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Zhang A, Xing Y, Zheng J, Li C, Hua Y, Hu J, Tian Z, Bai Y. Constraint-Induced Movement Therapy Modulates Neuron Recruitment and Neurotransmission Homeostasis of the Contralesional Cortex to Enhance Function Recovery after Ischemic Stroke. ACS OMEGA 2024; 9:21612-21625. [PMID: 38764659 PMCID: PMC11097180 DOI: 10.1021/acsomega.4c02537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
Stroke often results in long-term and severe limb dysfunction for a majority of patients, significantly limiting their activities and social participation. Constraint-induced movement therapy (CIMT) is a rehabilitation approach aimed explicitly at enhancing upper limb motor function following a stroke. However, the precise mechanism remains unknown. This study explores how CIMT may alleviate forelimb paralysis in ischemic mice, potentially through structural and functional remodeling of brain regions beyond the infarct area, especially the contralateral cortex. We demonstrated that CIMT recruits neurons from the contralesional cortex into the network that innervates the affected forelimb, as evidenced by PRV retrograde nerve tracing. Additionally, we investigated how CIMT influences synaptic plasticity in the contralateral cortex by evaluating synaptic growth marker levels and neurotransmission's homeostatic regulation. Our findings uncover a rehabilitative mechanism by which CIMT treats ischemic stroke, characterized by increased recruitment of neurons from the contralateral cortex into the network that innervates the affected forelimb, facilitated by homeostatic regulation of neurotransmission.
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Affiliation(s)
- Anjing Zhang
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
- Department
of Neurological Rehabilitation Medicine, The First Rehabilitation Hospital of Shanghai, Shanghai 200093, P.R. China
| | - Ying Xing
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Jiayuan Zheng
- Department
of Integrative Medicine and Neurobiology, School of Basic Medical
Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers
Center for Brain Science, Institutes of Brain Science, Institute of
Acupuncture Research, Academy of Integrative Medicine, Shanghai Key
Laboratory for Acupuncture Mechanism and Acupoint Function, Shanghai
Medical College, Fudan University, Shanghai 200433, China
| | - Congqin Li
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Yan Hua
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Jian Hu
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Zhanzhuang Tian
- Department
of Integrative Medicine and Neurobiology, School of Basic Medical
Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers
Center for Brain Science, Institutes of Brain Science, Institute of
Acupuncture Research, Academy of Integrative Medicine, Shanghai Key
Laboratory for Acupuncture Mechanism and Acupoint Function, Shanghai
Medical College, Fudan University, Shanghai 200433, China
| | - Yulong Bai
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
- National
Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
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Eibl T, Schrey M, Liebert A, Ritter L, Lange R, Steiner HH, Schebesch KM. Influence of clinical and tumor-specific factors on the resting motor threshold in navigated transcranial magnetic stimulation. Neurophysiol Clin 2023; 53:102920. [PMID: 37944292 DOI: 10.1016/j.neucli.2023.102920] [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: 08/25/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Preoperative non-invasive mapping of motor function with navigated transcranial magnetic stimulation (nTMS) has become a widely used diagnostic procedure. Determination of the patient-individual resting motor threshold (rMT) is of great importance to achieve reliable results when conducting nTMS motor mapping. Factors which contribute to differences in rMT of brain tumor patients have not been fully investigated. METHODS We included adult patients with all types of de novo and recurrent intracranial lesions, suspicious for intra-axial brain tumors. The outcome measure was the rMT of the upper extremity, defined as the stimulation intensity eliciting motor evoked potentials with amplitudes greater than 50µV in 50 % of applied stimulations. RESULTS Eighty nTMS examinations in 75 patients (37.5 % female) aged 57.9 ± 14.9 years were evaluated. In non-parametric testing, rMT values were higher in patients with upper extremity paresis (p = 0.024) and lower in patients with high grade gliomas (HGG) (p = 0.001). rMT inversely correlated with patient age (rs=-0.28, p = 0.013) and edema volume (rs=-0.28, p = 0.012) In regression analysis, infiltration of the precentral gyrus (p<0.001) increased rMT values. Values of rMT were reduced in high grade gliomas (p<0.001), in patients taking Levetiracetam (p = 0.019) and if perilesional edema infiltrated motor eloquent brain (p<0.001). Subgroup analyses of glioma patients revealed similar results. Values of rMT did not differ between hand and forearm muscles. CONCLUSION Most factors confounding rMT in our study were specific to the lesion. These factors contributed to the variability in cortical excitability and must be considered in clinical work with nTMS to achieve reliable results with nTMS motor mapping.
