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Lee K, Barradas V, Schweighofer N. Self-organizing recruitment of compensatory areas maximizes residual motor performance post-stroke. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.28.601213. [PMID: 39005333 PMCID: PMC11244868 DOI: 10.1101/2024.06.28.601213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Whereas the orderly recruitment of compensatory motor cortical areas after stroke depends on the size of the motor cortex lesion affecting arm and hand movements, the mechanisms underlying this reorganization are unknown. Here, we hypothesized that the recruitment of compensatory areas results from the motor system's goal to optimize performance given the anatomical constraints before and after the lesion. This optimization is achieved through two complementary plastic processes: a homeostatic regulation process, which maximizes information transfer in sensory-motor networks, and a reinforcement learning process, which minimizes movement error and effort. To test this hypothesis, we developed a neuro-musculoskeletal model that controls a 7-muscle planar arm via a cortical network that includes a primary motor cortex and a premotor cortex that directly project to spinal motor neurons, and a contra-lesional primary motor cortex that projects to spinal motor neurons via the reticular formation. Synapses in the cortical areas are updated via reinforcement learning and the activity of spinal motor neurons is adjusted through homeostatic regulation. The model replicated neural, muscular, and behavioral outcomes in both non-lesioned and lesioned brains. With increasing lesion sizes, the model demonstrated systematic recruitment of the remaining primary motor cortex, premotor cortex, and contra-lesional cortex. The premotor cortex acted as a reserve area for fine motor control recovery, while the contra-lesional cortex helped avoid paralysis at the cost of poor joint control. Plasticity in spinal motor neurons enabled force generation after large cortical lesions despite weak corticospinal inputs. Compensatory activity in the premotor and contra-lesional motor cortex was more prominent in the early recovery period, gradually decreasing as the network minimized effort. Thus, the orderly recruitment of compensatory areas following strokes of varying sizes results from biologically plausible local plastic processes that maximize performance, whether the brain is intact or lesioned.
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Affiliation(s)
- Kevin Lee
- Computer Science, University of Southern California, Los Angeles, USA
| | - Victor Barradas
- Institute of Innovative Research, Tokyo Institute of Technology, Yokohama, Japan
| | - Nicolas Schweighofer
- Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, USA
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2
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Li R, Pozorski V, Dabbs K, Haebig M, Cox CR, Pletcher C, Wey A, Barzgari A, Theisen F, Okonkwo O, Gallagher CL. A longitudinal evaluation of personalized intrinsic network topography and cognitive decline in Parkinson's disease. Eur J Neurosci 2024; 60:3795-3811. [PMID: 38752411 DOI: 10.1111/ejn.16380] [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: 03/11/2023] [Revised: 12/28/2023] [Accepted: 04/18/2024] [Indexed: 07/06/2024]
Abstract
Resting state functional magnetic resonance imaging (R-fMRI) offers insight into how synchrony within and between brain networks is altered in disease states. Individual and disease-related variability in intrinsic connectivity networks may influence our interpretation of R-fMRI data. We used a personalized approach designed to account for individual variation in the spatial location of correlation maxima to evaluate R-fMRI differences between Parkinson's disease (PD) patients who showed cognitive decline, those who remained cognitively stable and cognitively stable controls. We compared fMRI data from these participant groups, studied at baseline and 18 months later, using both network-based statistics (NBS) and calculations of mean inter- and intra-network connectivity within pre-defined functional networks. The NBS analysis showed that PD participants who remained cognitively stable showed exclusively (at baseline) or predominantly (at follow-up) increased intra-network connectivity, whereas decliners showed exclusively reduced intra-network and inter- (ventral attention and default mode) connectivity, in comparison with the control group. Evaluation of mean connectivity between all regions of interest (ROIs) within a priori networks showed that decliners had consistently reduced inter-network connectivity for ventral attention, somatomotor, visual and striatal networks and reduced intra-network connectivity for ventral attention network to striatum and cerebellum. These findings suggest that specific functional connectivity covariance patterns differentiate PD cognitive subtypes and may predict cognitive decline. Further, increased intra and inter-network synchrony may support cognitive function in the face of PD-related network disruptions.
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Affiliation(s)
- Renxi Li
- William S. Middleton V.A. Hospital, Madison, Wisconsin, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Vincent Pozorski
- William S. Middleton V.A. Hospital, Madison, Wisconsin, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kevin Dabbs
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Maureen Haebig
- William S. Middleton V.A. Hospital, Madison, Wisconsin, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Christopher R Cox
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Colleen Pletcher
- William S. Middleton V.A. Hospital, Madison, Wisconsin, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Alexandra Wey
- William S. Middleton V.A. Hospital, Madison, Wisconsin, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Amy Barzgari
- William S. Middleton V.A. Hospital, Madison, Wisconsin, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Frances Theisen
- William S. Middleton V.A. Hospital, Madison, Wisconsin, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Ozioma Okonkwo
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Wisconsin Alzheimer Disease Research Center, Madison, Wisconsin, USA
| | - Catherine L Gallagher
- William S. Middleton V.A. Hospital, Madison, Wisconsin, USA
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Wisconsin Alzheimer Disease Research Center, Madison, Wisconsin, USA
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Yu P, Dong R, Wang X, Tang Y, Liu Y, Wang C, Zhao L. Neuroimaging of motor recovery after ischemic stroke - functional reorganization of motor network. Neuroimage Clin 2024; 43:103636. [PMID: 38950504 PMCID: PMC11267109 DOI: 10.1016/j.nicl.2024.103636] [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: 03/10/2024] [Revised: 06/01/2024] [Accepted: 06/27/2024] [Indexed: 07/03/2024]
Abstract
The long-term motor outcome of acute stroke patients may be correlated to the reorganization of brain motor network. Abundant neuroimaging studies contribute to understand the pathological changes and recovery of motor networks after stroke. In this review, we summarized how current neuroimaging studies have increased understanding of reorganization and plasticity in post stroke motor recovery. Firstly, we discussed the changes in the motor network over time during the motor-activation and resting states, as well as the overall functional integration trend of the motor network. These studies indicate that the motor network undergoes dynamic bilateral hemispheric functional reorganization, as well as a trend towards network randomization. In the second part, we summarized the current study progress in the application of neuroimaging technology to early predict the post-stroke motor outcome. In the third part, we discuss the neuroimaging techniques commonly used in the post-stroke recovery. These methods provide direct or indirect visualization patterns to understand the neural mechanisms of post-stroke motor recovery, opening up new avenues for studying spontaneous and treatment-induced recovery and plasticity after stroke.
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Affiliation(s)
- Pei Yu
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ruoyu Dong
- Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xiao Wang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yuqi Tang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Yaning Liu
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Can Wang
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ling Zhao
- School of Acupuncture and Massage, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
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4
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Wu B, Yang L, Xi C, Yao H, Chen L, Fan F, Wu G, Du Z, Hu J, Hu S. Corticospinal-specific Shh overexpression in combination with rehabilitation promotes CST axonal sprouting and skilled motor functional recovery after ischemic stroke. Mol Neurobiol 2024; 61:2186-2196. [PMID: 37864058 DOI: 10.1007/s12035-023-03642-y] [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] [Received: 04/30/2023] [Accepted: 09/06/2023] [Indexed: 10/22/2023]
Abstract
Ischemic stroke often leads to permanent neurological impairments, largely due to limited neuroplasticity in adult central nervous system. Here, we first showed that the expression of Sonic Hedgehog (Shh) in corticospinal neurons (CSNs) peaked at the 2nd postnatal week, when corticospinal synaptogenesis occurs. Overexpression of Shh in adult CSNs did not affect motor functions and had borderline effects on promoting the recovery of skilled locomotion following ischemic stroke. In contrast, CSNs-specific Shh overexpression significantly enhanced the efficacy of rehabilitative training, resulting in robust axonal sprouting and synaptogenesis of corticospinal axons into the denervated spinal cord, along with significantly improved behavioral outcomes. Mechanistically, combinatory treatment led to additional mTOR activation in CSNs when compared to that evoked by rehabilitative training alone. Taken together, our study unveiled a role of Shh, a morphogen involved in early development, in enhancing neuroplasticity, which significantly improved the outcomes of rehabilitative training. These results thus provide novel insights into the design of combinatory treatment for stroke and traumatic central nervous system injuries.
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Affiliation(s)
- Biwu Wu
- Department of Neurosurgery and Neurocritical Care, Affiliated Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200042, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Lei Yang
- Department of Neurosurgery and Neurocritical Care, Affiliated Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200042, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Caihua Xi
- Department of Neurosurgery and Neurocritical Care, Affiliated Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200042, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Haijun Yao
- Department of Neurosurgery and Neurocritical Care, Affiliated Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200042, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Long Chen
- Department of Neurosurgery and Neurocritical Care, Affiliated Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200042, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Fengqi Fan
- Pain Department of Yueyang Integrated Traditional Chinese and Western Medicine Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gang Wu
- Department of Neurosurgery and Neurocritical Care, Affiliated Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200042, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Zhouying Du
- Department of Neurosurgery and Neurocritical Care, Affiliated Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200042, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Jin Hu
- Department of Neurosurgery and Neurocritical Care, Affiliated Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200042, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- Neurosurgical Institute of Fudan University, Shanghai, China
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Shukun Hu
- Department of Neurosurgery and Neurocritical Care, Affiliated Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200042, China.
- National Center for Neurological Disorders, Shanghai, China.
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.
- Neurosurgical Institute of Fudan University, Shanghai, China.
- Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
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Gao Z, Lv S, Ran X, Wang Y, Xia M, Wang J, Qiu M, Wei Y, Shao Z, Zhao Z, Zhang Y, Zhou X, Yu Y. Influencing factors of corticomuscular coherence in stroke patients. Front Hum Neurosci 2024; 18:1354332. [PMID: 38562230 PMCID: PMC10982423 DOI: 10.3389/fnhum.2024.1354332] [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: 12/12/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Stroke, also known as cerebrovascular accident, is an acute cerebrovascular disease with a high incidence, disability rate, and mortality. It can disrupt the interaction between the cerebral cortex and external muscles. Corticomuscular coherence (CMC) is a common and useful method for studying how the cerebral cortex controls muscle activity. CMC can expose functional connections between the cortex and muscle, reflecting the information flow in the motor system. Afferent feedback related to CMC can reveal these functional connections. This paper aims to investigate the factors influencing CMC in stroke patients and provide a comprehensive summary and analysis of the current research in this area. This paper begins by discussing the impact of stroke and the significance of CMC in stroke patients. It then proceeds to elaborate on the mechanism of CMC and its defining formula. Next, the impacts of various factors on CMC in stroke patients were discussed individually. Lastly, this paper addresses current challenges and future prospects for CMC.
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Affiliation(s)
- Zhixian Gao
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Shiyang Lv
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Xiangying Ran
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Yuxi Wang
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Mengsheng Xia
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Junming Wang
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Mengyue Qiu
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Yinping Wei
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Zhenpeng Shao
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Zongya Zhao
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Yehong Zhang
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
| | - Xuezhi Zhou
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
| | - Yi Yu
- School of Medical Engineering, Xinxiang Medical University, Xinxiang, China
- Engineering Technology Research Center of Neurosense and Control of Henan Province, Xinxiang, China
- Henan International Joint Laboratory of Neural Information Analysis and Drug Intelligent Design, Xinxiang, China
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6
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Manuweera T, Wagenknecht A, Kleckner AS, Dorsey SG, Zhu S, Tivarus ME, Kesler SR, Ciner A, Kleckner IR. Preliminary evaluation of novel Bodily Attention Task to assess the role of the brain in chemotherapy-induced peripheral neurotoxicity (CIPN). Behav Brain Res 2024; 460:114803. [PMID: 38070689 PMCID: PMC10860373 DOI: 10.1016/j.bbr.2023.114803] [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: 07/24/2023] [Revised: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
Chemotherapy-induced peripheral neurotoxicity (CIPN) is a common, sometimes dose-limiting side effect of neurotoxic chemotherapy. Treatment is limited because its pathophysiology is poorly understood. Compared to research on peripheral mechanisms, the role of the brain in CIPN is understudied and it may be important to develop better treatments. We propose a novel task that assesses brain activation associated with attention to bodily sensations (interoception), without the use of painful stimulation, to understand how CIPN symptoms may be processed in the brain. The goals of this preliminary study were to assess, 1) feasibility of the task, 2) sensitivity to changes in brain activity, and 3) suitability for assessing relationships between brain activation and CIPN severity. Eleven participants with varying types of cancer completed a brain fMRI scan and rated CIPN severity (CIPN-20) before and/or 12 weeks after starting neurotoxic chemotherapy. The Bodily Attention Task is a 7.5-min long fMRI task involving attentional focus on the left fingertips, the heart, or a flashing word "target" for visual attention (reference condition). Feasibility was confirmed, as 73% of all data collected were usable and participants reported feeling or focus during 75% of the trials. Regarding brain activity, finger attention increased activation in somatosensory regions (primary sensory cortex, insula) and sensory integration regions (precuneus, dorsolateral prefrontal cortex). Exploratory analyses suggested that brain activation may be associated with CIPN severity. A larger sample size and accounting of confounding factors is needed to test for replication and to identify brain and interoceptive biomarkers to help improve the prediction, prevention, and treatment of CIPN.
