological organization for proximal vs. distal effectors in the upper extremities, the purpose of the present experiment was to evaluate how the level of bilateral interference depends on whether the bilateral interference task is performed with homologous or non-homologous effectors as the primary task. Fourteen participants first performed a unilateral primary motor task with the dominant arm with (1) proximal and (2) distal controlled joysticks. Performance in the unilateral condition with the dominant arm was compared to the same effector’s performance when two different bilateral interference tasks were performed simultaneously with the non-dominant arm. The two different bilateral interference tasks were subdivided into (1) homologous and (2) non-homologous effectors. The results showed a significant decrease in performance for both proximal and distal controlled joysticks, and this effect was independent of whether the bilateral interference tasks were introduced with homologous or non-homologous effectors. The overall performance decrease as a result of bilateral interference was larger for proximal compared to distal controlled joysticks. Furthermore, a proximal bilateral interference caused a larger performance decrement independent of whether the primary motor task was controlled by a proximal or distal joystick. A novel finding was that the distal joystick performance equally interfered with either homologous (distal bilateral interference) or non-homologous (proximal bilateral interference) interference tasks performed simultaneously. The results indicate that the proximal–distal distinction is an important organismic constraint on motor control and for understanding bilateral communication and interference in general and, in particular, how bilateral interference caused by homologous vs. non-homologous effectors impacts motor performance for proximal and distal effectors. The results seem to map neuroanatomical and neurophysiological differences for these effectors.
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Affiliation(s)
- Morten Andreas Aune
- Department of Sport Science, Sport and Human Movement Science Research Group (SaHMS), Nord University, Levanger, Norway
| | - Håvard Lorås
- Department of Sport Science, Sport and Human Movement Science Research Group (SaHMS), Nord University, Levanger, Norway.,Department of Teacher Education, Faculty of Social and Educational Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Alexander Nynes
- Department of Sport Science, Sport and Human Movement Science Research Group (SaHMS), Nord University, Levanger, Norway
| | - Tore Kristian Aune
- Department of Sport Science, Sport and Human Movement Science Research Group (SaHMS), Nord University, Levanger, Norway
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26
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Electroacupuncture in the Contralesional Hemisphere Improves Neurological Function Involving GABA in Ischemia-Reperfusion Injury Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5564494. [PMID: 34335824 PMCID: PMC8289595 DOI: 10.1155/2021/5564494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/14/2022]
Abstract
This study investigated the effect and mechanism of electroacupuncture (EA) on the contralesional hemisphere in rats with ischemic stroke. EA of 2 Hz was applied on the contralesionally Luoque (BL8) and Tongtian (BL7) acupoints of the scalp to investigate the neurological status and mechanism in ischemia–reperfusion injury rats. The differences in the neurological deficit score and Rotarod test time between days 3 and 15 after reperfusion were significantly lower in the sham group (0.00 (−1.00, 0.00) and 3.53 (−0.39, 7.48) second, respectively) than in the EA group (−4.00 (−4.00, −3.00) and 44.80 (41.69, 54.13) second, respectively, both p < 0.001). The ratio of infarction volume was 0.19 ± 0.04 in the sham group greater than 0.07 ± 0.04 in the EA group (p < 0.001). On day 15, in the cerebral cortex of the lesioned hemisphere, the gamma-aminobutyric acid (GABA)-A/actin ratio in the normal group (1.11 ± 0.36) was higher than that in the sham group (0.38 ± 0.07, p < 0.05) and similar to that in the EA group (0.69 ± 0.18, p > 0.05); the difference between the EA and sham groups was significant (p < 0.05). EA of 2 Hz on the BL8 and BL7 acupoints on the contralesional scalp can improve motor function and also can reduce infarction volume, and this effect of EA, and that GABA-A, plays at least a partial role in ischemia–reperfusion injury rats.
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Izadi-Najafabadi S, Zwicker JG. White Matter Changes With Rehabilitation in Children With Developmental Coordination Disorder: A Randomized Controlled Trial. Front Hum Neurosci 2021; 15:673003. [PMID: 34149383 PMCID: PMC8209514 DOI: 10.3389/fnhum.2021.673003] [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: 02/26/2021] [Accepted: 04/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Children with developmental coordination disorder (DCD) have difficulty learning motor skills, which can affect their participation in activities of daily living and psychosocial well-being. Over 50% of children with DCD also have attention deficit hyperactivity disorder (ADHD), which further exacerbates their motor problems and impact on quality of life. A rehabilitation approach known as Cognitive Orientation to Occupational Performance uses problem-solving strategies to help children learn motor skills they wish to achieve. While this cognitive approach has been effective for children with DCD, few studies have examined the effectiveness of this approach for children with co-occurring ADHD. Further, the underlying mechanism and neural basis of this intervention are largely unknown. Methods: In this randomized waitlist-controlled trial, we used MRI to examine white matter microstructure after intervention in 8–12-year-old children with DCD (n = 28) and with DCD and co-occurring ADHD (n = 25). Children in both groups were randomized to either a treatment group or waitlist group at their first MRI. The treatment group began the intervention after their MRI scan and returned for a post-treatment scan at 3 months, and follow-up scan at 6 months; the waitlist group waited 3 months before their second MRI, received the intervention, and then had a post-treatment scan. Each child received intervention once weekly for 10 weeks. Diffusion tensor imaging was used to acquire white matter diffusion parameters and was analyzed using tract-based spatial statistics (TBSS). Results and Conclusion: Children with DCD showed significant improvement in white matter microstructure in the bilateral anterior thalamic radiation, bilateral sensorimotor tract, bilateral cingulum, fornix, splenium and body of corpus callosum, right inferior fronto-occipital fasciculus, and white matter pathways to bilateral inferior gyri, right middle frontal gyrus, frontal medial cortex, and left cuneus. We suggest that these rehabilitation-induced neural changes in children with DCD occurred in regions associated with attention, self-regulation, motor planning, and inter-hemispheric communication, which positively affected brain connectivity and motor function. In contrast, children with DCD and co-occurring ADHD did not show any brain changes following the intervention. Modifications to the treatment protocol might help address the attentional and self-regulatory needs of children with a dual diagnosis. Clinical Trial Registration: ClinicalTrials.gov ID: NCT02597751.