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Affiliation(s)
- Thomas Eibl
- Department of Neurosurgery, Paracelsus Medical University Nuremberg, Germany.
| | - Michael Schrey
- Department of Neurosurgery, Paracelsus Medical University Nuremberg, Germany
| | - Adrian Liebert
- Department of Neurosurgery, Paracelsus Medical University Nuremberg, Germany
| | - Leonard Ritter
- Department of Neurosurgery, Paracelsus Medical University Nuremberg, Germany
| | - Rüdiger Lange
- Department of Neurology, Paracelsus Medical University Nuremberg, Germany
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Burdea G, Kim N, Polistico K, Kadaru A, Grampurohit N, Hundal J, Pollack S. Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports. JMIR Rehabil Assist Technol 2022; 9:e26990. [PMID: 35416787 PMCID: PMC9047881 DOI: 10.2196/26990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 08/16/2021] [Accepted: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND BrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games. OBJECTIVE The aim of this study is to design and test a robotic rehabilitation table-based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase. METHODS A new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations. RESULTS The 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225% and 100% increase), grasp strength (27% and 16% increase), and pinch strength (31% and 15% increase). The shoulder flexion range increased by 17% and 18% and elbow supination range by 75% and 58%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale). CONCLUSIONS The design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance. TRIAL REGISTRATION ClinicalTrials.gov NCT04252170; https://clinicaltrials.gov/ct2/show/NCT04252170.
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Affiliation(s)
- Grigore Burdea
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
- Electrical and Computer Engineering Department, Rutgers-The State University of New Jersey, Piscataway, NJ, United States
| | - Nam Kim
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
| | - Kevin Polistico
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
| | - Ashwin Kadaru
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
| | - Namrata Grampurohit
- Corporate Laboratories, Bright Cloud International Corp, North Brunswick, NJ, United States
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jasdeep Hundal
- Hundal Neuropsychology Group, Hillsborough, NJ, United States
- Robert Wood Johnson Medical School, Rutgers-The State University of New Jersey, Department of Neurology, New Brunswick, NJ, United States
| | - Simcha Pollack
- Computer Information Systems and Decision Sciences, St John's University, New York City, NY, United States
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Veldema J, Nowak DA, Gharabaghi A. Resting motor threshold in the course of hand motor recovery after stroke: a systematic review. J Neuroeng Rehabil 2021; 18:158. [PMID: 34732203 PMCID: PMC8564987 DOI: 10.1186/s12984-021-00947-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background Resting motor threshold is an objective measure of cortical excitability. Numerous studies indicate that the success of motor recovery after stroke is significantly determined by the direction and extent of cortical excitability changes. A better understanding of this topic (particularly with regard to the level of motor impairment and the contribution of either cortical hemisphere) may contribute to the development of effective therapeutical strategies in this cohort. Objectives This systematic review collects and analyses the available evidence on resting motor threshold and hand motor recovery in stroke patients. Methods PubMed was searched from its inception through to 31/10/2020 on studies investigating resting motor threshold of the affected and/or the non-affected hemisphere and motor function of the affected hand in stroke cohorts. Results Overall, 92 appropriate studies (including 1978 stroke patients and 377 healthy controls) were identified. The analysis of the data indicates that severe hand impairment is associated with suppressed cortical excitability within both hemispheres and with great between-hemispheric imbalance of cortical excitability. Favorable motor recovery is associated with an increase of ipsilesional motor cortex excitability and reduction of between-hemispheric imbalance. The direction of change of contralesional motor cortex excitability depends on the amount of hand motor impairment. Severely disabled patients show an increase of contralesional motor cortex excitability during motor recovery. In contrast, recovery of moderate to mild hand motor impairment is associated with a decrease of contralesional motor cortex excitability. Conclusions This data encourages a differential use of rehabilitation strategies to modulate cortical excitability. Facilitation of the ipsilesional hemisphere may support recovery in general, whereas facilitation and inhibition of the contralesional hemisphere may enhance recovery in severe and less severely impaired patients, respectively.