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Affiliation(s)
- Thushini Manuweera
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA.
| | - Amelia Wagenknecht
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Amber S Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Susan G Dorsey
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Shijun Zhu
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
| | - Madalina E Tivarus
- Department of Imaging Sciences and Department of Neuroscience University of Rochester Medical Center, Rochester, NY, USA
| | - Shelli R Kesler
- Department of Adult Health, School of Nursing, University of Texas at Austin, Austin, TX, USA
| | - Aaron Ciner
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ian R Kleckner
- Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, Baltimore, MD, USA
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Gurdiel-Álvarez F, Navarro-López V, Varela-Rodríguez S, Juárez-Vela R, Cobos-Rincón A, Sánchez-González JL. Transcranial magnetic stimulation therapy for central post-stroke pain: systematic review and meta-analysis. Front Neurosci 2024; 18:1345128. [PMID: 38419662 PMCID: PMC10899389 DOI: 10.3389/fnins.2024.1345128] [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: 11/27/2023] [Accepted: 02/01/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Although rare, central post-stroke pain remains one of the most refractory forms of neuropathic pain. It has been reported that repetitive transcranial magnetic stimulation (rTMS) may be effective in these cases of pain. Aim The aim of this study was to investigate the efficacy of rTMS in patients with central post-stroke pain (CPSP). Methods We included randomized controlled trials or Controlled Trials published until October 3rd, 2022, which studied the effect of rTMS compared to placebo in CPSP. We included studies of adult patients (>18 years) with a clinical diagnosis of stroke, in which the intervention consisted of the application of rTMS to treat CSP. Results Nine studies were included in the qualitative analysis; 6 studies (4 RCT and 2 non-RCT), with 180 participants, were included in the quantitative analysis. A significant reduction in CPSP was found in favor of rTMS compared with sham, with a large effect size (SMD: -1.45; 95% CI: -1.87; -1.03; p < 0.001; I2: 58%). Conclusion The findings of the present systematic review with meta-analysis suggest that there is low quality evidence for the effectiveness of rTMS in reducing CPSP. Systematic review registration Identifier (CRD42022365655).
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Affiliation(s)
- Francisco Gurdiel-Álvarez
- International Doctoral School, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
- Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Víctor Navarro-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain
| | - Sergio Varela-Rodríguez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Raúl Juárez-Vela
- Nursing Department, Faculty of Health Sciences, University of La Rioja, Research Group GRUPAC, Logroño, Spain
| | - Ana Cobos-Rincón
- Nursing Department, Faculty of Health Sciences, University of La Rioja, Research Group GRUPAC, Logroño, Spain
| | - Juan Luis Sánchez-González
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
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8
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Harris JL, Wang X, Christian SK, Novikova L, Kalani A, Hui D, Ferren S, Barbay S, Ortiz JP, Nudo RJ, Brooks WM, Wilkins HM, Chalise P, Michaelis ML, Michaelis EK, Swerdlow RH. Traumatic Brain Injury Alters the Trajectory of Age-Related Mitochondrial Change. J Alzheimers Dis 2024; 97:1793-1806. [PMID: 38306050 DOI: 10.3233/jad-231237] [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: 02/03/2024]
Abstract
Background Some epidemiologic studies associate traumatic brain injury (TBI) with Alzheimer's disease (AD). Objective To test whether a TBI-induced acceleration of age-related mitochondrial change could potentially mediate the reported TBI-AD association. Methods We administered unilateral controlled cortical impact (CCI) or sham injuries to 5-month-old C57BL/6J and tau transgenic rTg4510 mice. In the non-transgenics, we assessed behavior (1-5 days, 1 month, and 15 months), lesion size (1 and 15 months), respiratory chain enzymes (1 and 15 months), and mitochondrial DNA copy number (mtDNAcn) (1 and 15 months) after CCI/sham. In the transgenics we quantified post-injury mtDNAcn and tangle burden. Results In the non-transgenics CCI caused acute behavioral deficits that improved or resolved by 1-month post-injury. Protein-normalized complex I and cytochrome oxidase activities were not significantly altered at 1 or 15 months, although complex I activity in the CCI ipsilesional cortex declined during that period. Hippocampal mtDNAcn was not altered by injury at 1 month, increased with age, and rose to the greatest extent in the CCI contralesional hippocampus. In the injured then aged transgenics, the ipsilesional hippocampus contained less mtDNA and fewer tangles than the contralesional hippocampus; mtDNAcn and tangle counts did not correlate. Conclusions As mice age their brains increase mtDNAcn as part of a compensatory response that preserves mitochondrial function, and TBI enhances this response. TBI may, therefore, increase the amount of compensation required to preserve late-life mitochondrial function. If TBI does modify AD risk, altering the trajectory or biology of aging-related mitochondrial changes could mediate the effect.
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Affiliation(s)
- Janna L Harris
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
- Departments of Cell Biology and Physiology, University of Kansas Alzheimer's Disease Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Xiaowan Wang
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Sarah K Christian
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Lesya Novikova
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Anuradha Kalani
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Dongwei Hui
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Sadie Ferren
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Scott Barbay
- Departments of Physical Medicine and Rehabilitation, University of Kansas Alzheimer's Disease Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Judit Perez Ortiz
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Randolph J Nudo
- Departments of Physical Medicine and Rehabilitation, University of Kansas Alzheimer's Disease Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
| | - William M Brooks
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
- Departments of Neurology, University of Kansas Alzheimer's Disease Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Heather M Wilkins
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
- Departments of Neurology, University of Kansas Alzheimer's Disease Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Prabhakar Chalise
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
- Departments of Biostatistics and Data Science, University of Kansas Alzheimer's Disease Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Mary Lou Michaelis
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Elias K Michaelis
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
| | - Russell H Swerdlow
- University of Kansas Alzheimer's Disease Research Center, Kansas City, KS, USA
- Departments of Cell Biology and Physiology, University of Kansas Alzheimer's Disease Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
- Departments of Neurology, University of Kansas Alzheimer's Disease Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
- Departments of Biochemistry and Molecular Biology, University of Kansas Alzheimer's Disease Research Center, The University of Kansas Medical Center, Kansas City, KS, USA
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9
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Kheirollahi A, Sadeghi S, Orandi S, Moayedi K, Khajeh K, Khoobi M, Golestani A. Chondroitinase as a therapeutic enzyme: Prospects and challenges. Enzyme Microb Technol 2024; 172:110348. [PMID: 37898093 DOI: 10.1016/j.enzmictec.2023.110348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/28/2023] [Accepted: 10/19/2023] [Indexed: 10/30/2023]
Abstract
The chondroitinases (Chase) are bacterial lyases that specifically digest chondroitin sulfate and/or dermatan sulfate glycosaminoglycans via a β-elimination reaction and generate unsaturated disaccharides. In recent decades, these enzymes have attracted the attention of many researchers due to their potential applications in various aspects of medicine from the treatment of spinal cord injury to use as an analytical tool. In spite of this diverse spectrum, the application of Chase is faced with several limitations and challenges such as thermal instability and lack of a suitable delivery system. In the current review, we address potential therapeutic applications of Chase with emphasis on the challenges ahead. Then, we summarize the latest achievements to overcome the problems by considering the studies carried out in the field of enzyme engineering, drug delivery, and combination-based therapy.
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Affiliation(s)
- Asma Kheirollahi
- Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Solmaz Sadeghi
- Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shirin Orandi
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kiana Moayedi
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Khosro Khajeh
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran 14115-154, Iran
| | - Mehdi Khoobi
- Department of Radiopharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmaceutical Biomaterials and Medical Biomaterials Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Golestani
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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10
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Evancho A, Tyler WJ, McGregor K. A review of combined neuromodulation and physical therapy interventions for enhanced neurorehabilitation. Front Hum Neurosci 2023; 17:1151218. [PMID: 37545593 PMCID: PMC10400781 DOI: 10.3389/fnhum.2023.1151218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Rehabilitation approaches for individuals with neurologic conditions have increasingly shifted toward promoting neuroplasticity for enhanced recovery and restoration of function. This review focuses on exercise strategies and non-invasive neuromodulation techniques that target neuroplasticity, including transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and peripheral nerve stimulation (PNS). We have chosen to focus on non-invasive neuromodulation techniques due to their greater potential for integration into routine clinical practice. We explore and discuss the application of these interventional strategies in four neurological conditions that are frequently encountered in rehabilitation settings: Parkinson's Disease (PD), Traumatic Brain Injury (TBI), stroke, and Spinal Cord Injury (SCI). Additionally, we discuss the potential benefits of combining non-invasive neuromodulation with rehabilitation, which has shown promise in accelerating recovery. Our review identifies studies that demonstrate enhanced recovery through combined exercise and non-invasive neuromodulation in the selected patient populations. We primarily focus on the motor aspects of rehabilitation, but also briefly address non-motor impacts of these conditions. Additionally, we identify the gaps in current literature and barriers to implementation of combined approaches into clinical practice. We highlight areas needing further research and suggest avenues for future investigation, aiming to enhance the personalization of the unique neuroplastic responses associated with each condition. This review serves as a resource for rehabilitation professionals and researchers seeking a comprehensive understanding of neuroplastic exercise interventions and non-invasive neuromodulation techniques tailored for specific diseases and diagnoses.
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Affiliation(s)
- Alexandra Evancho
- Department of Physical Therapy, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
| | - William J. Tyler
- Department of Biomedical Engineering, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
- Department of Physical Medicine and Rehabilitation, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Keith McGregor
- Department of Clinical and Diagnostic Studies, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, United States
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11
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Chakraborty P, Saha S, Deco G, Banerjee A, Roy D. Structural-and-dynamical similarity predicts compensatory brain areas driving the post-lesion functional recovery mechanism. Cereb Cortex Commun 2023; 4:tgad012. [PMID: 37559936 PMCID: PMC10409568 DOI: 10.1093/texcom/tgad012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 08/11/2023] Open
Abstract
The focal lesion alters the excitation-inhibition (E-I) balance and healthy functional connectivity patterns, which may recover over time. One possible mechanism for the brain to counter the insult is global reshaping functional connectivity alterations. However, the operational principles by which this can be achieved remain unknown. We propose a novel equivalence principle based on structural and dynamic similarity analysis to predict whether specific compensatory areas initiate lost E-I regulation after lesion. We hypothesize that similar structural areas (SSAs) and dynamically similar areas (DSAs) corresponding to a lesioned site are the crucial dynamical units to restore lost homeostatic balance within the surviving cortical brain regions. SSAs and DSAs are independent measures, one based on structural similarity properties measured by Jaccard Index and the other based on post-lesion recovery time. We unravel the relationship between SSA and DSA by simulating a whole brain mean field model deployed on top of a virtually lesioned structural connectome from human neuroimaging data to characterize global brain dynamics and functional connectivity at the level of individual subjects. Our results suggest that wiring proximity and similarity are the 2 major guiding principles of compensation-related utilization of hemisphere in the post-lesion functional connectivity re-organization process.