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Affiliation(s)
- Sara Izadi-Najafabadi
- Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada.,Brain, Behaviour, and Development Theme, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Jill G Zwicker
- Brain, Behaviour, and Development Theme, BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,Sunny Hill Health Centre at BC Children's Hospital, Vancouver, BC, Canada.,CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
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28
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Bootsma JM, Caljouw SR, Veldman MP, Maurits NM, Rothwell JC, Hortobágyi T. Neural Correlates of Motor Skill Learning Are Dependent on Both Age and Task Difficulty. Front Aging Neurosci 2021; 13:643132. [PMID: 33828478 PMCID: PMC8019720 DOI: 10.3389/fnagi.2021.643132] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/23/2021] [Indexed: 12/21/2022] Open
Abstract
Although a general age-related decline in neural plasticity is evident, the effects of age on neural plasticity after motor practice are inconclusive. Inconsistencies in the literature may be related to between-study differences in task difficulty. Therefore, we aimed to determine the effects of age and task difficulty on motor learning and associated brain activity. We used task-related electroencephalography (EEG) power in the alpha (8–12 Hz) and beta (13–30 Hz) frequency bands to assess neural plasticity before, immediately after, and 24-h after practice of a mirror star tracing task at one of three difficulty levels in healthy younger (19–24 yr) and older (65–86 yr) adults. Results showed an age-related deterioration in motor performance that was more pronounced with increasing task difficulty and was accompanied by a more bilateral activity pattern for older vs. younger adults. Task difficulty affected motor skill retention and neural plasticity specifically in older adults. Older adults that practiced at the low or medium, but not the high, difficulty levels were able to maintain improvements in accuracy at retention and showed modulation of alpha TR-Power after practice. Together, these data indicate that both age and task difficulty affect motor learning, as well as the associated neural plasticity.
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Affiliation(s)
- Josje M Bootsma
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Simone R Caljouw
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Menno P Veldman
- Movement Control and Neuroplasticity Research Group, Department of Movement Science, KU Leuven, Leuven, Belgium.,Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Natasha M Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - John C Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, United Kingdom
| | - Tibor Hortobágyi
- Department of Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Araneda R, Dricot L, Ebner-Karestinos D, Paradis J, Gordon AM, Friel KM, Bleyenheuft Y. Brain activation changes following motor training in children with unilateral cerebral palsy: An fMRI study. Ann Phys Rehabil Med 2021; 64:101502. [PMID: 33647530 DOI: 10.1016/j.rehab.2021.101502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intensive motor-learning-based interventions have demonstrated efficacy for improving motor function in children with unilateral spastic cerebral palsy (USCP). Although this improvement has been associated mainly with neuroplastic changes in the primary sensori-motor cortices, this plasticity may also involve a wider fronto-parietal network for motor learning. OBJECTIVE To determine whether hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) induces brain activation changes in an extensive network for motor skill learning and whether these changes are related to functional changes observed after HABIT-ILE. METHODS In total, 25 children with USCP were behaviourally assessed in manual dexterity and everyday activities before and after HABIT-ILE. Functional imagery monitored brain activity while participants manipulated objects using their less-affected, more-affected or both hands. Two random-effects-group analyses performed at the whole-brain level assessed the brain activity network before and after therapy. Three other random-effects-group analyses assessed brain activity changes after therapy. Spearman's correlations were used to evaluate the correlation between behavioural and brain activity changes. RESULTS The same fronto-parietal network was identified before and after therapy. After the intervention, the more-affected hand manipulation elicited a decrease in activity on the motor cortex of the non-lesional hemisphere and an increase in activity on motor areas of the lesional hemisphere. The less-affected hand manipulation generated a decrease in activity of sensorimotor areas in the non-lesional hemisphere. Both-hands manipulation elicited an increase in activity of both hemispheres. Furthermore, we observed an association between brain activity changes and changes in everyday activity assessments. CONCLUSION Brain activation changes were observed in a fronto-parietal network underlying motor skill learning with HABIT-ILE in children with USCP. Two different patterns were observed, probably related to different phases of motor skill learning, representing an increased practice-dependent brain recruitment or a brain activation refinement by more efficient means. CLINICALTRIALS.GOV: NCT01700777 &NCT02667613.
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Affiliation(s)
- Rodrigo Araneda
- Institute of neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Laurance Dricot
- Institute of neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Julie Paradis
- Institute of neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Andrew M Gordon
- Department of biobehavioural sciences, Teachers college, Columbia University, New York, USA
| | - Kathleen M Friel
- Burke-Cornell medical research institute, White Plains, New York, USA
| | - Yannick Bleyenheuft
- Institute of neuroscience, Université catholique de Louvain, Brussels, Belgium.
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30
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Wang Y, Zhu H, Elangovan N, Cappello L, Sandini G, Masia L, Konczak J. A robot-aided visuomotor wrist training induces gains in proprioceptive and movement accuracy in the contralateral wrist. Sci Rep 2021; 11:5281. [PMID: 33674684 PMCID: PMC7935923 DOI: 10.1038/s41598-021-84767-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
Proprioceptive training is a neurorehabilitation approach known to improve proprioceptive acuity and motor performance of a joint/limb system. Here, we examined if such learning transfers to the contralateral joints. Using a robotic exoskeleton, 15 healthy, right-handed adults (18-35 years) trained a visuomotor task that required making increasingly small wrist movements challenging proprioceptive function. Wrist position sense just-noticeable-difference thresholds (JND) and spatial movement accuracy error (MAE) in a wrist-pointing task that was not trained were assessed before and immediately as well as 24 h after training. The main results are: first, training reduced JND thresholds (- 27%) and MAE (- 33%) in the trained right wrist. Sensory and motor gains were observable 24 h after training. Second, in the untrained left wrist, mean JND significantly decreased (- 32%) at posttest. However, at retention the effect was no longer significant. Third, motor error at the untrained wrist declined slowly. Gains were not significant at posttest, but MAE was significantly reduced (- 27%) at retention. This study provides first evidence that proprioceptive-focused visuomotor training can induce proprioceptive and motor gains not only in the trained joint but also in the contralateral, homologous joint. We discuss the possible neurophysiological mechanism behind such sensorimotor transfer and its implications for neurorehabilitation.
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Affiliation(s)
- Yizhao Wang
- Department of Rehabilitation Medicine, Tianjin Huanhu Hospital, Tianjin, China.
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, USA.
