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Srivastava S, Seamon BA, Marebwa BK, Wilmskoetter J, Bowden MG, Gregory CM, Seo NJ, Hanlon CA, Bonilha L, Brown TR, Neptune RR, Kautz SA. The relationship between motor pathway damage and flexion-extension patterns of muscle co-excitation during walking. Front Neurol 2022; 13:968385. [PMID: 36388195 PMCID: PMC9650203 DOI: 10.3389/fneur.2022.968385] [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: 06/13/2022] [Accepted: 10/12/2022] [Indexed: 01/16/2023] Open
Abstract
Background Mass flexion-extension co-excitation patterns during walking are often seen as a consequence of stroke, but there is limited understanding of the specific contributions of different descending motor pathways toward their control. The corticospinal tract is a major descending motor pathway influencing the production of normal sequential muscle coactivation patterns for skilled movements. However, control of walking is also influenced by non-corticospinal pathways such as the corticoreticulospinal pathway that possibly contribute toward mass flexion-extension co-excitation patterns during walking. The current study sought to investigate the associations between damage to corticospinal (CST) and corticoreticular (CRP) motor pathways following stroke and the presence of mass flexion-extension patterns during walking as evaluated using module analysis. Methods Seventeen healthy controls and 44 stroke survivors were included in the study. We used non-negative matrix factorization for module analysis of paretic leg electromyographic activity. We typically have observed four modules during walking in healthy individuals. Stroke survivors often have less independently timed modules, for example two-modules presented as mass flexion-extension pattern. We used diffusion tensor imaging-based analysis where streamlines connecting regions of interest between the cortex and brainstem were computed to evaluate CST and CRP integrity. We also used a coarse classification tree analysis to evaluate the relative CST and CRP contribution toward module control. Results Interhemispheric CST asymmetry was associated with worse lower extremity Fugl-Meyer score (p = 0.023), propulsion symmetry (p = 0.016), and fewer modules (p = 0.028). Interhemispheric CRP asymmetry was associated with worse lower extremity Fugl-Meyer score (p = 0.009), Dynamic gait index (p = 0.035), Six-minute walk test (p = 0.020), Berg balance scale (p = 0.048), self-selected walking speed (p = 0.041), and propulsion symmetry (p = 0.001). The classification tree model reveled that substantial ipsilesional CRP or CST damage leads to a two-module pattern and poor walking ability with a trend toward increased compensatory contralesional CRP based control. Conclusion Both CST and CRP are involved with control of modules during walking and damage to both may lead to greater reliance on the contralesional CRP, which may contribute to a two-module pattern and be associated with worse walking performance.
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Affiliation(s)
- Shraddha Srivastava
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,*Correspondence: Shraddha Srivastava
| | - Bryant A. Seamon
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Barbara K. Marebwa
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Janina Wilmskoetter
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Mark G. Bowden
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Chris M. Gregory
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Na Jin Seo
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Colleen A. Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Truman R. Brown
- Department of Radiology and Radiological Science, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Richard R. Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, United States
| | - Steven A. Kautz
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
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Vatinno AA, Simpson A, Ramakrishnan V, Bonilha HS, Bonilha L, Seo NJ. The Prognostic Utility of Electroencephalography in Stroke Recovery: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2022; 36:255-268. [PMID: 35311412 PMCID: PMC9007868 DOI: 10.1177/15459683221078294] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND Improved ability to predict patient recovery would guide post-stroke care by helping clinicians personalize treatment and maximize outcomes. Electroencephalography (EEG) provides a direct measure of the functional neuroelectric activity in the brain that forms the basis for neuroplasticity and recovery, and thus may increase prognostic ability. OBJECTIVE To examine evidence for the prognostic utility of EEG in stroke recovery via systematic review/meta-analysis. METHODS Peer-reviewed journal articles that examined the relationship between EEG and subsequent clinical outcome(s) in stroke were searched using electronic databases. Two independent researchers extracted data for synthesis. Linear meta-regressions were performed across subsets of papers with common outcome measures to quantify the association between EEG and outcome. RESULTS 75 papers were included. Association between EEG and clinical outcomes was seen not only early post-stroke, but more than 6 months post-stroke. The most studied prognostic potential of EEG was in predicting independence and stroke severity in the standard acute stroke care setting. The meta-analysis showed that EEG was associated with subsequent clinical outcomes measured by the Modified Rankin Scale, National Institutes of Health Stroke Scale, and Fugl-Meyer Upper Extremity Assessment (r = .72, .70, and .53 from 8, 13, and 12 papers, respectively). EEG improved prognostic abilities beyond prediction afforded by standard clinical assessments. However, the EEG variables examined were highly variable across studies and did not converge. CONCLUSIONS EEG shows potential to predict post-stroke recovery outcomes. However, evidence is largely explorative, primarily due to the lack of a definitive set of EEG measures to be used for prognosis.