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Affiliation(s)
- Priyanka Chakraborty
- Cognitive Brain Dynamics Lab, National Brain Research Centre, NH-8, Manesar, Haryana 122051, India
| | - Suman Saha
- Cognitive Brain Dynamics Lab, National Brain Research Centre, NH-8, Manesar, Haryana 122051, India
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de la Recerca i Estudis Avançats, Barcelona, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia
| | - Arpan Banerjee
- Cognitive Brain Dynamics Lab, National Brain Research Centre, NH-8, Manesar, Haryana 122051, India
| | - Dipanjan Roy
- Cognitive Brain Dynamics Lab, National Brain Research Centre, NH-8, Manesar, Haryana 122051, India
- School of AIDE, Center for Brain Research and Applications, IIT Jodhpur, NH-62, Surpura Bypass Rd, Karwar, Rajasthan 342030, India
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12
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Maguire C, Betschart M, Pohl J, Primani F, Taeymans J, Hund-Georgiadis M. Effects of moderate-intensity aerobic exercise on serum BDNF and motor learning in the upper-limb in patients after chronic-stroke: A randomized, controlled feasibility study with embedded health economic evaluation. NeuroRehabilitation 2023; 52:485-506. [PMID: 36806518 DOI: 10.3233/nre-220239] [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: 02/19/2023]
Abstract
BACKGROUND Brain-derived neurotrophic factor (BDNF) promotes activity-dependent neuroplasticity and is released following aerobic-exercise. OBJECTIVE Feasibility and efficacy of 1.Moderate-Intensity Cycle-Ergometer-Training (MI-ET) and 2.Low-Intensity Circuit-Training (LI-CT) on BDNF-serum-concentration in chronic-stroke and consequently efficacy of motor-learning in varying BDNF-concentrations (neuroplasticity being the substrate for motor-learning) via upper-limb robotic-training (RT) in both groups. METHODS Randomised-control feasibility-study. 12-week, 3x/week intervention, 17 chronic-stroke-survivors randomized into: (1) MI-ET&RT or (2) LI-CT&RT. Both groups completed 40 mins MI-ET or LI-CT followed by 40 mins RT. Feasibility outcomes: (1) screening and enrollment-rates, (2) retention-rates, (3) adherence: (i) attendance-rates, (ii) training-duration, (4) adverse events. Primary clinical outcomes: 1. serum-BDNF changes pre-post training (immediate) and pre-training basal-levels over 12-weeks (long-term). 2.upper-limb performance with Action-Research-Arm-Test (ARAT). Additionally, feasibility of an embedded health economic evaluation (HEE) to evaluate health-costs and cost-effectiveness. OUTCOMES cost-questionnaire return-rates, cost-of-illness (COI) and Health-Utitility-Index (HUI). RESULTS 21.5% of eligible and contactable enrolled. 10 randomized to MI-ET and 7 to LI-CT. 85% of training-sessions were completed in MI-ET (306/360) and 76.3% in LI-CT-group (165/216). 12-weeks: Drop-outs MI-ET-10%, LI-CT-43%. CLINICAL OUTCOMES No significant changes in immediate or long-term serum-BDNF in either group. Moderate-intensity aerobic-training did not increase serum-BDNF post-stroke. Individual but no group clinically-relevant changes in ARAT-scores. HEE outcomes at 12-weeks: 100% cost-questionnaires returned. Group-costs baseline and after treatment, consistently favouring MI-ET group. COI: (1-year-time-frame): MI-ET 67382 SD (43107) Swiss-Francs and LI-CT 95701(29473) Swiss-Francs. CONCLUSION The study is feasible with modifications. Future studies should compare high-intensity versus moderate-intensity aerobic-exercise combined with higher dosage arm-training.
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Affiliation(s)
- Clare Maguire
- REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland.,Physiotherapy, Department of Health, Bern University of Applied Science, Bern, Switzerland
| | - Martina Betschart
- REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland.,Physiotherapy, Department of Health, Bern University of Applied Science, Bern, Switzerland.,Kantonal Hospital Winterthur, Winterthur, Switzerland
| | - Johannes Pohl
- Department of Neurology, University Hospital Zurich, Zurich Switzerland
| | - Francesca Primani
- REHAB, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland.,Physiotherapy, Department of Health, Bern University of Applied Science, Bern, Switzerland
| | - Jan Taeymans
- Physiotherapy, Department of Health, Bern University of Applied Science, Bern, Switzerland.,Faculty of Movement and Rehabilitation Sciences, Universiteit Brussel, Brussel, Belgium
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Wang L, Wang Y, Chen Y, Liu B, Chou D, Bian X, Li R, Wang M, Zheng C. Rhynchophylline ameliorates cerebral ischemia by improving the synaptic plasticity in a middle cerebral artery occlusion induced stroke model. Eur J Pharmacol 2023; 940:175390. [PMID: 36400162 DOI: 10.1016/j.ejphar.2022.175390] [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: 08/01/2022] [Revised: 11/01/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Previous studies have documented that rhynchophylline exerts antioxidative and anti-inflammatory effects on ischemic neuronal damage in vitro or in vivo. There is a considerable lack of direct evidence for its role in neural function and neuroplasticity after ischemic stroke. AIMS This study aims to explore the role of rhynchophylline in middle cerebral artery occlusion (MCAO) induced ischemic stroke model and the potential mechanisms. METHODS Mice were randomly divided into the following three groups: Sham, MCAO + ddH2O, and MCAO + Rhy(40 mg/kg by oral gavage) groups. Cerebral ischemia was induced by MCAO. Cerebral blood flow was monitored to indicate the success of the ischemic model. The neurological severity score and a series of related behavior tests were performed(after MCAO 3d,7d,14d,21d,28d). Golgi staining and Sholl analysis were used to evaluate the complexity of dendrites and the density of dendritic spines. Immunohistochemistry was used to detect the expression of synapsin I and NeuN. RESULTS Administration of rhynchophylline for 7 consecutive days after the onset of cerebral ischemia alleviated the sensory-motor functional defects and ameliorated hippocampus-dependent spatial memory injury as well as reduced the infarct volume induced by MCAO. However, golgi staining and sholl analysis showed that rhynchophylline improved dendritic complexity and spine density as well as the synaptic plasticity. Furthermore,the expression of synapsin I and Neun was significantly reduced after cerebral ischemia and rhynchophylline administration ameliorated the loss of synapsin I. CONCLUSION Rhynchophylline is a promising treatment for ischemic stroke via improving synaptic plasticity and ameliorating the sensory-motor function.
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Affiliation(s)
- Lei Wang
- Department of Physiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, China
| | - Yuguang Wang
- Department of Orthopaedics, Characteristic Medical Center of Chinese People's Armed Police Force, China
| | - YuJie Chen
- Department of Physiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, China
| | - Bo Liu
- Department of Physiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, China
| | - Dylan Chou
- Department of Physiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, China
| | - Xingyu Bian
- Department of Physiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, China
| | - Ruoxin Li
- Department of Physiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, China
| | - Mingxiao Wang
- Department of Physiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, China.
| | - Chen Zheng
- Department of Physiology, Zhuhai Campus of Zunyi Medical University, Zhuhai, Guangdong, China.
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14
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Branscheidt M, Hadjiosif AM, Anaya MA, Keller J, Widmer M, Runnalls KD, Luft AR, Bastian AJ, Krakauer JW, Celnik PA. Reinforcement Learning Is Impaired in the Sub-acute Post-stroke Period. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.25.525408. [PMID: 36747674 PMCID: PMC9900808 DOI: 10.1101/2023.01.25.525408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Neurorehabilitation approaches are frequently predicated on motor learning principles. However, much is left to be understood of how different kinds of motor learning are affected by stroke causing hemiparesis. Here we asked if two kinds of motor learning often employed in rehabilitation, (1) reinforcement learning and (2) error-based adaptation, are altered at different times after stroke. Methods In a cross-sectional design, we compared learning in two groups of patients with stroke, matched for their baseline motor execution deficit on the paretic side. The early group was tested within 3 months following stroke (N = 35) and the late group was tested more than 6 months after stroke (N = 30). Two types of task were studied: one based on reinforcement learning and the other on error-based learning. Results We found that reinforcement learning was impaired in the early but not the late group, whereas error-based learning was unaffected compared to controls. These findings could not be attributed to differences in baseline execution, cognitive impairment, gender, age, or lesion volume and location. Conclusions The presence of a specific impairment in reinforcement learning in the first 3 months after stroke has important implications for rehabilitation. It might be necessary to either increase the amount of reinforcement feedback given early or even delay onset of certain forms of rehabilitation training, e.g., like constraint-induced movement therapy, and instead emphasize others forms of motor learning in this early time period. A deeper understanding of stroke-related changes in motor learning capacity has the potential to facilitate the development of new, more precise treatment interventions.
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Affiliation(s)
- Meret Branscheidt
- Cereneo center for rehabilitation and neurology, Weggis, Switzerland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | | | - Manuel A. Anaya
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Jennifer Keller
- Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland
| | - Mario Widmer
- Cereneo center for rehabilitation and neurology, Weggis, Switzerland
- Department of Therapy, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Keith D. Runnalls
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Andreas R Luft
- Cereneo center for rehabilitation and neurology, Weggis, Switzerland
- University Hospital Zurich, Zurich, Switzerland
| | - Amy J. Bastian
- Department of Neuroscience, Johns Hopkins University, Maryland
- Kennedy Krieger Institute, Johns Hopkins University, Baltimore, Maryland
| | - John W. Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
- Department of Neuroscience, Johns Hopkins University, Maryland
- Santa Fe Institute, Santa Fe, New Mexico
| | - Pablo A. Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
- Department of Neuroscience, Johns Hopkins University, Maryland
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15
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Kanishka, Jha SK. Compensatory cognition in neurological diseases and aging: A review of animal and human studies. AGING BRAIN 2023; 3:100061. [PMID: 36911258 PMCID: PMC9997140 DOI: 10.1016/j.nbas.2022.100061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/06/2022] [Accepted: 12/12/2022] [Indexed: 12/27/2022] Open
Abstract
Specialized individual circuits in the brain are recruited for specific functions. Interestingly, multiple neural circuitries continuously compete with each other to acquire the specialized function. However, the dominant among them compete and become the central neural network for that particular function. For example, the hippocampal principal neural circuitries are the dominant networks among many which are involved in learning processes. But, in the event of damage to the principal circuitry, many times, less dominant networks compensate for the primary network. This review highlights the psychopathologies of functional loss and the aspects of functional recuperation in the absence of the hippocampus.
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Affiliation(s)
- Kanishka
- School of Life Sciences, Jawaharlal Nehru University, New Delhi 110067, India
| | - Sushil K Jha
- School of Life Sciences, Jawaharlal Nehru University, New Delhi 110067, India
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16
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Lu Z, Tang H, Li S, Zhu S, Li S, Huang Q. Role of Circulating Exosomes in Cerebrovascular Diseases: A Comprehensive Review. Curr Neuropharmacol 2023; 21:1575-1593. [PMID: 36847232 PMCID: PMC10472809 DOI: 10.2174/1570159x21666230214112408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/04/2022] [Accepted: 11/03/2022] [Indexed: 03/01/2023] Open
Abstract
Exosomes are lipid bilayer vesicles that contain multiple macromolecules secreted by the parent cells and play a vital role in intercellular communication. In recent years, the function of exosomes in cerebrovascular diseases (CVDs) has been intensively studied. Herein, we briefly review the current understanding of exosomes in CVDs. We discuss their role in the pathophysiology of the diseases and the value of the exosomes for clinical applications as biomarkers and potential therapies.