- College of Exercise and Health Sciences, Tianjin University of Sport, Tianjin, China.
| | - Huiying Zhu
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, USA
| | - Naveen Elangovan
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, USA
| | - Leonardo Cappello
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Pisa, Italy
| | - Giulio Sandini
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Lorenzo Masia
- Institut für Technische Informatik, Universität Heidelberg, Heidelberg, Germany
| | - Jürgen Konczak
- Human Sensorimotor Control Laboratory, School of Kinesiology, University of Minnesota, Minneapolis, USA
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Visual-Electrotactile Stimulation Feedback to Improve Immersive Brain-Computer Interface Based on Hand Motor Imagery. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2021. [DOI: 10.1155/2021/8832686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In the aging society, the number of people suffering from vascular disorders is rapidly increasing and has become a social problem. The death rate due to stroke, which is the second leading cause of global mortality, has increased by 40% in the last two decades. Stroke can also cause paralysis. Of late, brain-computer interfaces (BCIs) have been garnering attention in the rehabilitation field as assistive technology. A BCI for the motor rehabilitation of patients with paralysis promotes neural plasticity, when subjects perform motor imagery (MI). Feedback, such as visual and proprioceptive, influences brain rhythm modulation to contribute to MI learning and motor function restoration. Also, virtual reality (VR) can provide powerful graphical options to enhance feedback visualization. This work aimed to improve immersive VR-BCI based on hand MI, using visual-electrotactile stimulation feedback instead of visual feedback. The MI tasks include grasping, flexion/extension, and their random combination. Moreover, the subjects answered a system perception questionnaire after the experiments. The proposed system was evaluated with twenty able-bodied subjects. Visual-electrotactile feedback improved the mean classification accuracy for the grasping (93.00%
3.50%) and flexion/extension (95.00%
5.27%) MI tasks. Additionally, the subjects achieved an acceptable mean classification accuracy (maximum of 86.5%
5.80%) for the random MI task, which required more concentration. The proprioceptive feedback maintained lower mean power spectral density in all channels and higher attention levels than those of visual feedback during the test trials for the grasping and flexion/extension MI tasks. Also, this feedback generated greater relative power in the
-band for the premotor cortex, which indicated better MI preparation. Thus, electrotactile stimulation along with visual feedback enhanced the immersive VR-BCI classification accuracy by 5.5% and 4.5% for the grasping and flexion/extension MI tasks, respectively, retained the subject’s attention, and eased MI better than visual feedback alone.
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Lench DH, Hutchinson S, Woodbury ML, Hanlon CA. Kinematic Measures of Bimanual Performance are Associated With Callosum White Matter Change in People With Chronic Stroke. Arch Rehabil Res Clin Transl 2021; 2:100075. [PMID: 33543100 PMCID: PMC7853365 DOI: 10.1016/j.arrct.2020.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives To investigate the relationship between bimanual performance deficits measured using kinematics and callosum (CC) white matter changes that occur in people with chronic stroke. Design Cross-sectional, observational study of participants with chronic stroke and age-matched controls. Setting Recruitment and assessments occurred at a stroke recovery research center. Behavioral assessments were performed in a controlled laboratory setting. Magnetic resonance imaging scans were performed at the Center for Biomedical Imaging. Participants Individuals were enrolled and completed the study (N=39; 21 participants with chronic stroke; 18 age-matched controls with at least 2 stroke risk factors). Main Outcome Measures Diffusion imaging metrics were obtained for each individual’s CC and corticospinal tract (CST), including mean kurtosis (MK) and fractional anisotropy (FA). A battery of motor assessments, including bimanual kinematics, were collected from individuals while performing bimanual reaching. Results Participants with stroke had lower FA and MK in the CST of the lesioned hemisphere when compared with the non-lesioned hemisphere. The FA and MK values in the CST were correlated with measures of unimanual hand performance. In addition, participants with stroke had significantly lower FA and MK in the CC than matched controls. CC diffusion metrics positively correlated with hand asymmetry and trunk displacement during bimanual performance, even when correcting for age and lesion volume. Conclusions These data confirm previous studies that linked CST integrity to unimanual performance and provide new data demonstrating a link between CC integrity and both bimanual motor deficits and compensatory movements. Fractional anisotropy and mean kurtosis in the corpus callosum are lower in participants with stroke. Hand position symmetry and trunk displacement are disrupted during bimanual tasks. Corpus callosum white matter correlated with bimanual kinematics in participants with stroke.
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Key Words
- ANOVA, analysis of variance
- ARAT, Action Research Arm Test
- CC, corpus callosum
- CST, corticospinal tract
- DKI, diffusion kurtosis imaging
- DTI, diffusion tensor imaging
- Diffusion
- FA, fractional anisotropy
- FMA, Fugl-Meyer Assessment
- M1, primary motor cortex
- MK, mean kurtosis
- MRI, magnetic resonance imaging
- Motor Activity
- Pyramidal Tracts
- ROI, region of interest
- Rehabilitation
- SMA, supplementary motor area
- Stroke
- UE, upper extremity
- WMFT, Wolf Motor Function Test
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Affiliation(s)
- Daniel H. Lench
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Scott Hutchinson
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Michelle L. Woodbury
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Colleen A. Hanlon
- Departments of Psychiatry and Neurosciences, College of Medicine, Medical University of South Carolina, Charleston, SC
- Department of Health Research, College of Health Professions, Medical University of South Carolina, Charleston, SC
- Department of Cancer Biology, College of Medicine, Wake Forest Health Sciences, Winston-Salem, NC
- Corresponding author Colleen A. Hanlon, PhD, 1 Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, NC 27157.
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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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Ghazwani Y, Patay Z, Sadighi ZS, Sparrow J, Upadhyaya S, Boop F, Gajjar A, Qaddoumi I. Handedness switching as a presenting sign for pediatric low-grade gliomas: An insight into brain plasticity from a short case series. J Pediatr Rehabil Med 2021; 14:31-36. [PMID: 33386828 DOI: 10.3233/prm-190637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe clinical data, rehabilitation services, and outcomes of children with handedness switching as their presenting symptom before low-grade glioma (LGG) diagnosis. METHODS A retrospective chart review was performed for five patients (four female and four white) with LGG and confirmed handedness switching before LGG diagnosis. RESULTS All children were less than 8 years at diagnosis, and two patients were less than 3 years. All children were initially right-handed and experienced loss of motor function, ranging from weakness to paresis, in their dominant hand. The median time from switching handedness to diagnosis was 1 month (range: 0.75-60 months). Rehabilitation was offered for three patients, and motor function deficits in the initial dominant hand were resolved in two of the total cohort. At long-term follow-up, hand dominance returned to the initial hand in three patients. CONCLUSIONS Handedness switching should be acknowledged as a potential sign of LGG in children, and early long-term rehabilitation services should be offered for these children.