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Affiliation(s)
- Jitka Veldema
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital and University of Tübingen, Otfried-Mueller-Str.45, 72076, Tübingen, Germany.
| | - Dennis Alexander Nowak
- Department of Neurology, VAMED Hospital Kipfenberg, Konrad-Regler-Straße 1, 85110, Kipfenberg, Germany
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital and University of Tübingen, Otfried-Mueller-Str.45, 72076, Tübingen, Germany
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Numssen O, Zier AL, Thielscher A, Hartwigsen G, Knösche TR, Weise K. Efficient high-resolution TMS mapping of the human motor cortex by nonlinear regression. Neuroimage 2021; 245:118654. [PMID: 34653612 DOI: 10.1016/j.neuroimage.2021.118654] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 09/22/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) is a powerful tool to investigate causal structure-function relationships in the human brain. However, a precise delineation of the effectively stimulated neuronal populations is notoriously impeded by the widespread and complex distribution of the induced electric field. Here, we propose a method that allows rapid and feasible cortical localization at the individual subject level. The functional relationship between electric field and behavioral effect is quantified by combining experimental data with numerically modeled fields to identify the cortical origin of the modulated effect. Motor evoked potentials (MEPs) from three finger muscles were recorded for a set of random stimulations around the primary motor area. All induced electric fields were nonlinearly regressed against the elicited MEPs to identify their cortical origin. We could distinguish cortical muscle representation with high spatial resolution and localized them primarily on the crowns and rims of the precentral gyrus. A post-hoc analysis revealed exponential convergence of the method with the number of stimulations, yielding a minimum of about 180 random stimulations to obtain stable results. Establishing a functional link between the modulated effect and the underlying mode of action, the induced electric field, is a fundamental step to fully exploit the potential of TMS. In contrast to previous approaches, the presented protocol is particularly easy to implement, fast to apply, and very robust due to the random coil positioning and therefore is suitable for practical and clinical applications.
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Affiliation(s)
- Ole Numssen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1a, 04103 Leipzig, Germany.
| | - Anna-Leah Zier
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1a, 04103 Leipzig, Germany; Methods and Development Group "Brain Networks", Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1a, 04103 Leipzig, Germany
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Denmark; Technical University of Denmark, Center for Magnetic Resonance, Department of Health Technology, Kongens Lyngby, Denmark
| | - Gesa Hartwigsen
- Lise Meitner Research Group Cognition and Plasticity, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1a, 04103 Leipzig, Germany
| | - Thomas R Knösche
- Methods and Development Group "Brain Networks", Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1a, 04103 Leipzig, Germany; Technische Universität Ilmenau, Institute of Biomedical Engineering and Informatics, Gustav-Kirchhoff-Straße 2, 98693 Ilmenau, Germany
| | - Konstantin Weise
- Methods and Development Group "Brain Networks", Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstr. 1a, 04103 Leipzig, Germany; Technische Universität Ilmenau, Advanced Electromagnetics Group, Helmholtzplatz 2, 98693 Ilmenau, Germany
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The Myelin Content of the Human Precentral Hand Knob Reflects Interindividual Differences in Manual Motor Control at the Physiological and Behavioral Level. J Neurosci 2021; 41:3163-3179. [PMID: 33653698 PMCID: PMC8026359 DOI: 10.1523/jneurosci.0390-20.2021] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 02/22/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022] Open
Abstract