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Affiliation(s)
- Zhiwen Lu
- Department of Neurovascular Centre, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Haishuang Tang
- Department of Nerurosurgery, Naval Medical Center of PLA, Navy Medical University, Shanghai, 200050, China
| | - Sisi Li
- Department of Cerebrovascular Intervention, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200080, China
| | - Shijie Zhu
- Department of Neurovascular Centre, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Siqi Li
- Department of Neurovascular Centre, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
| | - Qinghai Huang
- Department of Neurovascular Centre, Changhai Hospital, Naval Medical University, Shanghai, 200433, China
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17
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Swanson VA, Johnson C, Zondervan DK, Bayus N, McCoy P, Ng YFJ, Schindele, BS J, Reinkensmeyer DJ, Shaw S. Optimized Home Rehabilitation Technology Reduces Upper Extremity Impairment Compared to a Conventional Home Exercise Program: A Randomized, Controlled, Single-Blind Trial in Subacute Stroke. Neurorehabil Neural Repair 2023; 37:53-65. [PMID: 36636751 PMCID: PMC9896541 DOI: 10.1177/15459683221146995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Upper extremity (UE) stroke rehabilitation requires patients to perform exercises at home, yet patients show limited benefit from paper-based home exercise programs. OBJECTIVE To compare the effectiveness of 2 home exercise programs for reducing UE impairment: a paper-based approach and a sensorized exercise system that incorporates recommended design features for home rehabilitation technology. METHODS In this single-blind, randomized controlled trial, 27 participants in the subacute phase of stroke were assigned to the sensorized exercise (n = 14) or conventional therapy group (n = 13), though 2 participants in the conventional therapy group were lost to follow-up. Participants were instructed to perform self-guided movement training at home for at least 3 hours/week for 3 consecutive weeks. The sensorized exercise group used FitMi, a computer game with 2 puck-like sensors that encourages movement intensity and auto-progresses users through 40 exercises. The conventional group used a paper book of exercises. The primary outcome measure was the change in Upper Extremity Fugl-Meyer (UEFM) score from baseline to follow-up. Secondary measures included the Modified Ashworth Scale for spasticity (MAS) and the Visual Analog Pain (VAP) scale. RESULTS Participants who used FitMi improved by an average of 8.0 ± 4.6 points on the UEFM scale compared to 3.0 ± 6.1 points for the conventional participants, a significant difference (t-test, P = .029). FitMi participants exhibited no significant changes in UE MAS or VAP scores. CONCLUSIONS A sensor-based exercise system incorporating a suite of recommended design features significantly and safely reduced UE impairment compared to a paper-based, home exercise program. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03503617.
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Affiliation(s)
- Veronica A. Swanson
- Department of Mechanical and Aerospace
Engineering, Henry Samueli School of Engineering, University of California, Irvine,
Irvine, CA, USA,Veronica A. Swanson, University of
California, Irvine, 3225 Engineering Gateway, Irvine, CA 92697-3975, USA.
| | - Christopher Johnson
- Department of Biomedical Engineering,
Henry Samueli School of Engineering, University of California, Irvine, Irvine, CA,
USA
| | | | - Nicole Bayus
- Rancho Research Institute, Rancho Los
Amigos National Rehabilitation Hospital, Downey, USA
| | - Phylicia McCoy
- Arthur J. Bond Department of Mechanical
Engineering, Alabama A&M University, Huntsville, AL, USA
| | - Yat Fung Joshua Ng
- School of Social Sciences, University
of California, Irvine, Irvine, CA, USA
| | - Jenna Schindele, BS
- Mathematics and Statistics, University
of California, Los Angeles, Los Angeles, CA, USA
| | - David J. Reinkensmeyer
- Department of Mechanical and Aerospace
Engineering, Henry Samueli School of Engineering, University of California, Irvine,
Irvine, CA, USA,Department of Anatomy and Neurobiology,
UC Irvine School of Medicine, University of California, Irvine, Irvine, CA,
USA
| | - Susan Shaw
- Department of Neurology, Rancho Los
Amigos National Rehabilitation Center, Downey, CA, USA
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18
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Cherni Y, Tremblay A, Simon M, Bretheau F, Blanchette AK, Mercier C. Corticospinal Responses Following Gait-Specific Training in Stroke Survivors: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15585. [PMID: 36497663 PMCID: PMC9737604 DOI: 10.3390/ijerph192315585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
Corticospinal excitability is subject to alterations after stroke. While the reversal of these alterations has been proposed as an underlying mechanism for improved walking capacity after gait-specific training, this has not yet been clearly demonstrated. Therefore, the objective of this review is to evaluate the effect of gait-specific training on corticospinal excitability in stroke survivors. We conducted an electronic database search in four databases (i.e., Medline, Embase, CINAHL and Web of Science) in June 2022. Two authors screened in an independent way all the studies and selected those that investigated the effect of gait-specific training on variables such as motor-evoked potential amplitude, motor threshold, map size, latency, and corticospinal silent period in stroke survivors. Nineteen studies investigating the effect of gait-specific training on corticospinal excitability were included. Some studies showed an increased MEP amplitude (7/16 studies), a decreased latency (5/7studies), a decreased motor threshold (4/8 studies), an increased map size (2/3 studies) and a decreased cortical silent period (1/2 study) after gait-specific training. No change has been reported in terms of short interval intracortical inhibition after training. Five studies did not report any significant effect after gait-specific training on corticospinal excitability. The results of this systematic review suggest that gait-specific training modalities can drive neuroplastic adaptation among stroke survivors. However, given the methodological disparity of the included studies, additional clinical trials of better methodological quality are needed to establish conclusions. The results of this review can therefore be used to develop future studies to better understand the effects of gait-specific training on the central nervous system.
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Affiliation(s)
- Yosra Cherni
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
- TOPMED, Centre Collégial de Transfert de Technologie en Orthèses, Prothèses et Équipements Médicaux, Québec City, QC G1S 1C1, Canada
| | - Alexia Tremblay
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Margaux Simon
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Floriane Bretheau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
| | - Andréanne K. Blanchette
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec City, QC G1M 2S8, Canada
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec City, QC G1V 0A6, Canada
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19
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Kuwahara W, Miyawaki Y, Kaneko F. Impact of the Upper Limb Physiotherapy on Behavioral and Brain Adaptations in Post-Stroke Patients. JOURNAL OF ROBOTICS AND MECHATRONICS 2022. [DOI: 10.20965/jrm.2022.p0718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many stroke patients suffer from motor impairments due to paralysis, and consequently, motor paralysis of upper limbs seems to be particularly prone to residual impairment compared to that of lower limbs. Although ‘learned non-use’ that by managing reasonably well using only the unaffected upper limb in their actions, the patients can achieve their desired behavior, and these success experiences strengthen this pattern of behavior can be interpreted as a post-stroke adaptation, physiotherapy may lead to poor recovery of motor impairment. This review article discusses the impact of upper limb physiotherapy after stroke on behavioral/brain adaptations. Our previous studies demonstrated that patients with severe post-stroke sensorimotor impairments in a chronic phase might have abnormal functional connectivity. To prevent such adaptation after stroke, upper limb physiotherapy is important. In rehabilitation practices, hyper-adaptation has been often observed in not only behavioral but also brain changes. Although several studies are reporting clinical efficacy in patients with moderate to mild paralysis, there might be no effective treatment for patients with severe motor paralysis. To overcome these serious problems, we have developed a novel approach, kinesthetic illusion induced by visual stimulation (KINVIS) therapy. We showed that the effects of KINVIS therapy with therapeutic exercise on upper limb motor functions were mediated by spasticity, and functional connectivity in the brain was also changed with the improvement of motor function after KINVIS therapy. Brain changes underlying behavioral changes need to be more examined, and the adaptation of stroke patients needs to be clarified in detail.
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Force acquisition frequency is less impaired compared to grip strength or hand dexterity in individuals with chronic stroke. Exp Brain Res 2022; 240:2513-2521. [DOI: 10.1007/s00221-022-06432-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/27/2022] [Indexed: 11/04/2022]
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Xia Y, Tanaka K, Yang M, Izumi S. Body representation underlies response of proprioceptive acuity to repetitive peripheral magnetic stimulation. Front Hum Neurosci 2022; 16:924123. [PMID: 36016664 PMCID: PMC9395609 DOI: 10.3389/fnhum.2022.924123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Proprioceptive acuity is of great significance in basic research exploring a possible neural mechanism of fine motor control and in neurorehabilitation practice promoting motor function recovery of limb-disabled people. Moreover, body representation relies on the integration of multiple somatic sensations, including proprioception that is mainly generated in muscles and tendons of human joints. This study aimed to examine two hypotheses: First, different extension positions of wrist joint have different proprioceptive acuities, which might indicate different body representations of wrist joint in the brain. Second, repetitive peripheral magnetic stimulation (rPMS) applied peripherally to the forearm radial nerve and extensors could change proprioceptive acuity at the wrist joint. Thirty-five healthy participants were recruited then randomly divided into the real stimulation group (n = 15) and the sham stimulation group (n = 20). The participants’ non-dominant side wrist joint position sense was tested at six extension positions within the physiological joint motion range (i.e., 10°, 20°, 30°, 40°, 50°, 60°) both before stimulation and after stimulation. Results showed that proprioceptive bias (arithmetic difference of target position and replicated position) among six extension positions could be divided into lower-extension position (i.e., 10°, 20°, 30°) and higher-extension position (i.e., 40°, 50°, 60°). One session rPMS could influence proprioceptive bias in lower-extension position but not in higher-extension position. However, proprioceptive precision (standard deviation within lower-extension position and higher-extension position) was not influenced. To conclude, proprioceptive bias may vary between different wrist extension positions due to different hand postures being related to changes in body representation, and different functions relating to proprioceptive bias and proprioceptive precision may underlie two aspects of body representation.
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Affiliation(s)
- Yunxiang Xia
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kento Tanaka
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Man Yang
- Graduate School of Dalian Medical University, Dalian, China
| | - Shinichi Izumi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- *Correspondence: Shinichi Izumi,
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22
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Frost SB, Chen D, Barbay S, Friel KM, Plautz EJ, Nudo RJ. Reorganization of Ventral Premotor Cortex After Ischemic Brain Injury: Effects of Forced Use. Neurorehabil Neural Repair 2022; 36:514-524. [PMID: 35559809 PMCID: PMC9378490 DOI: 10.1177/15459683221101622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Physical use of the affected upper extremity can have a beneficial effect on motor recovery in people after stroke. Few studies have examined neurological mechanisms underlying the effects of forced use in non-human primates. In particular, the ventral premotor cortex (PMV) has been previously implicated in recovery after injury. OBJECTIVE To examine changes in motor maps in PMV after a period of forced use following ischemic infarct in primary motor cortex (M1). METHODS Intracortical microstimulation (ICMS) techniques were used to derive motor maps in PMV of four adult squirrel monkeys before and after an experimentally induced ischemic infarct in the M1 distal forelimb area (DFL) in the dominant hemisphere. Monkeys wore a sleeved jacket (generally 24 hrs/day) that forced limb use contralateral to the infarct in tasks requiring skilled digit use. No specific rehabilitative training was provided. RESULTS At 3 mos post-infarct, ICMS maps revealed a significant expansion of the DFL representation in PMV relative to pre-infarct baseline (mean = +77.3%; n = 3). Regression analysis revealed that the magnitude of PMV changes was largely driven by M1 lesion size, with a modest effect of forced use. One additional monkey examined after ∼18 months of forced use demonstrated a 201.7% increase, unprecedented in non-human primate studies. CONCLUSIONS Functional reorganization in PMV following an ischemic infarct in the M1 DFL is primarily driven by M1 lesion size. Additional expansion occurs in PMV with extremely long periods of forced use but such extended constraint is not considered clinically feasible.