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Affiliation(s)
- Amanda A Vatinno
- Department of Health Sciences and Research, College of Health Professions, 2345Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Annie Simpson
- Department of Health Sciences and Research, College of Health Professions, 2345Medical University of South Carolina (MUSC), Charleston, SC, USA
- Department of Healthcare Leadership and Management, College of Health Professions, 2345MUSC, Charleston, SC, USA
| | | | - Heather S Bonilha
- Department of Health Sciences and Research, College of Health Professions, 2345Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, 2345MUSC, Charleston, SC, USA
| | - Na Jin Seo
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
- Department of Health Sciences and Research, 2345MUSC, Charleston, SC, USA
- Division of Occupational Therapy, Department of Rehabilitation Sciences, MUSC, Charleston, SC, USA
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Merged swing-muscle synergies and their relation to walking characteristics in subacute post-stroke patients: An observational study. PLoS One 2022; 17:e0263613. [PMID: 35120178 PMCID: PMC8815905 DOI: 10.1371/journal.pone.0263613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/21/2022] [Indexed: 11/19/2022] Open
Abstract
In post-stroke patients, muscle synergy (the coordination of motor modules during walking) is impaired. In some patients, the muscle synergy termed module 1 (hip/knee extensors) is merged with module 2 (ankle plantar flexors), and in other cases, module 1 is merged with module 4 (knee flexors). However, post-stroke individuals with a merging pattern of module 3 (hip flexor and ankle dorsiflexor) and module 4, which is the swing-muscle synergy, have not been reported. This study aimed to determine the muscle-synergy merging subtypes of post-stroke during comfortable walking speed (cws). We also examined the effect of experimental lower-limb angle modulation on the muscle synergy patterns of walking in each subtype. Forty-one participants were assessed under three conditions: cws, long stepping on the paretic side (p-long), and long stepping on the non-paretic side (np-long). Lower-limb flexion and extension angles and the electromyogram were measured during walking. Subtype classification was based on the merging pattern of the muscle synergies, and we examined the effect of different lower-limb angles on the muscle synergies. We identified three merging subtypes: module 1 with module 2 (subtype 1), module 1 with module 4 (subtype 2), and module 3 with module 4 (subtype 3). In the cws condition, the lower-limb flexion angle was reduced in subtype 3, and the lower-limb extension angle was decreased in subtype 1. A more complex muscle synergy was observed only in subtype 3 in the p-long condition versus cws (p = 0.036). This subtype classification of walking impairments based on the merging pattern of the muscle synergies could be useful for the selection of a rehabilitation strategy according to the individual’s particular neurological condition. Rehabilitation with increased lower-limb flexion may be effective for the training of patients with merging of modules 3 and 4 in comfortable walking.
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Mizuta N, Hasui N, Nishi Y, Higa Y, Matsunaga A, Deguchi J, Yamamoto Y, Nakatani T, Taguchi J, Morioka S. Association between temporal asymmetry and muscle synergy during walking with rhythmic auditory cueing in stroke survivors living with impairments. Arch Rehabil Res Clin Transl 2022; 4:100187. [PMID: 35756980 PMCID: PMC9214337 DOI: 10.1016/j.arrct.2022.100187] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We examined the effect of temporal gait asymmetry on muscle synergy post stroke. In our design, the temporal asymmetry during gait was experimentally modulated. The temporal asymmetry was modulated using rhythmic auditory cueing. Rhythmic auditory cueing with gait immediately improved temporal asymmetry and muscle synergy deficits. The temporal asymmetry affected muscle synergy more than kinematics.
Objective To examine the relationship between temporal asymmetry and complexity of muscle synergy during walking using rhythmic auditory cueing (RAC) and the factors related to changes in muscle synergy during walking with RAC in survivors of stroke. Design Cross-sectional study. Setting Wards at 2 medical corporation hospitals. Participants Forty survivors of stroke (N=40; mean age, 70.4±10.3 years; time since stroke, 72.2±32.3 days) who could walk without physical assistance. Interventions Not applicable. Main Outcome Measures The participants were assessed in a random block design under 2 conditions: comfortable walking speed (CWS) and walking with RAC. Single-leg support time, kinematics, and electromyograms were measured. Factors related to the complexity of muscle synergy (variance accounted for by 1 synergy [VAF1]) between the walking conditions were examined using hierarchical multiple regression analysis. Results In the RAC condition, lower limb flexion and knee flexion angles, single-leg support time on the paretic side, and the symmetry index of single-leg support time were increased compared with those in the CWS condition. VAF1 was decreased in the RAC condition (73.9±0.15) compared with that in the CWS condition (76.9±0.13, P=.002). Hierarchical multiple regression analysis revealed that the change in VAF1 was explained by change in single-leg support time (R2=0.43, P=.002). Conclusions The RAC condition demonstrated a more complex representation of muscle synergy than the CWS condition; the change in single-leg support time on the paretic side related to the changes in muscle synergy more than changes in lower limb angle. These findings can help in the walking-training concept to improve muscle synergy deficits in survivors of stroke.