The primary motor cortex hand area (M1HAND) and adjacent dorsal premotor cortex (PMd) form the so-called motor hand knob in the precentral gyrus. M1HAND and PMd are critical for dexterous hand use and are densely interconnected via corticocortical axons, lacking a sharp demarcating border. In 24 young right-handed volunteers, we performed multimodal mapping to delineate the relationship between structure and function in the right motor hand knob. Quantitative structural magnetic resonance imaging (MRI) at 3 tesla yielded regional R1 maps as a proxy of cortical myelin content. Participants also underwent functional MRI (fMRI). We mapped task-related activation and temporal precision, while they performed a visuomotor synchronization task requiring visually cued abduction movements with the left index or little finger. We also performed sulcus-aligned transcranial magnetic stimulation of the motor hand knob to localize the optimal site (hotspot) for evoking a motor evoked potential (MEP) in two intrinsic hand muscles. Individual motor hotspot locations varied along the rostrocaudal axis. The more rostral the motor hotspot location in the precentral crown, the longer were corticomotor MEP latencies. “Hotspot rostrality” was associated with the regional myelin content in the precentral hand knob. Cortical myelin content also correlated positively with task-related activation of the precentral crown and temporal precision during the visuomotor synchronization task. Together, our results suggest a link among cortical myelination, the spatial cortical representation, and temporal precision of finger movements. We hypothesize that the myelination of cortical axons facilitates neuronal integration in PMd and M1HAND and, hereby, promotes the precise timing of movements. SIGNIFICANCE STATEMENT Here we used magnetic resonance imaging and transcranial magnetic stimulation of the precentral motor hand knob to test for a link among cortical myelin content, functional corticomotor representations, and manual motor control. A higher myelin content of the precentral motor hand knob was associated with more rostral corticomotor presentations, with stronger task-related activation and a higher precision of movement timing during a visuomotor synchronization task. We propose that a high precentral myelin content enables fast and precise neuronal integration in M1 (primary motor cortex) and dorsal premotor cortex, resulting in higher temporal precision during dexterous hand use. Our results identify the degree of myelination as an important structural feature of the neocortex that is tightly linked to the function and behavior supported by the cortical area.
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Fluet G, Qiu Q, Patel J, Mont A, Cronce A, Yarossi M, Merians A, Adamovich S. Virtual Rehabilitation of the Paretic Hand and Arm in Persons With Stroke: Translation From Laboratory to Rehabilitation Centers and the Patient's Home. Front Neurol 2021; 12:623261. [PMID: 33584529 PMCID: PMC7876436 DOI: 10.3389/fneur.2021.623261] [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] [Received: 10/29/2020] [Accepted: 01/04/2021] [Indexed: 12/18/2022] Open
Abstract
The anatomical and physiological heterogeneity of strokes and persons with stroke, along with the complexity of normal upper extremity movement make the possibility that any single treatment approach will become the definitive solution for all persons with upper extremity hemiparesis due to stroke unlikely. This situation and the non-inferiority level outcomes identified by many studies of virtual rehabilitation are considered by some to indicate that it is time to consider other treatment modalities. Our group, among others, has endeavored to build on the initial positive outcomes in studies of virtual rehabilitation by identifying patient populations, treatment settings and training schedules that will best leverage virtual rehabilitation's strengths. We feel that data generated by our lab and others suggest that (1) persons with stroke may adapt to virtual rehabilitation of hand function differently based on their level of impairment and stage of recovery and (2) that less expensive, more accessible home based equipment seems to be an effective alternative to clinic based treatment that justifies continued optimism and study.