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Affiliation(s)
- Yahya Ghazwani
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zoltan Patay
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Zsila S Sadighi
- Department of Neurology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jessica Sparrow
- Department of Rehabilitation Services, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Santhosh Upadhyaya
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Frederick Boop
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Amar Gajjar
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Pham NT, Nishijo M, Nghiem TTG, Pham TT, Tran NN, Le VQ, Vu TH, Tran HA, Phan HAV, Do Q, Takiguchi T, Nishino Y, Nishijo H. Effects of perinatal dioxin exposure on neonatal electroencephalography (EEG) activity of the quiet sleep stage in the most contaminated area from Agent Orange in Vietnam. Int J Hyg Environ Health 2020; 232:113661. [PMID: 33296778 DOI: 10.1016/j.ijheh.2020.113661] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the effects of perinatal dioxin exposure indicated by dioxins in breast milk on neonatal electroencephalography (EEG) power in the quiet sleep stage, and associations with neurodevelopmental outcomes at 2 years of age. STUDY DESIGN Fifty-one mother-newborn pairs were enrolled for neonatal EEG analysis in the quiet sleep stage from a birth cohort recruited at a prefecture hospital in Bien Hoa city, Vietnam. Relative EEG power in intra-burst-intervals and high-voltage-bursts in the trace alternant pattern were computed from EEG data during the quiet sleep stage. Forty-three mother-child pairs participated in a 2-year follow-up survey to examine neurodevelopment using the Bayley-III scale and gaze behavior exhibited by fixation duration on the face of a child talking in videos. The general linear model and regression linear model were used for data analysis after adjusting for confounding factors. RESULTS Perinatal dioxin exposure, particularly 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure, influenced relative EEG power values mainly in the intra-burst-interval part of the trace alternant pattern in the quiet sleep stage. In intra-burst-intervals, decreased frontal delta power and increased frontal and parietal alpha power values in the left hemisphere and temporal beta power values in the right hemisphere were associated with increased TCDD exposure, with significant dose-response relationships. Almost none of the relative power values in these brain regions were associated with Bayley III scores, but relative delta power values were significantly associated with face fixation duration in left frontal and parietal regions at 2 years of age. CONCLUSION Perinatal dioxin exposure influences neuronal activity in the quiet sleep stage, leading to poor communication ability indicated by gaze behavior in early childhood.
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Affiliation(s)
- Ngoc Thao Pham
- Department of Epidemiology and Public Health, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Muneko Nishijo
- Department of Epidemiology and Public Health, Kanazawa Medical University, Ishikawa, 920-0293, Japan.
| | - Thi Thuy Giang Nghiem
- System Emotional Science, Graduate School of Medicine, University of Toyama, Toyama, Japan
| | - The Tai Pham
- Vietnam Military Medical University, 160 Phung Hung, Ha Dong, Ha Noi, Viet Nam
| | - Ngoc Nghi Tran
- Ministry of Health, Vietnamese Government, Hanoi, Viet Nam
| | - Van Quan Le
- Vietnam Military Medical University, 160 Phung Hung, Ha Dong, Ha Noi, Viet Nam
| | - Thi Hoa Vu
- Department of Epidemiology and Public Health, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Hai Anh Tran
- Vietnam Military Medical University, 160 Phung Hung, Ha Dong, Ha Noi, Viet Nam
| | - Huy Anh Vu Phan
- Department of Health, Dongnai Prefectural Government, Bienhoa, Dongnai, Viet Nam
| | - Quyet Do
- Vietnam Military Medical University, 160 Phung Hung, Ha Dong, Ha Noi, Viet Nam
| | - Tomoya Takiguchi
- Department of Epidemiology and Public Health, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Yoshikazu Nishino
- Department of Epidemiology and Public Health, Kanazawa Medical University, Ishikawa, 920-0293, Japan
| | - Hisao Nishijo
- System Emotional Science, Graduate School of Medicine, University of Toyama, Toyama, Japan
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Baltar A, Piscitelli D, Marques D, Shirahige L, Monte-Silva K. Baseline Motor Impairment Predicts Transcranial Direct Current Stimulation Combined with Physical Therapy-Induced Improvement in Individuals with Chronic Stroke. Neural Plast 2020; 2020:8859394. [PMID: 33299400 PMCID: PMC7710411 DOI: 10.1155/2020/8859394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 01/12/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) can enhance the effect of conventional therapies in post-stroke neurorehabilitation. The ability to predict an individual's potential for tDCS-induced recovery may permit rehabilitation providers to make rational decisions about who will be a good candidate for tDCS therapy. We investigated the clinical and biological characteristics which might predict tDCS plus physical therapy effects on upper limb motor recovery in chronic stroke patients. A cohort of 80 chronic stroke individuals underwent ten to fifteen sessions of tDCS plus physical therapy. The sensorimotor function of the upper limb was assessed by means of the upper extremity section of the Fugl-Meyer scale (UE-FM), before and after treatment. A backward stepwise regression was used to assess the effect of age, sex, time since stroke, brain lesion side, and basal level of motor function on UE-FM improvement after treatment. Following the intervention, UE-FM significantly improved (p < 0.05), and the magnitude of the change was clinically important (mean 6.2 points, 95% CI: 5.2-7.4). The baseline level of UE-FM was the only significant predictor (R 2 = 0.90, F (1, 76) = 682.80, p < 0.001) of tDCS response. These findings may help to guide clinical decisions according to the profile of each patient. Future studies should investigate whether stroke severity affects the effectiveness of tDCS combined with physical therapy.