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Affiliation(s)
- Shawn B. Frost
- Dept. Rehabilitation Medicine; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Daofen Chen
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Physical Therapy & Rehabilitation Science; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Scott Barbay
- Dept. Rehabilitation Medicine; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Kathleen M. Friel
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Erik J. Plautz
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
| | - Randolph J. Nudo
- Dept. Rehabilitation Medicine; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Landon Center on Aging; Univ. of Kansas Medical Center, Kansas City, KS 66160
- Dept. of Molecular and Integrative Physiology; Univ. of Kansas Medical Center, Kansas City, KS 66160
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Bice AR, Xiao Q, Kong J, Yan P, Rosenthal ZP, Kraft AW, Smith KP, Wieloch T, Lee JM, Culver JP, Bauer AQ. Homotopic contralesional excitation suppresses spontaneous circuit repair and global network reconnections following ischemic stroke. eLife 2022; 11:e68852. [PMID: 35723585 PMCID: PMC9333991 DOI: 10.7554/elife.68852] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Understanding circuit-level manipulations that affect the brain's capacity for plasticity will inform the design of targeted interventions that enhance recovery after stroke. Following stroke, increased contralesional activity (e.g. use of the unaffected limb) can negatively influence recovery, but it is unknown which specific neural connections exert this influence, and to what extent increased contralesional activity affects systems- and molecular-level biomarkers of recovery. Here, we combine optogenetic photostimulation with optical intrinsic signal imaging to examine how contralesional excitatory activity affects cortical remodeling after stroke in mice. Following photothrombosis of left primary somatosensory forepaw (S1FP) cortex, mice either recovered spontaneously or received chronic optogenetic excitation of right S1FP over the course of 4 weeks. Contralesional excitation suppressed perilesional S1FP remapping and was associated with abnormal patterns of stimulus-evoked activity in the unaffected limb. This maneuver also prevented the restoration of resting-state functional connectivity (RSFC) within the S1FP network, RSFC in several networks functionally distinct from somatomotor regions, and resulted in persistent limb-use asymmetry. In stimulated mice, perilesional tissue exhibited transcriptional changes in several genes relevant for recovery. Our results suggest that contralesional excitation impedes local and global circuit reconnection through suppression of cortical activity and several neuroplasticity-related genes after stroke, and highlight the importance of site selection for targeted therapeutic interventions after focal ischemia.
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Affiliation(s)
- Annie R Bice
- Department of Radiology, Washington University in St. LouisSaint LouisUnited States
| | - Qingli Xiao
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | - Justin Kong
- Department of Biology, Washington University in St. LouisSaint LouisUnited States
| | - Ping Yan
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | | | - Andrew W Kraft
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | - Karen P Smith
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | | | - Jin-Moo Lee
- Department of Neurology, Washington University in St. LouisSaint LouisUnited States
| | - Joseph P Culver
- Department of Radiology, Washington University in St. LouisSt. LouisUnited States
| | - Adam Q Bauer
- Department of Radiology, Washington University in St. LouisSaint LouisUnited States
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Demers M, Varghese R, Winstein C. Retrospective Analysis of Task-Specific Effects on Brain Activity After Stroke: A Pilot Study. Front Hum Neurosci 2022; 16:871239. [PMID: 35721357 PMCID: PMC9201099 DOI: 10.3389/fnhum.2022.871239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEvidence supports cortical reorganization in sensorimotor areas induced by constraint-induced movement therapy (CIMT). However, only a few studies examined the neural plastic changes as a function of task specificity. This retrospective analysis aims to evaluate the functional brain activation changes during a precision and a power grasp task in chronic stroke survivors who received 2-weeks of CIMT compared to a no-treatment control group.MethodsFourteen chronic stroke survivors, randomized to CIMT (n = 8) or non-CIMT (n = 6), underwent functional MRI (fMRI) before and after a 2-week period. Two behavioral measures, the 6-item Wolf Motor Function Test (WMFT-6) and the Motor Activity Log (MAL), and fMRI brain scans were collected before and after a 2-week period. During scan runs, participants performed two different grasp tasks (precision, power). Pre to post changes in laterality index (LI) were compared by group and task for two predetermined motor regions of interest: dorsal premotor cortex (PMd) and primary motor cortex (MI).ResultsIn contrast to the control group, the CIMT group showed significant improvements in the WMFT-6. For the MAL, both groups showed a trend toward greater improvements from baseline. Two weeks of CIMT resulted in a relative increase in activity in a key region of the motor network, PMd of the lesioned hemisphere, under precision grasp task conditions compared to the non-treatment control group. No changes in LI were observed in MI for either task or group.ConclusionThese findings provide preliminary evidence for task-specific effects of CIMT in the promotion of recovery-supportive cortical reorganization in chronic stroke survivors.
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Affiliation(s)
- Marika Demers
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Rini Varghese
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
| | - Carolee Winstein
- Motor Behavior and Neurorehabilitation Laboratory, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- *Correspondence: Carolee Winstein,
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Sousa ASP, Moreira J, Silva C, Mesquita I, Macedo R, Silva A, Santos R. Usability of Functional Electrical Stimulation in Upper Limb Rehabilitation in Post-Stroke Patients: A Narrative Review. SENSORS 2022; 22:s22041409. [PMID: 35214311 PMCID: PMC8963083 DOI: 10.3390/s22041409] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/10/2022]
Abstract
Stroke leads to significant impairment in upper limb (UL) function. The goal of rehabilitation is the reestablishment of pre-stroke motor stroke skills by stimulating neuroplasticity. Among several rehabilitation approaches, functional electrical stimulation (FES) is highlighted in stroke rehabilitation guidelines as a supplementary therapy alongside the standard care modalities. The aim of this study is to present a comprehensive review regarding the usability of FES in post-stroke UL rehabilitation. Specifically, the factors related to UL rehabilitation that should be considered in FES usability, as well a critical review of the outcomes used to assess FES usability, are presented. This review reinforces the FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation by enabling the possibility of delivering intensive periods of treatment with comparatively less demand on human resources. However, the lack of studies evaluating FES usability through motor control outcomes, specifically movement quality indicators, combined with user satisfaction limits the definition of FES optimal therapeutical window for different UL functional tasks. FES systems capable of integrating postural control muscles involving other anatomic regions, such as the trunk, during reaching tasks are required to improve UL function in post-stroke patients.
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Affiliation(s)
- Andreia S. P. Sousa
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
- Correspondence: or ; Tel.: +351-222-061-000
| | - Juliana Moreira
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
| | - Cláudia Silva
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
| | - Inês Mesquita
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Functional Sciences, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
| | - Rui Macedo
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
| | - Augusta Silva
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (J.M.); (C.S.); (R.M.); (A.S.)
| | - Rubim Santos
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physics, School of Health, Polytechnic of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
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Bagnato S. The role of plasticity in the recovery of consciousness. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:375-395. [PMID: 35034750 DOI: 10.1016/b978-0-12-819410-2.00020-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Disorders of consciousness (DOCs), i.e., coma, vegetative state, and minimally conscious state are the consequences of a severe brain injury that disrupts the brain ability to generate consciousness. Recovery from DOCs requires functional and structural changes in the brain. The sites where these plastic changes take place vary according to the pathophysiology of the DOC. The ascending reticular activating system of the brainstem and its complex connections with the thalamus and cortex are involved in the pathophysiology of coma. Subcortical structures, such as the striatum and globus pallidus, together with thalamocortical and corticothalamic projections, the basal forebrain, and several networks among different cortical areas are probably involved in vegetative and minimally conscious states. Some mechanisms of plasticity that allegedly operate in each of these sites to promote recovery of consciousness will be discussed in this chapter. While some mechanisms of plasticity work at a local level, others produce functional changes in complex neuronal networks, for example by entraining neuronal oscillations. The specific mechanisms of brain plasticity represent potential targets for future treatments aiming to restore consciousness in patients with severe DOCs.
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Affiliation(s)
- Sergio Bagnato
- Unit of Neurophysiology and Unit for Severe Acquired Brain Injuries, Rehabilitation Department, Giuseppe Giglio Foundation, Cefalù (PA), Italy.
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27
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Changes in Bihemispheric Structural Connectivity Following Middle Cerebral Artery Infarction. J Pers Med 2022; 12:jpm12010081. [PMID: 35055396 PMCID: PMC8781463 DOI: 10.3390/jpm12010081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 02/01/2023] Open
Abstract
This study investigated the changes in the structural connectivity of the bilateral hemispheres over time following a middle cerebral artery infarction. Eighteen patients in the subacute group and nine patients in the chronic group with mild upper extremity motor impairment (Fugl-Meyer motor assessment score for the upper limb > 43) following middle cerebral artery infarction were retrospectively evaluated in this study. All the patients underwent T1-weighted and diffusion tensor imaging. Tract-based statistical analyses of fractional anisotropy were used to compare the changes in the bilateral structural connectivity with those of age-matched normal controls. The corticospinal tract pathway of the affected hemisphere, corpus callosum, and corona radiata of the unaffected hemisphere had decreased structural connectivity in the subacute group, while the motor association area and anterior corpus callosum in the bilateral frontal lobes had increased structural connectivity in the chronic group. The bilateral hemispheres were influenced even in patients with mild motor impairment following middle cerebral artery infarction, and the structural connectivity of the bilateral hemispheres changed according to the time following the stroke.
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Haire CM, Tremblay L, Vuong V, Patterson KK, Chen JL, Burdette JH, Schaffert N, Thaut MH. Therapeutic Instrumental Music Training and Motor Imagery in Post-Stroke Upper-Extremity Rehabilitation: A Randomized-Controlled Pilot Study. Arch Rehabil Res Clin Transl 2022; 3:100162. [PMID: 34977544 PMCID: PMC8683865 DOI: 10.1016/j.arrct.2021.100162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the potential benefits of 3 therapeutic instrumental music performance (TIMP)-based interventions in rehabilitation of the affected upper-extremity (UE) for adults with chronic poststroke hemiparesis. Design Randomized-controlled pilot study. Setting University research facility. Participants Community-dwelling volunteers (N=30; 16 men, 14 women; age range, 33-76 years; mean age, 55.9 years) began and completed the protocol. All participants had sustained a unilateral stroke more than 6 months before enrollment (mean time poststroke, 66.9 months). Intervention Two baseline assessments, a minimum of 1 week apart; 9 intervention sessions (3 times/week for 3 weeks), in which rhythmically cued, functional arm movements were mapped onto musical instruments; and 1 post-test following the final intervention. Participants were block-randomized to 1 of 3 conditions: group 1 (45 minutes TIMP), group 2 (30 minutes TIMP, 15 minutes metronome-cued motor imagery [TIMP+cMI]), and group 3 (30 minutes TIMP, 15 minutes motor imagery without cues [TIMP+MI]). Assessors and investigators were blinded to group assignment. Main Outcome Measures Fugl-Meyer Upper-Extremity (FM-UE) and Wolf Motor Function Test- Functional Ability Scale (WMFT-FAS). Secondary measures were motor activity log (MAL)–amount of use scale and trunk impairment scale. Results All groups made statistically significant gains on the FM-UE (TIMP, P=.005, r=.63; TIMP+cMI, P=.007, r=.63; TIMP+MI, P=.007, r=.61) and the WMFT-FAS (TIMP, P=.024, r=.53; TIMP+cMI, P=.008, r=.60; TIMP+MI, P=.008, r=.63). Comparing between-group percent change differences, on the FM-UE, TIMP scored significantly higher than TIMP+cMI (P=.032, r=.57), but not TIMP+MI. There were no differences in improvement on WMFT-FAS across conditions. On the MAL, gains were significant for TIMP (P=.030, r=.54) and TIMP+MI (P=.007, r=.63). Conclusion TIMP-based techniques, with and without MI, led to significant improvements in paretic arm control on primary outcomes. Replacing a physical training segment with imagery-based training resulted in similar improvements; however, synchronizing internal and external cues during auditory-cMI may pose additional sensorimotor integration challenges.