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Affiliation(s)
- Gerard Fluet
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Jigna Patel
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Ashley Mont
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Amanda Cronce
- New Jersey Institute of Technology, Newark, NJ, United States
| | - Mathew Yarossi
- Department of Physical Therapy, Movement and Rehabilitation Science, Northeastern University, Boston, MA, United States
| | - Alma Merians
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Sergei Adamovich
- Rutgers Biomedical and Health Sciences, Newark, NJ, United States
- New Jersey Institute of Technology, Newark, NJ, United States
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Salehi Dehno N, Kamali F, Shariat A, Jaberzadeh S. Unilateral Strength Training of the Less Affected Hand Improves Cortical Excitability and Clinical Outcomes in Patients With Subacute Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2021; 102:914-924. [PMID: 33460575 DOI: 10.1016/j.apmr.2020.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate whether unilateral strength training helps improve cortical excitability and clinical outcomes after stroke. DESIGN Randomized controlled trial. SETTING Rehabilitation sciences research center. PARTICIPANTS Patients with subacute stroke (N=26) were randomly assigned to a control group (n=13) or the experimental group (n=13). INTERVENTIONS Participants in both groups received conventional physiotherapy. The experimental group also received unilateral strength training of the less affected wrist extensors. Interventions were applied for 4 weeks (12 sessions, 3 d/wk). MAIN OUTCOME MEASURES Cortical excitability in both the ipsilesional hemisphere (ipsiH) and contralesional hemisphere (contraH) was assessed by measuring resting motor threshold (RMT), active motor threshold (AMT), motor evoked potential (MEP), and cortical silent period (CSP) at baseline and after the 4-week intervention period. Clinical outcomes were obtained by evaluating wrist extension strength in both the more affected and less affected hands, upper extremity motor function, activities of daily living (ADL), and spasticity. RESULTS The experimental group showed greater MEP amplitude (P=.001) in the ipsiH and shorter CSP duration in both the ipsiH (P=.042) and contraH (P=.038) compared with the control group. However, the reductions in RMT and AMT in both hemispheres were not significantly different between groups. Improvements in wrist extension strength in the more affected (P=.029) and less affected (P=.001) hand, upper extremity motor function (P=.04), and spasticity (P=.014) were greater in the experimental group. No significant difference in ADLs was detected between groups. CONCLUSIONS A combination of unilateral strength training and conventional physiotherapy appears to be a beneficial therapeutic modality for improving cortical excitability and some clinical outcomes in patients with stroke.
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Affiliation(s)
- Nasrin Salehi Dehno
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fahimeh Kamali
- Physical Therapy Department, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran; Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abdolhamid Shariat
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Autologous Mesenchymal Stem Cells Improve Motor Recovery in Subacute Ischemic Stroke: a Randomized Clinical Trial. Transl Stroke Res 2020; 11:910-923. [PMID: 32462427 DOI: 10.1007/s12975-020-00787-z] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 12/14/2022]
Abstract
While preclinical stroke studies have shown that mesenchymal stem cells (MSCs) promote recovery, few randomized controlled trials (RCT) have assessed cell therapy in humans. In this RCT, we assessed the safety, feasibility, and efficacy of intravenous autologous bone marrow-derived MSCs in subacute stroke. ISIS-HERMES was a single-center, open-label RCT, with a 2-year follow-up. We enrolled patients aged 18-70 years less than 2 weeks following moderate-severe ischemic carotid stroke. Patients were randomized 2:1 to receive intravenous MSCs or not. Primary outcomes assessed feasibility and safety. Secondary outcomes assessed global and motor recovery. Passive wrist movement functional MRI (fMRI) activity in primary motor cortex (MI) was employed as a motor recovery biomarker. We compared "treated" and "control" groups using as-treated analyses. Of 31 enrolled patients, 16 patients received MSCs. Treatment feasibility was 80%, and there were 10 and 16 adverse events in treated patients, and 12 and 24 in controls at 6-month and 2-year follow-up, respectively. Using mixed modeling analyses, we observed no treatment effects on the Barthel Index, NIHSS, and modified-Rankin scores, but significant improvements in motor-NIHSS (p = 0.004), motor-Fugl-Meyer scores (p = 0.028), and task-related fMRI activity in MI-4a (p = 0.031) and MI-4p (p = 0.002). Intravenous autologous MSC treatment following stroke was safe and feasible. Motor performance and task-related MI activity results suggest that MSCs improve motor recovery through sensorimotor neuroplasticity. ClinicalTrials.gov Identifier NCT00875654.