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Affiliation(s)
- Adriana Baltar
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Daniele Piscitelli
- School of Medicine and Surgery, University of Milano Bicocca, Milano, Italy
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Déborah Marques
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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Gong Y, Long XM, Xu Y, Cai XY, Ye M. Effects of repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation on motor function and cortex excitability in subacute stroke patients: A randomized controlled trial. Clin Rehabil 2020; 35:718-727. [PMID: 33222502 DOI: 10.1177/0269215520972940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore effects of repetitive transcranial magnetic stimulation (rTMS) combined with transcranial direct current stimulation (tDCS) on motor function and cortex excitability in subacute stroke patients. DESIGN Randomized controlled trial. SETTING Inpatient hospitals. SUBJECTS Sixty-five participants were randomly assigned to four groups: sham, 1Hz rTMS, cathodic tDCS combined with 1Hz rTMS (tDCS-/rTMS-) and anodic tDCS combined with 1Hz rTMS (tDCS+/rTMS-). INTERVENTIONS Four interventions were used, including sham, 1Hz rTMS, and cathodal or anodal tDCS, followed by 1Hz rTMS over contralesional motor cortex, which continued for four weeks. MAIN MEASURES Outcome measures were motor function and cortical excitability, evaluated by Fugl-Meyer Assessment, National Institutes of Health Stroke Scale and Barthel Index, resting Motion Threshold, Motor Evoked Potentials and Central Motor Conduction Time, assessed at baseline, four weeks and eight weeks. RESULTS At four weeks after interventions, Fugl-Meyer Assessment lower limb change score in tDCS+/rTMS- group was significantly larger than other three groups (P < 0.001). There were significant differences in bilateral Motor Evoked Potentials changes between tDCS+/rTMS- group and sham group (P < 0.05). At eight weeks, compared to other groups, National Institutes of Health Stroke Scale (P = 0.003), Barthel Index (P = 0.002), FMA lower limb score (P < 0.001), and bilateral resting Motion Threshold, Motor Evoked Potentials (P < 0.05) showed significant changes in tDCS+/rTMS- group. Furthermore, Fugl-Meyer Assessment lower limb change score was associated with increased ipsilesional Motor Evoked Potentials (r = 0.703 P < 0.001) in tDCS+/rTMS- group. CONCLUSION 1Hz rTMS combined with anode tDCS stimulation protocol could be a preferable rehabilitative strategy for motor recovery in subacute stroke patients.
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Affiliation(s)
- Yan Gong
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.,Department of Physical Medicine and Rehabilitation, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xian-Ming Long
- Department of Rheumatology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ying Xu
- Department of Physical Medicine and Rehabilitation, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Xiu-Ying Cai
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ming Ye
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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38
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Binder E, Leimbach M, Pool EM, Volz LJ, Eickhoff SB, Fink GR, Grefkes C. Cortical reorganization after motor stroke: A pilot study on differences between the upper and lower limbs. Hum Brain Mapp 2020; 42:1013-1033. [PMID: 33165996 PMCID: PMC7856649 DOI: 10.1002/hbm.25275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/03/2020] [Accepted: 09/29/2020] [Indexed: 11/11/2022] Open
Abstract
Stroke patients suffering from hemiparesis may show substantial recovery in the first months poststroke due to neural reorganization. While reorganization driving improvement of upper hand motor function has been frequently investigated, much less is known about the changes underlying recovery of lower limb function. We, therefore, investigated neural network dynamics giving rise to movements of both the hands and feet in 12 well-recovered left-hemispheric chronic stroke patients and 12 healthy participants using a functional magnetic resonance imaging sparse sampling design and dynamic causal modeling (DCM). We found that the level of neural activity underlying movements of the affected right hand and foot positively correlated with residual motor impairment, in both ipsilesional and contralesional premotor as well as left primary motor (M1) regions. Furthermore, M1 representations of the affected limb showed significantly stronger increase in BOLD activity compared to healthy controls and compared to the respective other limb. DCM revealed reduced endogenous connectivity of M1 of both limbs in patients compared to controls. However, when testing for the specific effect of movement on interregional connectivity, interhemispheric inhibition of the contralesional M1 during movements of the affected hand was not detected in patients whereas no differences in condition-dependent connectivity were found for foot movements compared to controls. In contrast, both groups featured positive interhemispheric M1 coupling, that is, facilitation of neural activity, mediating movements of the affected foot. These exploratory findings help to explain why functional recovery of the upper and lower limbs often develops differently after stroke, supporting limb-specific rehabilitative strategies.
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Affiliation(s)
- Ellen Binder
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany
| | - Martha Leimbach
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Eva-Maria Pool
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany
| | - Lukas J Volz
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Psychological and Brain Sciences, University of California, Santa Barbara, California, USA
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany.,Institute for Clinical Neuroscience, Heinrich-Heine-University, Duesseldorf, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany
| | - Christian Grefkes
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Institute of Neuroscience and Medicine (INM-1, INM-3), Research Centre Juelich, Juelich, Germany
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39
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Aune MA, Lorås H, Djuvsland A, Ingvaldsen RP, Aune TK. More Pronounced Bimanual Interference in Proximal Compared to Distal Effectors of the Upper Extremities. Front Psychol 2020; 11:544990. [PMID: 33192790 PMCID: PMC7652815 DOI: 10.3389/fpsyg.2020.544990] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/06/2020] [Indexed: 01/24/2023] Open
Abstract
Bimanual performance depends on effective and modular bilateral communication between the two bodysides. Bilateral neural interactions between the bodysides could cause bimanual interference, and the neuromuscular system for proximal and distal muscles is differently organized, where proximal muscles have more bilateral interneurons at both cortical and spinal level compared to distal muscles. These differences might increase the potential for bimanual interference between proximal arm muscles, because of greater proportions of bilateral interneurons to proximal muscles. The purpose of the present experiment was to evaluate potential differences in bimanual interference between proximal versus distal effectors in the upper extremities. 14 participants first performed a unilateral primary motor task with dominant arm with (1) a proximal and (2) distal controlled joysticks (condition A). Performance in condition A, was compared with the same effector’s performance when a bimanual interference task was performed simultaneously with the non-dominant arm (condition B). The results showed a significant bimanual interference for both the proximal and distal controlled joysticks. Most interestingly, the bimanual interference was larger for the proximal joystick compared to the distal controlled joystick. The increase in spatial accuracy error was higher for the proximal controlled joystick, compared with the distal controlled joystick. These results indicate that the proximal-distal distinction is an important organismic constraint on motor control, and especially for bilateral communication. There seem to be an undesired bilateral interference for both proximal and distal muscles. The interference is higher in the case of proximal effectors compared distal effectors, and the results seem to map the neuroanatomical and neurophysiological differences for these effectors.