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Affiliation(s)
- Catherine M Haire
- Faculty of Music, University of Toronto, Toronto, Ontario, Canada.,Music and Health Science Research Collaboratory, University of Toronto, Toronto, Ontario, Canada
| | - Luc Tremblay
- Faculty of Kinesiology, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Veronica Vuong
- Faculty of Music, University of Toronto, Toronto, Ontario, Canada.,Music and Health Science Research Collaboratory, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kara K Patterson
- Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Joyce L Chen
- Faculty of Kinesiology, University of Toronto, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | - Nina Schaffert
- Department of Movement Science, University of Hamburg, Hamburg, Germany.,BeSB GmbH Sound Engineering Berlin, Berlin, Germany
| | - Michael H Thaut
- Faculty of Music, University of Toronto, Toronto, Ontario, Canada.,Music and Health Science Research Collaboratory, University of Toronto, Toronto, Ontario, Canada.,Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Jitsuki S. [CRMP2 binding compound accelerates functional recovery from central nervous system damage]. Nihon Yakurigaku Zasshi 2022; 157:244-247. [PMID: 35781453 DOI: 10.1254/fpj.22011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Brain injury causes temporary or permanent impairment of brain function due to an accident or circulation disorders. Even after rehabilitation training, there are often persistent functional impairments. Recent advances in our understanding of the repair mechanisms of neural circuits after brain injury have led to the possibility that these mechanisms may offer potential therapeutic targets for drugs that promote functional recovery after brain injury. Neuroplasticity is believed to be important for the recovery process after brain injury in the brain regions associated with injured region for compensation. The effectiveness of drugs for restoring brain function after stroke investigated in a variety of animal models and clinical trials has been focused on drugs that act on the monoamine system to modulate neuroplasticity, as well as other targets such as NMDA receptors and CCR5. Recently, we focused on novel small compound, edonerpic maleate, as a drug which facilitates experience-dependent synaptic delivery of AMPA receptor. We found that edonerpic maleate binds to Collapsin-response mediator protein 2, a downstream molecule of Semaphorin and enhance synaptic plasticity by facilitating synaptic delivery of AMPA receptors, thereby promoting functional recovery in a rehabilitation-dependent manner after brain injury in rodents and non-human primates. Further investigations is needed to seek more appropriate drug targets from both preclinical animal studies and clinical trials, and to translate preclinical results into successful clinical trials.
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Affiliation(s)
- Susumu Jitsuki
- Department of Biochemistry, Mie University Graduate school of Medicine
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30
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Hu S, Wu G, Wu B, Du Z, Zhang Y. Rehabilitative training paired with peripheral stimulation promotes motor recovery after ischemic cerebral stroke. Exp Neurol 2021; 349:113960. [PMID: 34953896 DOI: 10.1016/j.expneurol.2021.113960] [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: 08/03/2021] [Revised: 12/12/2021] [Accepted: 12/18/2021] [Indexed: 12/22/2022]
Abstract
Spontaneous recovery of ischemic stroke is very limited and often results in the loss of motor and sensory function. Till now, rehabilitative training is the most widely accepted therapy to improve long-term outcome. However, its effectiveness is often suboptimal, largely due to a sharp decline of neuroplasticity in adults. In this study, we hypothesized that a combination of proprioceptive stimulation and rehabilitative training will promote neuroplasticity and functional recovery post injury. To test this hypothesis, we first established a photothrombotic stroke model that lesions the hindlimb sensorimotor cortex. Next, we demonstrated that injecting Cre-dependent AAV-retro viruses into the dorsal column of PV-Cre mice achieves specific and efficient targeting of proprioceptors. With chemogenetics, this method enables chronic activation of proprioceptors. We then assessed effects of combinatorial treatment on motor and sensory functional recovery. Our results showed that pairing proprioceptive stimulation with rehabilitative training significantly promoted skilled motor, but not tactile sensory functional recovery. This further led to significant improvement when compared to rehabilitation training or proprioceptor stimulation alone. Mechanistically, combinatorial treatment promoted cortical layer V neuronal mTOR activity and sprouting of corticospinal axon into the area where proprioceptive afferents terminate in the denervated side of the spinal cord. Serving as a proof of principle, our study thus provided novel insights into the application of combining proprioceptive stimulation and rehabilitative training to improve functional recovery of ischemic stroke and other traumatic brain or spinal cord injuries.
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Affiliation(s)
- Shukun Hu
- Department of Neurosurgery, Affiliated Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Gang Wu
- Department of Neurosurgery, Affiliated Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Biwu Wu
- Department of Neurosurgery, Affiliated Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Zhouying Du
- Department of Neurosurgery, Affiliated Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China
| | - Yi Zhang
- Department of Neurosurgery, Affiliated Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China; Neurosurgical Institute of Fudan University, Shanghai, China; Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China.
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Kim B, Schweighofer N, Haldar JP, Leahy RM, Winstein CJ. Corticospinal Tract Microstructure Predicts Distal Arm Motor Improvements in Chronic Stroke. J Neurol Phys Ther 2021; 45:273-281. [PMID: 34269747 PMCID: PMC8460613 DOI: 10.1097/npt.0000000000000363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE The corticospinal tract (CST) is a crucial brain pathway for distal arm and hand motor control. We aimed to determine whether a diffusion tensor imaging (DTI)-derived CST metric predicts distal upper extremity (UE) motor improvements in chronic stroke survivors. METHODS We analyzed clinical and neuroimaging data from a randomized controlled rehabilitation trial. Participants completed clinical assessments and neuroimaging at baseline and clinical assessments 4 months later, postintervention. Using univariate linear regression analysis, we determined the linear relationship between the DTI-derived CST fractional anisotropy asymmetry (FAasym) and the percentage of baseline change in log-transformed average Wolf Motor Function Test time for distal items (ΔlnWMFT-distal_%). The least absolute shrinkage and selection operator (LASSO) linear regressions with cross-validation and bootstrapping were used to determine the relative weighting of CST FAasym, other brain metrics, clinical outcomes, and demographics on distal motor improvement. Logistic regression analyses were performed to test whether the CST FAasym can predict clinically significant UE motor improvement. RESULTS lnWMFT-distal significantly improved at the group level. Baseline CST FAasym explained 26% of the variance in ΔlnWMFT-distal_%. A multivariate LASSO model including baseline CST FAasym, age, and UE Fugl-Meyer explained 39% of the variance in ΔlnWMFT-distal_%. Further, CST FAasym explained more variance in ΔlnWMFT-distal_% than the other significant predictors in the LASSO model. DISCUSSION AND CONCLUSIONS CST microstructure is a significant predictor of improvement in distal UE motor function in the context of an UE rehabilitation trial in chronic stroke survivors with mild-to-moderate motor impairment.Video Abstract available for more insight from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A350).
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Affiliation(s)
- Bokkyu Kim
- Department of Physical Therapy Education, SUNY Upstate Medical University, Syracuse, NY, United States
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
- Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, United States
| | - Justin P. Haldar
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA, United States
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA, United States
| | - Richard M. Leahy
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, CA, United States
- Brain and Creativity Institute, University of Southern California, Los Angeles, CA, United States
| | - Carolee J. Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States
- Department. of Neurology, University of Southern California, Los Angeles, CA, United States
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A cortical injury model in a non-human primate to assess execution of reach and grasp actions: implications for recovery after traumatic brain injury. J Neurosci Methods 2021; 361:109283. [PMID: 34237383 PMCID: PMC9969347 DOI: 10.1016/j.jneumeth.2021.109283] [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: 03/26/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Technological advances in developing experimentally controlled models of traumatic brain injury (TBI) are prevalent in rodent models and these models have proven invaluable in characterizing temporal changes in brain and behavior after trauma. To date no long-term studies in non-human primates (NHPs) have been published using an experimentally controlled impact device to follow behavioral performance over time. NEW METHOD We have employed a controlled cortical impact (CCI) device to create a focal contusion to the hand area in primary motor cortex (M1) of three New World monkeys to characterize changes in reach and grasp function assessed for 3 months after the injury. RESULTS The CCI destroyed most of M1 hand representation reducing grey matter by 9.6 mm3, 12.9 mm3, and 15.5 mm3 and underlying corona radiata by 7.4 mm3, 6.9 mm3, and 5.6 mm3 respectively. Impaired motor function was confined to the hand contralateral to the injury. Gross hand-use was only mildly affected during the first few days of observation after injury while activity requiring skilled use of the hand was impaired over three months. COMPARISON WITH EXISTING METHOD(S) This study is unique in establishing a CCI model of TBI in an NHP resulting in persistent impairments in motor function evident in volitional use of the hand. CONCLUSIONS Establishing an NHP model of TBI is essential to extend current rodent models to the complex neural architecture of the primate brain. Moving forward this model can be used to investigate novel therapeutic interventions to improve or restore impaired motor function after trauma.
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Kim K, Yoo SJ, Kim SY, Lee T, Lim SH, Jang JE, Je M, Moon C, Choi JW. Subthreshold electrical stimulation as a low power electrical treatment for stroke rehabilitation. Sci Rep 2021; 11:14048. [PMID: 34234199 PMCID: PMC8263745 DOI: 10.1038/s41598-021-93354-x] [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: 02/19/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022] Open
Abstract
As a promising future treatment for stroke rehabilitation, researchers have developed direct brain stimulation to manipulate the neural excitability. However, there has been less interest in energy consumption and unexpected side effect caused by electrical stimulation to bring functional recovery for stroke rehabilitation. In this study, we propose an engineering approach with subthreshold electrical stimulation (STES) to bring functional recovery. Here, we show a low level of electrical stimulation boosted causal excitation in connected neurons and strengthened the synaptic weight in a simulation study. We found that STES with motor training enhanced functional recovery after stroke in vivo. STES was shown to induce neural reconstruction, indicated by higher neurite expression in the stimulated regions and correlated changes in behavioral performance and neural spike firing pattern during the rehabilitation process. This will reduce the energy consumption of implantable devices and the side effects caused by stimulating unwanted brain regions.
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Affiliation(s)
- Kyungsoo Kim
- Brain Engineering Convergence Research Center, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Seung-Jun Yoo
- Department of Brain and Cognitive Sciences, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - So Yeon Kim
- Convergence Research Advanced Centre for Olfaction, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea.,Department of Brain and Cognitive Sciences, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Taeju Lee
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Sung-Ho Lim
- Brain Engineering Convergence Research Center, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Jae-Eun Jang
- Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea
| | - Minkyu Je
- Department of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea
| | - Cheil Moon
- Brain Engineering Convergence Research Center, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea. .,Convergence Research Advanced Centre for Olfaction, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea. .,Department of Brain and Cognitive Sciences, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea.
| | - Ji-Woong Choi
- Brain Engineering Convergence Research Center, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea. .,Department of Information and Communication Engineering, Daegu Gyeongbuk Institute of Science and Technology, Daegu, Korea.
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Baronchelli F, Zucchella C, Serrao M, Intiso D, Bartolo M. The Effect of Robotic Assisted Gait Training With Lokomat® on Balance Control After Stroke: Systematic Review and Meta-Analysis. Front Neurol 2021; 12:661815. [PMID: 34295298 PMCID: PMC8289887 DOI: 10.3389/fneur.2021.661815] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/04/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Disturbances of balance control are common after stroke, affecting the quality of gait and increasing the risk of falls. Because balance and gait disorders may persist also in the chronic stage, reducing individual independence and participation, they represent primary goals of neurorehabilitation programs. For this purpose, in recent years, numerous technological devices have been developed, among which one of the most widespread is the Lokomat®, an actuated exoskeleton that guide the patient's limbs, simulating a symmetrical bilateral gait. Preliminary evidence suggests that beyond gait parameters, robotic assisted gait training may also improve balance. Therefore, the aim of this systematic review was to summarize evidence about the effectiveness of Lokomat® in improving balance in stroke patients. Methods: Randomized controlled trials published between January 1989 and August 2020, comparing Lokomat® training to conventional therapy for stroke patients, were retrieved from seven electronic databases. Balance, assessed by means of validated clinical scales, was considered as outcome measure. The Physiotherapy Evidence Database (PEDro) scale was used to evaluate the methodological quality of the studies. The study protocol was registered on PROSPERO (no. CRD42020197531). Results: After the removal of the duplicates, according to the inclusion criteria, 13 studies were selected, involving 445 subacute or chronic stroke patients. Eleven papers contributed to three meta-analyses. Favorable results for recovery of balance in stroke survivors treated with Lokomat® were shown using Timed Up and Go (pooled mean difference = −3.40, 95% CI −4.35 to −2.44; p < 0.00001) and Rivermead Mobility Index as outcome measures (pooled mean difference = 0.40, 95% CI 0.26–0.55; p < 0.00001). Inconclusive results were found when balance was measured by means of the Berg Balance Scale (pooled mean difference = 0.17, 95% CI −0.26 to 0.60; p = 0.44). Conclusions: Overall, most studies have shown beneficial effects of Lokomat® on balance recovery for stroke survivors, at least comparable to conventional physical therapy. However, due to the limited number of studies and their high heterogeneity, further research is needed to draw more solid and definitive conclusions.