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Yoo YJ, Kim JW, Kim JS, Hong BY, Lee KB, Lim SH. Corticospinal Tract Integrity and Long-Term Hand Function Prognosis in Patients With Stroke. Front Neurol 2019; 10:374. [PMID: 31037066 PMCID: PMC6476282 DOI: 10.3389/fneur.2019.00374] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background: The restoration of hand function is an important goal for patients with stroke. This study investigated the relationship between corticospinal tract (CST) integrity and the functional status of the hand in patients with stroke 6 months after onset and evaluated which of the following values would be useful for predicting hand function: fiber number (FN), fractional anisotropy (FA) at the mid-pons, and FA at the pontomedullary junction. Methods: The present retrospective cross-sectional observational study assessed 44 patients with stroke who were able to walk without using a walking aid or orthosis. The final hand function results were classified into three groups: no recovery (unable to grasp), partial recovery (able to grasp, unable to oppose), and full recovery (able to grasp and oppose). All subjects underwent diffusion tensor imaging (DTI) at 6 months after stroke onset. Values for FA at the mid-pons and pontomedullary junction and CST FN were measured. The normalization ratio for FN and FA was calculated using the following formula: data for affected hand/data for non-affected hand. Results: The normalized FN, FA (mid-pons), and FA (pontomedullary junction) DTI values differed significantly. The FA (mid-pons) value for the full recovery group was higher than those for the other groups. The FA (mid-pons) value for the partial recovery group was higher than that for the no recovery group. The normalized FA (mid-pons) value differed significantly among all three groups. Conclusions: The present study showed that CST integrity (at 6 months after onset) in patients with chronic stroke was related to functional hand status. In addition, the mid-pons FA value was more predictive of functional restoration of the hand than the FN or FA value at the pontomedullary junction. These results may be useful in predicting the functional restoration of the hand and understanding the functional prognosis of stroke.
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Affiliation(s)
- Yeun Jie Yoo
- Department of Rehabilitation Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jae Won Kim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Joon Sung Kim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyoung Bo Lee
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Yarossi M, Patel J, Qiu Q, Massood S, Fluet G, Merians A, Adamovich S, Tunik E. The Association Between Reorganization of Bilateral M1 Topography and Function in Response to Early Intensive Hand Focused Upper Limb Rehabilitation Following Stroke Is Dependent on Ipsilesional Corticospinal Tract Integrity. Front Neurol 2019; 10:258. [PMID: 30972004 PMCID: PMC6443957 DOI: 10.3389/fneur.2019.00258] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 02/26/2019] [Indexed: 01/12/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) induced motor evoked potentials (MEPs) are an established proxy of corticospinal excitability. As a binary measure, the presence (MEP+) or absence (MEP-) of ipsilesional hemisphere MEPs early following stroke is a robust indicator of long-term recovery, however this measure does not provide information about spatial cortical reorganization. MEPs have been systematically acquired over the sensorimotor cortex to "map" motor topography. In this investigation we compared the degree to which functional improvements resulting from early (<3 months post-stroke) intensive hand focused upper limb rehabilitation correlate with changes in motor topography between MEP+ and MEP- individuals. Following informed consent, 17 individuals (4 Female, 60.3 ± 9.4 years, 24.6 ± 24.01 days post first time stroke) received 8 one hour-sessions of training with virtual reality (VR)/Robotic simulations. Clinical tests [Box and Blocks Test (BBT), Wolf Motor Function Test (WMFT), Upper Extremity Fugl-Meyer (UEFMA)], kinematic and kinetic assessments [finger Active Range of Motion (finger AROM), Maximum Pinch Force (MPF)], and bilateral TMS mapping of 5 hand muscles were performed prior to (PRE), directly following (POST), and 1 month following (1M) training. Participants were divided into two groups (MEP+, MEP-) based on whether an MEP was present in the affected first dorsal interosseous (FDI) at any time point. MEP+ individuals improved significantly more than MEP- individuals from PRE to 1M on the WMFT, BBT, and finger AROM scores. Ipsilesional hemisphere FDI area increased significantly with time in the MEP+ group. FDI area of the contralesional hemisphere was not significantly different across time points or groups. In the MEP+ group, significant correlations were observed between PRE-1M changes in ipsilesional FDI area and WMFT, BBT, and finger AROM, and contralesional FDI area and UEFMA and MPF. In the MEP- group, no significant correlations were found between changes in contralesional FDI area and functional outcomes. We report preliminary evidence in a small sample that patterns of recovery and the association of recovery to bilateral changes in motor topography may depend on integrity of the ipsilesional cortical spinal tract as assessed by the presence of TMS evoked MEPs.