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Affiliation(s)
- Morten Andreas Aune
- Department of Sport Science, Sport and Human Movement Science Research Group (SaHMS), Nord University, Levanger, Norway
| | - Håvard Lorås
- Department of Sport Science, Sport and Human Movement Science Research Group (SaHMS), Nord University, Levanger, Norway.,Department of Teacher Education, Faculty of Social and Educational Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Ane Djuvsland
- Department of Sport Science, Sport and Human Movement Science Research Group (SaHMS), Nord University, Levanger, Norway
| | - Rolf Petter Ingvaldsen
- Department of Sport Science, Sport and Human Movement Science Research Group (SaHMS), Nord University, Levanger, Norway
| | - Tore Kristian Aune
- Department of Sport Science, Sport and Human Movement Science Research Group (SaHMS), Nord University, Levanger, Norway
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Kawano T, Hattori N, Uno Y, Hatakenaka M, Yagura H, Fujimoto H, Yoshioka T, Nagasako M, Otomune H, Kitajo K, Miyai I. Electroencephalographic Phase Synchrony Index as a Biomarker of Poststroke Motor Impairment and Recovery. Neurorehabil Neural Repair 2020; 34:711-722. [PMID: 32691673 PMCID: PMC7457459 DOI: 10.1177/1545968320935820] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background. Motor recovery after stroke is of great clinical interest. Besides magnetic resonance imaging functional connectivity, electroencephalographic synchrony is also an available biomarker. However, the clinical relevance of electroencephalographic synchrony in hemiparesis has not been fully understood. Objective. We aimed to demonstrate the usefulness of the phase synchrony index (PSI) by showing associations between the PSI and poststroke outcome in patients with hemiparesis. Methods. This observational study included 40 participants with cortical ischemic stroke (aged 69.8 ± 13.8 years) and 22 healthy controls (aged 66.9 ± 6.5 years). Nineteen-channel electroencephalography was recorded at 36.9 ± 11.8 days poststroke. Upper extremity Fugl-Meyer scores were assessed at the time of admission/before discharge (FM-UE1/FM-UE2; 32.6 ± 12.3/121.0 ± 44.7 days poststroke). Then, correlations between the PSIs and FM-UE1 as well as impairment reduction after rehabilitation (FM-UEgain) were analyzed. Results. The interhemispheric PSI (alpha band) between the primary motor areas (M1s) was lower in patients than in controls and was selectively correlated with FM-UE1 (P = .001). In contrast, the PSI (theta band) centered on the contralesional M1 was higher in patients than in controls and was selectively correlated with FM-UEgain (P = .003). These correlations remained significant after adjusting for confounding factors (age, time poststroke, National Institute of Health Stroke Scale, and lesion volume). Furthermore, the latter correlation was significant in severely impaired patients (FM-UE1 ≤ 10). Conclusions. This study showed that the PSIs were selectively correlated with motor impairment and recovery. Therefore, the PSIs may be potential biomarkers in persons with a hemispheric infarction.
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Affiliation(s)
- Teiji Kawano
- Morinomiya Hospital, Osaka, Japan.,Osaka University, Osaka, Japan.,RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, Wako, Japan
| | - Noriaki Hattori
- Morinomiya Hospital, Osaka, Japan.,Osaka University, Osaka, Japan.,RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, Wako, Japan.,University of Toyama, Toyama, Japan
| | - Yutaka Uno
- RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, Wako, Japan
| | | | | | | | | | | | | | - Keiichi Kitajo
- RIKEN CBS-TOYOTA Collaboration Center, RIKEN Center for Brain Science, Wako, Japan.,National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Japan.,The Graduate University for Advanced Studies (SOKENDAI), Okazaki, Japan
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41
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Human brain connectivity: Clinical applications for clinical neurophysiology. Clin Neurophysiol 2020; 131:1621-1651. [DOI: 10.1016/j.clinph.2020.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 12/12/2022]
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42
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Zink PJ, Philip BA. Cortical Plasticity in Rehabilitation for Upper Extremity Peripheral Nerve Injury: A Scoping Review. Am J Occup Ther 2020; 74:7401205030p1-7401205030p15. [PMID: 32078514 DOI: 10.5014/ajot.2020.036665] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
IMPORTANCE Poor outcomes after upper extremity peripheral nerve injury (PNI) may arise, in part, from the challenges and complexities of cortical plasticity. Occupational therapy practitioners need to understand how the brain changes after peripheral injury and how principles of cortical plasticity can be applied to improve rehabilitation for clients with PNI. OBJECTIVE To identify the mechanisms of cortical plasticity after PNI and describe how cortical plasticity can contribute to rehabilitation. DATA SOURCES PubMed and Embase (1900-2017) were searched for articles that addressed either (1) the relationship between PNI and cortical plasticity or (2) rehabilitative interventions based on cortical plastic changes after PNI. Study Selection and Data Collectio : PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Articles were selected if they addressed all of the following concepts: human PNI, cortical plasticity, and rehabilitation. Phantom limb pain and sensation were excluded. FINDINGS Sixty-three articles met the study criteria. The most common evidence level was Level V (46%). We identified four commonly studied mechanisms of cortical plasticity after PNI and the functional implications for each. We found seven rehabilitative interventions based on cortical plasticity: traditional sensory reeducation, activity-based sensory reeducation, selective deafferentation, cross-modal sensory substitution, mirror therapy, mental motor imagery, and action observation with simultaneous peripheral nerve stimulation. CONCLUSION AND RELEVANCE The seven interventions ranged from theoretically well justified (traditional and activity-based sensory reeducation) to unjustified (selective deafferentation). Overall, articles were heterogeneous and of low quality, and future research should prioritize randomized controlled trials for specific neuropathies, interventions, or cortical plasticity mechanisms. WHAT THIS ARTICLE ADDS This article reviews current knowledge about how the brain changes after PNI and how occupational therapy practitioners can take advantage of those changes for rehabilitation.
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Affiliation(s)
- Patrick J Zink
- Patrick J. Zink, MSOT, is Occupational Therapist, Select Physical Therapy, Kansas City, MO. At the time of the study, he was Student, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Benjamin A Philip
- Benjamin A. Philip, PhD, is Assistant Professor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO;
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Kim RK, Kang N. Bimanual Coordination Functions between Paretic and Nonparetic Arms: A Systematic Review and Meta-analysis. J Stroke Cerebrovasc Dis 2019; 29:104544. [PMID: 31818684 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104544] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 11/18/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bimanual coordination is essential for performing many everyday interlimb actions that require successful spatiotemporal interactions between the 2 arms. This systematic review and meta-analysis investigates bimanual coordination function of the upper extremities in patients with stroke. METHODS Seventeen studies that compared bimanual coordination functions in patients with stroke and age-matched healthy controls qualified for this meta-analysis. We categorized 25 comparisons from the 17 qualified studies into 6 types of bimanual actions based on 3 task constraints: (1), symmetry versus asymmetry movements, (2) parallel versus cooperative movements, and (3) independent goals versus a common goal. RESULTS Random effects meta-analysis revealed that patients with stroke had impaired kinematic (Hedges's g = -1.232 and P < .0001) and kinetic (Hedges's g = -.712 and P = .001) control of bimanual coordination as compared with the age-matched healthy controls. The moderator variable analysis on the 6 types of bimanual actions showed that bimanual coordination impairments after stroke appeared while performing both asymmetrical bimanual movements and symmetrical bimanual movements to achieve a common goal. Moreover, we observed a potential relationship between greater time since stroke onset and increased interlimb coordination impairments for chronic patients. CONCLUSIONS These findings suggest that restoring interlimb coordination functions after stroke may be a crucial rehabilitation goal for facilitating progress toward stroke motor recovery.