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Affiliation(s)
| | | | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Domenico Intiso
- Unit of Neuro-Rehabilitation and Rehabilitation Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Michelangelo Bartolo
- Neurorehabilitation Unit, Department of Rehabilitation, HABILITA Zingonia, Ciserano, Italy
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Progress in Mesenchymal Stem Cell Therapy for Ischemic Stroke. Stem Cells Int 2021; 2021:9923566. [PMID: 34221026 PMCID: PMC8219421 DOI: 10.1155/2021/9923566] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 12/12/2022] Open
Abstract
Ischemic stroke (IS) is a serious cerebrovascular disease with high morbidity and disability worldwide. Despite the great efforts that have been made, the prognosis of patients with IS remains unsatisfactory. Notably, recent studies indicated that mesenchymal stem cell (MSCs) therapy is becoming a novel research hotspot with large potential in treating multiple human diseases including IS. The current article is aimed at reviewing the progress of MSC treatment on IS. The mechanism of MSCs in the treatment of IS involved with immune regulation, neuroprotection, angiogenesis, and neural circuit reconstruction. In addition, nutritional cytokines, mitochondria, and extracellular vesicles (EVs) may be the main mediators of the therapeutic effect of MSCs. Transplantation of MSCs-derived EVs (MSCs-EVs) affords a better neuroprotective against IS when compared with transplantation of MSCs alone. MSC therapy can prolong the treatment time window of ischemic stroke, and early administration within 7 days after stroke may be the best treatment opportunity. The deliver routine consists of intraventricular, intravascular, intranasal, and intraperitoneal. Furthermore, several methods such as hypoxic preconditioning and gene technology could increase the homing and survival ability of MSCs after transplantation. In addition, MSCs combined with some drugs or physical therapy measures also show better neurological improvement. These data supported the notion that MSC therapy might be a promising therapeutic strategy for IS. And the application of new technology will promote MSC therapy of IS.
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Smart Protocols for Physical Therapy of Foot Drop Based on Functional Electrical Stimulation: A Case Study. Healthcare (Basel) 2021; 9:healthcare9050502. [PMID: 33925814 PMCID: PMC8146368 DOI: 10.3390/healthcare9050502] [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: 03/02/2021] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Functional electrical stimulation (FES) is used for treating foot drop by delivering electrical pulses to the anterior tibialis muscle during the swing phase of gait. This treatment requires that a patient can walk, which is mostly possible in the later phases of rehabilitation. In the early phase of recovery, the therapy conventionally consists of stretching exercises, and less commonly of FES delivered cyclically. Nevertheless, both approaches minimize patient engagement, which is inconsistent with recent findings that the full rehabilitation potential could be achieved by an active psycho-physical engagement of the patient during physical therapy. Following this notion, we proposed smart protocols whereby the patient sits and ankle movements are FES-induced by self-control. In six smart protocols, movements of the paretic ankle were governed by the non-paretic ankle with different control strategies, while in the seventh voluntary movements of the paretic ankle were used for stimulation triggering. One stroke survivor in the acute phase of recovery participated in the study. During the therapy, the patient’s voluntary ankle range of motion increased and reached the value of normal gait after 15 sessions. Statistical analysis did not reveal the differences between the protocols in FES-induced movements.
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Rahayu UB, Wibowo S, Setyopranoto I. Neurorestoration: Programme management for post-ischemic stroke patients. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2019.1656870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Umi Budi Rahayu
- Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Surakarta, Indonesia
| | - Samekto Wibowo
- Faculty of Medicine, Universitas Gadjah Mada Yogyakarta, Yogyakarta, Indonesia
| | - Ismail Setyopranoto
- Faculty of Medicine, Universitas Gadjah Mada Yogyakarta, Yogyakarta, Indonesia
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Rahayu UB, Wibowo S, Setyopranoto I, Hibatullah Romli M. Effectiveness of physiotherapy interventions in brain plasticity, balance and functional ability in stroke survivors: A randomized controlled trial. NeuroRehabilitation 2021; 47:463-470. [PMID: 33164953 DOI: 10.3233/nre-203210] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Brain injuries such as strokes cause damage and death of the neuron cells. Physiotherapy interventions help to improve patient's performance and ability. However, this is only theorized but the impact of the physiotherapy intervention on brain plasticity is not known. OBJECTIVE The present study aimed to investigate the effect of physiotherapy interventions on brain neuroplasticity by evaluating the brain plasticity regeneration, balance and functional ability. METHODS A randomized controlled trial was conducted with 64 stroke patients from three hospitals in the Surakarta region, Indonesia. Control groups (n = 32) received conventional physiotherapy and intervention groups (n = 32) received neurorestoration protocol, which both lasted for seven days. Efficacy of the interventions were measured on brain-derived neurotropic factor serum analysis, Berg Balance Scale and Barthel Index, respectively. RESULTS Both groups showed improvements in all parameters but only balance and functional performance had a statistically significant outcome. CONCLUSION Neurorestoration protocol that combined several established physiotherapy interventions was effective in improving balance and functional ability of stroke patients in only a seven days period.
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Affiliation(s)
- Umi Budi Rahayu
- Department of Physiotherapy, Faculty of Health Sciences, Universitas Muhammadiyah, Surakarta, Indonesia
| | - Samekto Wibowo
- Department of Neurology, Faculty of Medicine, Universitas Gadjah Mada Yogyakarta, Indonesia
| | - Ismail Setyopranoto
- Department of Neurology, Faculty of Medicine, Universitas Gadjah Mada Yogyakarta, Indonesia
| | - M Hibatullah Romli
- Department of Nursing & Rehabilitation, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Malaysia
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Jian C, Deng L, Liu H, Yan T, Wang X, Song R. Modulating and restoring inter-muscular coordination in stroke patients using two-dimensional myoelectric computer interface: a cross-sectional and longitudinal study. J Neural Eng 2021; 18. [DOI: 10.1088/1741-2552/abc29a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022]
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O’Brien J, Bracewell RM, Castillo JA. The effects of kinesthetic and visual motor imagery on interjoint coordination in the hemiplegic index finger: an experimental study using the index of temporal coordination. CADERNOS BRASILEIROS DE TERAPIA OCUPACIONAL 2021. [DOI: 10.1590/2526-8910.ctoao2170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Upper limb hemiparesis is a common impairment following stroke and can affect interjoint coordination. Motor imagery training is one treatment strategy. However, motor imagery can use visual or kinesthetic modalities and there has been a lack of research comparing the effectiveness of these modalities when treating the upper limb. The aim of this study was to compare visual and kinesthetic motor imagery in improving interjoint coordination in the hemiparetic index finger. Fifteen stroke survivors with upper limb hemiparesis were allocated to groups using kinesthetic or visual motor imagery, or a control group using guided relaxation. Reaching and grasping movements of the upper limb were captured using optoelectronic motion capture. Interjoint coordination of the hemiparetic index finger was analysed using the index of temporal coordination. No significant differences were found for interjoint coordination following treatment in either condition. Future work should focus on comparing kinesthetic and visual motor imagery in the rehabilitation of more proximal upper limb joints.
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Sousa ASP, Mesquita IA, Costa da Silva CI, Silva A, Macedo R, Imatz-Ojanguren E, Hernandez E, Keller T, Moreira J, Pereira da Fonseca PF, Santos R. Optimal Multifield Functional Electrical Stimulation Parameters for the "Turn on the Light" Task and Related Upper Limb Kinematics Repeatability in Poststroke Subjects. Arch Phys Med Rehabil 2020; 102:1180-1190. [PMID: 33253692 DOI: 10.1016/j.apmr.2020.10.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To characterize the optimal functional electrical stimulation (FES) parameters that assist the turn on the light task (TOTL) on poststroke participants and to analyze the related upper limb (UL) kinematics repeatability. DESIGN Cross-sectional study. SETTING Human movement research center. PARTICIPANTS Poststroke individuals (N=11) with history of a single unilateral stroke that resulted in a motor control dysfunction of the contralesional UL. INTERVENTIONS FES based on surface multifield technology applied to the contralesional wrist and finger extensors during the TOTL. MAIN OUTCOME MEASURES FES outcome metrics (virtual electrodes, stimulation duration, intensity) and kinematic metrics (end-point kinematics [absolute and relative duration, mean and peak velocities, relative instant of peak velocity, index of curvature, number of movement units] and joint kinematics [shoulder, elbow, wrist end position and range of movement]). Outcome measures were assessed 2 times with a 72-hour maximum time interval. CONCLUSION It was possible to establish reliable FES parameters that assisted the TOTL on poststroke participants. These stimulation parameters led to high to very high repeatability in terms of UL kinematics for most of the cases.
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Affiliation(s)
- Andreia S P Sousa
- Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Porto, Portugal.