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Affiliation(s)
- Mathew Yarossi
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States.,SPIRAL Group, Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States
| | - Jigna Patel
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Qinyin Qiu
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Supriya Massood
- Brookdale Rehabilitation - North Campus, Naples Community Hospital, Naples, FL, United States
| | - Gerard Fluet
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Alma Merians
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States
| | - Sergei Adamovich
- Department of Rehabilitation and Movement Sciences, School of Health Professions, Rutgers Biomedical and Health Sciences, Newark, NJ, United States.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Eugene Tunik
- Movement Neuroscience Laboratory, Department of Physical Therapy, Movement and Rehabilitation Science, Bouve College of Health Sciences, Northeastern University, Boston, MA, United States.,Department of Bioengineering, College of Engineering, Northeastern University, Boston, MA, United States.,Department of Electrical and Computer Engineering, College of Engineering, Northeastern University, Boston, MA, United States
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Lee KM, Joo MC, Yu YM, Kim MS. Mylohyoid motor evoked potentials can effectively predict persistent dysphagia 3 months poststroke. Neurogastroenterol Motil 2018. [PMID: 29532576 DOI: 10.1111/nmo.13323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The purpose of this study was to investigate the association between mylohyoid motor-evoked potentials (MH-MEP) and swallowing function and determine the value of MH-MEP for predicting aspiration 3 months poststroke. METHODS Subacute patients within a month of their first stroke were enrolled up for 2 consecutive years. Videofluoroscopic swallowing studies (VFSS) were performed twice. Patients were evaluated during VFSS using the penetration aspiration scale (PAS) and videofluoroscopic dysphagia scale (VDS). MH-MEP was recorded in the mylohyoid muscles. The active electrode was positioned submentally, 2 cm lateral to midline. Magnetic stimulation was performed on the contralateral motor cortex, 2-4 cm anterior and 4-6 cm lateral to the cranial vertex. The resting motor threshold (rMT), latency, and amplitude stimulation at 120% (amp120) and 150% (amp150) of the rMT were assessed. The ratio of each parameter was also estimated. The relationship between MH-MEP and VFSS findings was analyzed. KEY RESULTS Sixty-eight patients completed the study. On VFSS at 3 months poststroke, 24 (35.3%) patients showed aspiration. The rMT, rMT ratio, amp120 and amp120 ratio were significantly correlated with the PAS and VDS (P < .05). The rMT ratio (OR = 1.208, P = .001) and amp120 ratio (OR = 0.821, P = .002) were independent predictors of aspiration at 3 months. The optimal cut-off value of the rMT ratio was 126.1 (AUC = 0.94, sensitivity = 0.92, specificity = 0.89); that of the amp120 ratio was 66.5 (AUC = 0.89, sensitivity = 0.88, specificity = 0.86). CONCLUSIONS AND INFERENCES MH-MEP was well-correlated with dysphagia severity assessed by VFSS. The rMT ratio and amplitude ratio of MH-MEP can effectively predict persistent dysphagia 3 months poststroke.
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Affiliation(s)
- K M Lee
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - M C Joo
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Y M Yu
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - M-S Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
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Tarri M, Brihmat N, Gasq D, Lepage B, Loubinoux I, De Boissezon X, Marque P, Castel-Lacanal E. Five-day course of paired associative stimulation fails to improve motor function in stroke patients. Ann Phys Rehabil Med 2018; 61:78-84. [DOI: 10.1016/j.rehab.2017.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/26/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
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14
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Veldema J, Bösl K, Nowak DA. Cortico-spinal excitability and hand motor recovery in stroke: a longitudinal study. J Neurol 2018; 265:1071-1078. [DOI: 10.1007/s00415-018-8802-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 01/02/2018] [Accepted: 02/15/2018] [Indexed: 11/30/2022]
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