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Affiliation(s)
- Rye Kyeong Kim
- Division of Sport Science & Sport Science Institute, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea
| | - Nyeonju Kang
- Division of Sport Science & Sport Science Institute, Incheon National University, Incheon, South Korea; Neuromechanical Rehabilitation Research Laboratory, Incheon National University, Incheon, South Korea.
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Morya E, Monte-Silva K, Bikson M, Esmaeilpour Z, Biazoli CE, Fonseca A, Bocci T, Farzan F, Chatterjee R, Hausdorff JM, da Silva Machado DG, Brunoni AR, Mezger E, Moscaleski LA, Pegado R, Sato JR, Caetano MS, Sá KN, Tanaka C, Li LM, Baptista AF, Okano AH. Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes. J Neuroeng Rehabil 2019; 16:141. [PMID: 31730494 PMCID: PMC6858746 DOI: 10.1186/s12984-019-0581-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.
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Affiliation(s)
- Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Rio Grande do Norte Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Kátia Monte-Silva
- Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Claudinei Eduardo Biazoli
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Andre Fonseca
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Tommaso Bocci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Raaj Chatterjee
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Jeffrey M. Hausdorff
- Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Luciane Aparecida Moscaleski
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Science, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte Brazil
| | - João Ricardo Sato
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Marcelo Salvador Caetano
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Kátia Nunes Sá
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
| | - Clarice Tanaka
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Li Min Li
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Abrahão Fontes Baptista
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Alexandre Hideki Okano
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Graduate Program in Physical Education. State University of Londrina, Londrina, Paraná, Brazil
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Lack of evidence for interhemispheric inhibition in the lower face primary motor cortex. Clin Neurophysiol 2019; 130:1917-1925. [DOI: 10.1016/j.clinph.2019.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/01/2019] [Accepted: 07/17/2019] [Indexed: 11/18/2022]
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Lee SH, Jung HY, Yun SJ, Oh BM, Seo HG. Upper Extremity Rehabilitation Using Fully Immersive Virtual Reality Games With a Head Mount Display: A Feasibility Study. PM R 2019; 12:257-262. [PMID: 31218794 DOI: 10.1002/pmrj.12206] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/12/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND Rehabilitation therapy using a virtual reality (VR) system for stroke patients has gained attention. However, few studies have investigated fully immersive VR using a head-mount display (HMD) for upper extremity rehabilitation in stroke patients. OBJECTIVE To investigate the feasibility, preliminary efficacy, and usability of a fully immersive VR rehabilitation program using a commercially available HMD for upper-limb rehabilitation in stroke patients. DESIGN A feasibility study. SETTING Two rehabilitation centers. PARTICIPANTS Twelve stroke patients with upper extremity weakness. INTERVENTIONS Five upper extremity rehabilitation tasks were implemented in a virtual environment, and the participants wore an HMD (HTC Vive) and trained with appropriate tasks. Participants received a total of 10 sessions two to three times a week, consisting of 30 minutes per session. MAIN OUTCOME MEASURES Both patient participation and adverse effects of VR training were monitored. Primary efficacy was assessed using functional outcomes (Action Research Arm Test, Box and Block Test, and modified Barthel Index), before and after the intervention. Usability was assessed using a self-reported questionnaire. RESULTS Three patients discontinued VR training, and nine patients completed the entire training sessions and there were no adverse effects due to motion sickness. The patients who received all sessions showed significant functional improvement in all outcome measures after training (P < .05 for all measures). The overall satisfaction was 6.3 ± 0.8 on a 7-point Likert scale in all participants. CONCLUSIONS A fully immersive VR rehabilitation program using an HMD for rehabilitation of the upper extremities following stroke is feasible and, in this small study, no serious adverse effects were identified. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Incheon Workers Compensation Hospital, Incheon, Republic of Korea
- Department of Rehabilitation Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
| | - Hae-Yoon Jung
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Incheon Workers Compensation Hospital, Incheon, Republic of Korea
| | - Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Molina-Rueda F, Navarro-Fernández C, Cuesta-Gómez A, Alguacil-Diego IM, Molero-Sánchez A, Carratalá-Tejada M. Neuroplasticity Modifications Following a Lower-Limb Amputation: A Systematic Review. PM R 2019; 11:1326-1334. [PMID: 30989836 DOI: 10.1002/pmrj.12167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/07/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although there are studies that have examined brain functional reorganization following upper-limb amputation, understanding of the brain changes that occur in people with lower-limb amputation is limited. OBJECTIVE To investigate modifications in the brain following lower-limb amputation. METHODS We included case-control studies that evaluate neuroplasticity in the central nervous system using neuroimaging techniques. A literature search was conducted using MEDLINE, CINAHL, Web of Science, Scopus, and Cochrane. RESULTS Eleven articles were included (total n = 204 people with unilateral lower-limb amputation). These studies showed an increase in cerebellar gray matter volume in prosthesis users, as well as a decrease in thickness of the premotor cortex, orbitofrontal cortex, temporo-occipital junction, precentral gyrus, visual areas, and somatosensory cortex. Regarding white matter, the trials observed a decrease in the integrity at the corona radiata, the connections between the premotor areas, the fronto-occipital fasciculus and the corpus callosum. In addition, a decreased functional connectivity between cortical and subcortical areas has been described. CONCLUSIONS Lower-limb amputation causes changes in several brain structures that may occur in the absence of pain and regardless of prosthesis use. The modifications observed include thinning or loss of gray matter volume, decrease in the integrity of the white matter connections between brain structures and changes in the functional connectivity between cortical and subcortical areas. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Francisco Molina-Rueda
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Cristian Navarro-Fernández
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Alicia Cuesta-Gómez
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Isabel M Alguacil-Diego
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - Alberto Molero-Sánchez
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - María Carratalá-Tejada
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