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Affiliation(s)
- Naomichi Mizuta
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
- Corresponding author Naomichi Mizuta, PT, PhD, Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan.
| | - Naruhito Hasui
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Yuki Nishi
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Yasutaka Higa
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Ayaka Matsunaga
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Junji Deguchi
- Department of Rehabilitation, Nakazuyagi Hospital (HIMAWARIKAI Medical Corporation), Tokushima, Japan
| | - Yasutada Yamamoto
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Tomoki Nakatani
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Junji Taguchi
- Department of Therapy, Takarazuka Rehabilitation Hospital (SHOWAKAI Medical Corporation), Takarazuka, Japan
| | - Shu Morioka
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, Nara, Japan
- Neurorehabilitation Research Center, Kio University, Nara, Japan
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Janshen L, Santuz A, Arampatzis A. Muscle Synergies in Patients With Multiple Sclerosis Reveal Demand-Specific Alterations in the Modular Organization of Locomotion. Front Hum Neurosci 2021; 14:593365. [PMID: 33584221 PMCID: PMC7873056 DOI: 10.3389/fnhum.2020.593365] [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: 08/25/2020] [Accepted: 12/14/2020] [Indexed: 11/15/2022] Open
Abstract
For patients with multiple sclerosis (MS), deficits in gait significantly reduce the quality of life. Using the concept of muscle synergies, this study investigated the modular organization of motor control during level and inclined walking in MS patients (MSP) compared with healthy participants (HP) to identify the potential demand-specific adjustments in motor control in MSP. We hypothesized a widening of the time-dependent activation patterns (motor primitives) in MSP to increase the overlap of temporally-adjacent muscle synergies, especially during inclined walking, as a strategy to increase the robustness of motor control, thus compensating pathology-related deficits. We analyzed temporal gait parameters and muscle synergies from myoelectric signals of 13 ipsilateral leg muscles using non-negative matrix factorization. Compared with HP, MSP demonstrated a widening in the time-dependent coefficients (motor primitives), as well as altered relative muscle contribution (motor modules), in certain synergies during level and inclined walking. Moreover, inclined walking revealed a demand-specific adjustment in the modular organization in MSP, resulting in an extra synergy compared with HP. This further increased the overlap of temporally-adjacent muscle synergies to provide sufficient robustness in motor control to accomplish the more demanding motor task while coping with pathology-related motor deficits during walking.
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Affiliation(s)
- Lars Janshen
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alessandro Santuz
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin School of Movement Science, Humboldt-Universität zu Berlin, Berlin, Germany
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Allen JL, Kesar TM, Ting LH. Motor module generalization across balance and walking is impaired after stroke. J Neurophysiol 2019; 122:277-289. [PMID: 31066611 DOI: 10.1152/jn.00561.2018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Muscle coordination is often impaired after stroke, leading to deficits in the control of walking and balance. In this study, we examined features of muscle coordination associated with reduced walking performance in chronic stroke survivors using motor module (a.k.a. muscle synergy) analysis. We identified differences between stroke survivors and age-similar neurotypical controls in the modular control of both overground walking and standing reactive balance. In contrast to previous studies that demonstrated reduced motor module number poststroke, our cohort of stroke survivors did not exhibit a reduction in motor module number compared with controls during either walking or reactive balance. Instead, the pool of motor modules common to walking and reactive balance was smaller, suggesting reduced generalizability of motor module function across behaviors. The motor modules common to walking and reactive balance tended to be less variable and more distinct, suggesting more reliable output compared with motor modules specific to either behavior. Greater motor module generalization in stroke survivors was associated with faster walking speed, more normal step length asymmetry, and narrower step widths. Our work is the first to show that motor module generalization across walking and balance may help to distinguish important and clinically relevant differences in walking performance across stroke survivors that would have been overlooked by examining only a single behavior. Finally, because similar relationships between motor module generalization and walking performance have been demonstrated in healthy young adults and individuals with Parkinson's disease, this suggests that motor module generalization across walking and balance may be important for well-coordinated walking. NEW & NOTEWORTHY This is the first work to simultaneously examine neuromuscular control of walking and standing reactive balance in stroke survivors. We show that motor module generalization across these behaviors (i.e., recruiting common motor modules) is reduced compared with controls and is associated with slower walking speeds, asymmetric step lengths, and larger step widths. This is true despite no between-group differences in module number, suggesting that motor module generalization across walking and balance is important for well-coordinated walking.
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Affiliation(s)
- Jessica L Allen
- Department of Chemical and Biomedical Engineering, West Virginia University , Morgantown, West Virginia
| | - Trisha M Kesar
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine , Atlanta, Georgia
| | - Lena H Ting
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University School of Medicine , Atlanta, Georgia.,Wallace H. Coulter Department of Biomedical Engineering, Emory University and Georgia Institute of Technology , Atlanta, Georgia
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