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Nghiem GT, Nishijo M, Pham TN, Ito M, Pham TT, Tran AH, Nishimaru H, Nishino Y, Nishijo H. Adverse effects of maternal dioxin exposure on fetal brain development before birth assessed by neonatal electroencephalography (EEG) leading to poor neurodevelopment; a 2-year follow-up study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 667:718-729. [PMID: 30849612 DOI: 10.1016/j.scitotenv.2019.02.395] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 06/09/2023]
Abstract
We previously reported the adverse effects of perinatal dioxin exposure on child neurodevelopment around a former US military airbase in Vietnam. In the present study, we investigated the effects of maternal dioxin exposure on fetal brain development, which may predict neurodevelopmental outcomes in early childhood. A total of 55 newborns with mothers from dioxin-contaminated areas were recruited in the prefecture hospital in Bien Hoa, Vietnam. Dioxins in maternal breast milk collected 1 month after birth were used as a maternal exposure marker. Relative powers and coherence were computed from neonatal electroencephalogram (EEG) records during active sleep stages. Relationships between the EEG parameters and dioxin exposure markers were analyzed using linear regression and a general linear model after adjusting for gestational age, body length, and head circumference of infants at birth. Using data from 47 infants whose neurodevelopment was examined in a 2-year follow-up study, associations between EEG parameters and neurodevelopment were analyzed after adjusting for confounding factors. On the right frontal and parietal regions, relative delta powers were significantly decreased, and relative alpha and beta powers were significantly increased with increasing dioxin exposure. Increases in delta power and decreases in alpha power on the right frontal and parietal regions were associated with an increase in language scores at 2 years of age. Furthermore, intra- and inter-hemispheric coherence in theta and alpha bands were positively and inversely correlated with dioxin exposure, respectively, and increased intra-coherence in the right hemisphere was associated with lower language scores. These findings suggest that prenatal dioxin exposure affects neuronal activity and functional connectivity between brain regions, and may lead to poor language development.
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Affiliation(s)
- GiangThi Thuy Nghiem
- System Emotional Science, Graduate School of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Muneko Nishijo
- Department of Public Health, Kanazawa Medical University, Ishikawa 920-0293, Japan.
| | - Thao Ngoc Pham
- Department of Public Health, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Mika Ito
- Department of Obstetrics and Gynecology, University of Toyama, Toyama 930-0194, Japan
| | - Tai The Pham
- Biomedical and Pharmaceutical Research Center, Vietnamese Military Medical University, Hanoi, Viet Nam
| | - Anh Hai Tran
- Biomedical and Pharmaceutical Research Center, Vietnamese Military Medical University, Hanoi, Viet Nam
| | - Hiroshi Nishimaru
- System Emotional Science, Graduate School of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Yoshikazu Nishino
- Department of Public Health, Kanazawa Medical University, Ishikawa 920-0293, Japan
| | - Hisao Nishijo
- System Emotional Science, Graduate School of Medicine, University of Toyama, Toyama 930-0194, Japan
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Groeschel S, Holmström L, Northam G, Tournier JD, Baldeweg T, Latal B, Caflisch J, Vollmer B. Motor Abilities in Adolescents Born Preterm Are Associated With Microstructure of the Corpus Callosum. Front Neurol 2019; 10:367. [PMID: 31040815 PMCID: PMC6476930 DOI: 10.3389/fneur.2019.00367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Preterm birth is associated with increased risk of neuromotor impairment. Rates of major neuromotor impairment (cerebral palsy) have decreased; however, in a large proportion of those who do not develop cerebral palsy impaired neuromotor function is observed and this often has implications for everyday life. The aim of this study was to investigate motor performance in preterm born adolescents without cerebral palsy, and to examine associations with alterations of motor system pathway structure. Design/Methods: Thirty-two adolescents (12 males) without cerebral palsy, born before 33 weeks of gestation (mean 27.4 weeks, SD 2.4; birth weight mean 1,084.5 g; SD 387.2), treated at a single tertiary unit, were assessed (median age 16 years; min 14, max 18). Timed performance and quality of movements were assessed with the Zürich Neuromotor Assessment. Neuroimaging included Diffusion Magnetic Resonance Imaging for tractography of the major motor tracts and measurement of fractional anisotropy as a measure of microstructure of the tracts along the major motor pathways. Separate analyses were conducted for areas with predominantly single and predominantly crossing fiber regions. Results: Motor performance in both tasks assessing timed performance and quality of movements, was poorer than expected in the preterm group in relation to norm population. The strongest significant correlations were seen between performance in tasks assessing movement quality and fractional anisotropy in corpus callosum fibers connecting primary motor, primary somatosensory and premotor areas. In addition, timed motor performance was significantly related to fractional anisotropy in the cortico-spinal and thalamo-cortical to premotor area fibers, and the corpus callosum. Conclusions: Impairments in motor abilities are present in preterm born adolescents without major neuromotor impairment and in the absence of focal brain injury. Altered microstructure of the corpus callosum microstructure appears a crucial factor, in particular for movement quality.
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Affiliation(s)
- Samuel Groeschel
- Department of Child Neurology, Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Linda Holmström
- Neuropaediatric Research Unit, Department of Women's and Children's Health, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Gemma Northam
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom
| | - J-Donald Tournier
- Division of Imaging Sciences and Biomedical Engineering, Department of Biomedical Engineering, Centre for the Developing Brain, King's College London, London, United Kingdom
| | - Torsten Baldeweg
- Developmental Neurosciences Programme, UCL Institute of Child Health, London, United Kingdom
| | - Beatrice Latal
- Child Development Center and Children's Research Centre, University Children's Hospital Zürich, Zurich, Switzerland
| | - Jon Caflisch
- Child Development Center and Children's Research Centre, University Children's Hospital Zürich, Zurich, Switzerland
| | - Brigitte Vollmer
- Neuropaediatric Research Unit, Department of Women's and Children's Health, Karolinska Institutet Stockholm, Stockholm, Sweden.,Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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50
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Calabrò RS, Accorinti M, Porcari B, Carioti L, Ciatto L, Billeri L, Andronaco VA, Galletti F, Filoni S, Naro A. Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial. Clin Neurophysiol 2019; 130:767-780. [DOI: 10.1016/j.clinph.2019.02.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/28/2019] [Accepted: 02/13/2019] [Indexed: 01/16/2023]
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