| | - Inês Albuquerque Mesquita
- Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, Department of Functional Sciences, School of Health, Polytechnic of Porto, Porto, Portugal
| | - Cláudia Isabel Costa da Silva
- Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Porto, Portugal
| | - Augusta Silva
- Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Porto, Portugal
| | - Rui Macedo
- Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Porto, Portugal
| | | | - Erik Hernandez
- TECNALIA, Basque Research and Technology Alliance (BRTA) Spain
| | - Thierry Keller
- TECNALIA, Basque Research and Technology Alliance (BRTA) Spain
| | - Juliana Moreira
- Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health, Polytechnic of Porto, Porto, Portugal
| | | | - Rubim Santos
- Center for Rehabilitation Research - Human Movement System (Re)habilitation Area, Department of Physics, School of Health, Polytechnic of Porto, Porto, Portugal
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Rodgers H, Bosomworth H, Krebs HI, van Wijck F, Howel D, Wilson N, Finch T, Alvarado N, Ternent L, Fernandez-Garcia C, Aird L, Andole S, Cohen DL, Dawson J, Ford GA, Francis R, Hogg S, Hughes N, Price CI, Turner DL, Vale L, Wilkes S, Shaw L. Robot-assisted training compared with an enhanced upper limb therapy programme and with usual care for upper limb functional limitation after stroke: the RATULS three-group RCT. Health Technol Assess 2020; 24:1-232. [PMID: 33140719 PMCID: PMC7682262 DOI: 10.3310/hta24540] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Loss of arm function is common after stroke. Robot-assisted training may improve arm outcomes. OBJECTIVE The objectives were to determine the clinical effectiveness and cost-effectiveness of robot-assisted training, compared with an enhanced upper limb therapy programme and with usual care. DESIGN This was a pragmatic, observer-blind, multicentre randomised controlled trial with embedded health economic and process evaluations. SETTING The trial was set in four NHS trial centres. PARTICIPANTS Patients with moderate or severe upper limb functional limitation, between 1 week and 5 years following first stroke, were recruited. INTERVENTIONS Robot-assisted training using the Massachusetts Institute of Technology-Manus robotic gym system (InMotion commercial version, Interactive Motion Technologies, Inc., Watertown, MA, USA), an enhanced upper limb therapy programme comprising repetitive functional task practice, and usual care. MAIN OUTCOME MEASURES The primary outcome was upper limb functional recovery 'success' (assessed using the Action Research Arm Test) at 3 months. Secondary outcomes at 3 and 6 months were the Action Research Arm Test results, upper limb impairment (measured using the Fugl-Meyer Assessment), activities of daily living (measured using the Barthel Activities of Daily Living Index), quality of life (measured using the Stroke Impact Scale), resource use costs and quality-adjusted life-years. RESULTS A total of 770 participants were randomised (robot-assisted training, n = 257; enhanced upper limb therapy, n = 259; usual care, n = 254). Upper limb functional recovery 'success' was achieved in the robot-assisted training [103/232 (44%)], enhanced upper limb therapy [118/234 (50%)] and usual care groups [85/203 (42%)]. These differences were not statistically significant; the adjusted odds ratios were as follows: robot-assisted training versus usual care, 1.2 (98.33% confidence interval 0.7 to 2.0); enhanced upper limb therapy versus usual care, 1.5 (98.33% confidence interval 0.9 to 2.5); and robot-assisted training versus enhanced upper limb therapy, 0.8 (98.33% confidence interval 0.5 to 1.3). The robot-assisted training group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale) than the usual care group at 3 and 6 months. The enhanced upper limb therapy group had less upper limb impairment (as measured by the Fugl-Meyer Assessment motor subscale), better mobility (as measured by the Stroke Impact Scale mobility domain) and better performance in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the usual care group, at 3 months. The robot-assisted training group performed less well in activities of daily living (as measured by the Stroke Impact Scale activities of daily living domain) than the enhanced upper limb therapy group at 3 months. No other differences were clinically important and statistically significant. Participants found the robot-assisted training and the enhanced upper limb therapy group programmes acceptable. Neither intervention, as provided in this trial, was cost-effective at current National Institute for Health and Care Excellence willingness-to-pay thresholds for a quality-adjusted life-year. CONCLUSIONS Robot-assisted training did not improve upper limb function compared with usual care. Although robot-assisted training improved upper limb impairment, this did not translate into improvements in other outcomes. Enhanced upper limb therapy resulted in potentially important improvements on upper limb impairment, in performance of activities of daily living, and in mobility. Neither intervention was cost-effective. FUTURE WORK Further research is needed to find ways to translate the improvements in upper limb impairment seen with robot-assisted training into improvements in upper limb function and activities of daily living. Innovations to make rehabilitation programmes more cost-effective are required. LIMITATIONS Pragmatic inclusion criteria led to the recruitment of some participants with little prospect of recovery. The attrition rate was higher in the usual care group than in the robot-assisted training or enhanced upper limb therapy groups, and differential attrition is a potential source of bias. Obtaining accurate information about the usual care that participants were receiving was a challenge. TRIAL REGISTRATION Current Controlled Trials ISRCTN69371850. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 54. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Helen Rodgers
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen Bosomworth
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hermano I Krebs
- Mechanical Engineering Department, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Frederike van Wijck
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Nina Wilson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tracy Finch
- Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
| | | | - Laura Ternent
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Lydia Aird
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Sreeman Andole
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - David L Cohen
- London North West University Healthcare NHS Trust, London, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Gary A Ford
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Medical Sciences Division, University of Oxford, Oxford, UK
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard Francis
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Steven Hogg
- Lay investigator (contact Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK)
| | | | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Tyneside, UK
| | - Duncan L Turner
- School of Health, Sport and Bioscience, University of East London, London, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Scott Wilkes
- School of Medicine, University of Sunderland, Sunderland, UK
| | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Polanowska KE. Neuropsychological rehabilitation of acquired, non-progressive cognitive-behavioral disorders in evidence-based clinical recommendations. REHABILITACJA MEDYCZNA 2020. [DOI: 10.5604/01.3001.0014.4134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Neuropsychological rehabilitation is an important area of neurological rehabilitation. Its techniques are studied in terms of effectiveness and subjected to collective analyses in order to identify the best interventions.
Objective: The purpose of the article is to present current clinical recommendations for neuropsychological rehabilitation among adult patients with acquired, non-progressive brain damage usually caused by a stroke or head injury.
Data sources: The recommendations are based on the latest scientific papers containing systematic reviews and meta-analysis of studies on the rehabilitation of patients with cognitive dysfunctions and/or behavioral abnormalities.
Conclusions: To date, the highest recommendation and the status of practice standards in neuropsychological rehabilitation have been achieved by therapeutic techniques of 5 post-stroke disorders (attention deficits, mild memory deficits, left-sided visual neglect, aphasia, global decline in cognitive-behavioral functioning) and 5 post-traumatic disorders (attention deficits, mild memory deficits, mild and moderate executive dysfunctions, abnormalities in social functioning and interpersonal communication, global decline in cognitive-behavioral functioning). These techniques may be used independently or introduced in combination with interventions of a lower recommendation level, classified as practice guidelines or practice options. The use of lower grade recommendations should also be considered in situations where there are no standard techniques for specific forms of disorders. In the case of deficits for which no recommendations have yet been made, further research is necessary. This applies to agnosia, profound memory disorders and amnesia, as well as profound executive dysfunctions.
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Affiliation(s)
- Katarzyna Ewa Polanowska
- Clinical Neuropsychology Laboratory, 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland / Pracownia Neuropsychologii Klinicznej, II Klinika Neurologiczna, Instytut Psychiatrii i Neurologii w Warszawie
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Lubart A, Benbenishty A, Har-Gil H, Laufer H, Gdalyahu A, Assaf Y, Blinder P. Single Cortical Microinfarcts Lead to Widespread Microglia/Macrophage Migration Along the White Matter. Cereb Cortex 2020; 31:248-266. [PMID: 32954425 DOI: 10.1093/cercor/bhaa223] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 05/13/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022] Open
Abstract
Loss of cognitive function with aging is a complex and poorly understood process. Recently, clinical research has linked the occurrence of cortical microinfarcts to cognitive decline. Cortical microinfarcts form following the occlusion of penetrating vessels and are considered to be restricted to the proximity of the occluded vessel. Whether and how such local events propagate and affect remote brain regions remain unknown. To this end, we combined histological analysis and longitudinal diffusion tensor imaging (DTI), following the targeted-photothrombotic occlusion of single cortical penetrating vessels. Occlusions resulted in distant tissue reorganization across the mouse brain. This remodeling co-occurred with the formation of a microglia/macrophage migratory path along subcortical white matter tracts, reaching the contralateral hemisphere through the corpus callosum and leaving a microstructural signature detected by DTI-tractography. CX3CR1-deficient mice exhibited shorter trail lengths, differential remodeling, and only ipsilateral white matter tract changes. We concluded that microinfarcts lead to brain-wide remodeling in a microglial CX3CR1-dependent manner.
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Affiliation(s)
- Alisa Lubart
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Amit Benbenishty
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel.,Biological Regulation Department, The Weizmann Institute of Science, Rehovot, Israel
| | - Hagai Har-Gil
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Hadas Laufer
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Amos Gdalyahu
- Neurobiology, Biochemistry and Biophysics School, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yaniv Assaf
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel.,Neurobiology, Biochemistry and Biophysics School, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Pablo Blinder
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel.,Neurobiology, Biochemistry and Biophysics School, Tel Aviv University, Tel Aviv-Yafo, Israel
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45
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Lewis AF, Myers M, Heiser J, Kolar M, Baird JF, Stewart JC. Test-retest reliability and minimal detectable change of corticospinal tract integrity in chronic stroke. Hum Brain Mapp 2020; 41:2514-2526. [PMID: 32090440 PMCID: PMC7268047 DOI: 10.1002/hbm.24961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/07/2020] [Accepted: 02/11/2020] [Indexed: 02/04/2023] Open
Abstract
Diffusion tensor imaging (DTI) can be used to index white matter integrity of the corticospinal tract (CST) after stroke; however, the psychometric properties of DTI-based measures of white matter integrity are unknown. The purpose of this study was to examine test-retest reliability as determined by intraclass correlation coefficients (ICC) and calculate minimal detectable change (MDC) of DTI-based measures of CST integrity using three different approaches: a Cerebral Peduncle approach, a Probabilistic Tract approach, and a Tract Template approach. Eighteen participants with chronic stroke underwent DTI on the same magnetic resonance imaging scanner 4 days apart. For the Cerebral Peduncle approach, a researcher hand drew masks at the cerebral peduncle. For the Probabilistic Tract approach, tractography was seeded in motor areas of the cortex to the cerebral peduncle. For the Tract Template approach, a standard CST template was transformed into native space. For all approaches, the researcher performing analyses was blind to participant number and day of data collection. All three approaches had good to excellent test-retest reliability for fractional anisotropy (FA; ICCs >0.786). Mean diffusivity, axial diffusivity, and radial diffusivity were less reliable than FA. The ICC values were highest and MDC values were the smallest for the most automated approach (Tract Template), followed by the combined manual/automated approach (Probabilistic Tract) then the manual approach (Cerebral Peduncle). The results of this study may have implications for how DTI-based measures of CST integrity are used to define impairment, predict outcomes, and interpret change after stroke.
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Affiliation(s)
- Allison F. Lewis
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Makenzie Myers
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Jenny Heiser
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Melissa Kolar
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Jessica F. Baird
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
| | - Jill C. Stewart
- Department of Exercise ScienceUniversity of South CarolinaColumbiaSouth Carolina
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46
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Mann J. The medical avatar and its role in neurorehabilitation and neuroplasticity: A review. NeuroRehabilitation 2020; 46:467-482. [PMID: 32508340 DOI: 10.3233/nre-203063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND One of the most interesting emerging medical devices is the medical avatar - a digital representation of the patient that can be used toward myriad ends, the full potential of which remains to be explored. Medical avatars have been instantiated as telemedical tools used to establish a representation of the patient in tele-space, upon which data about the patient's health can be represented and goals and progress can be visually tracked. Manipulation of the medical avatar has also been explored as a means of increasing motivation and inducing neural plasticity. OBJECTIVE The article reviews the literature on body representation, simulation, and action-observation and explores how these components of neurorehabilitation are engaged by an avatar-based self-representation. METHODS Through a review of the literature on body representation, simulation, and action-observation and a review of how these components of neurorehabilitation can be engaged and manipulated with an avatar, the neuroplastic potential of the medical avatar is explored. Literature on the use of the medical avatar for neurorehabilitation is also reviewed. RESULTS This review demonstrates that the medical avatar has vast potentialities in neurorehabilitation and that further research on its use and effect is needed.
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Affiliation(s)
- Jessie Mann
- Virginia Tech Carilion Fralin Biomedical Research Institute, 2 Riverside Cr., Roanoke, VA 24016, USA. Tel.: + 1-201-423-3434; E-mail:
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Tscherpel C, Dern S, Hensel L, Ziemann U, Fink GR, Grefkes C. Brain responsivity provides an individual readout for motor recovery after stroke. Brain 2020; 143:1873-1888. [PMID: 32375172 PMCID: PMC7296846 DOI: 10.1093/brain/awaa127] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/30/2020] [Accepted: 03/01/2020] [Indexed: 12/17/2022] Open
Abstract
Promoting the recovery of motor function and optimizing rehabilitation strategies for stroke patients is closely associated with the challenge of individual prediction. To date, stroke research has identified critical pathophysiological neural underpinnings at the cellular level as well as with regard to network reorganization. However, in order to generate reliable readouts at the level of individual patients and thereby realize translation from bench to bedside, we are still in a need for innovative methods. The combined use of transcranial magnetic stimulation (TMS) and EEG has proven powerful to record both local and network responses at an individual's level. To elucidate the potential of TMS-EEG to assess motor recovery after stroke, we used neuronavigated TMS-EEG over ipsilesional primary motor cortex (M1) in 28 stroke patients in the first days after stroke. Twenty-five of these patients were reassessed after >3 months post-stroke. In the early post-stroke phase (6.7 ± 2.5 days), the TMS-evoked EEG responses featured two markedly different response morphologies upon TMS to ipsilesional M1. In the first group of patients, TMS elicited a differentiated and sustained EEG response with a series of deflections sequentially involving both hemispheres. This response type resembled the patterns of bilateral activation as observed in the healthy comparison group. By contrast, in a subgroup of severely affected patients, TMS evoked a slow and simplified local response. Quantifying the TMS-EEG responses in the time and time-frequency domain revealed that stroke patients exhibited slower and simple responses with higher amplitudes compared to healthy controls. Importantly, these patterns of activity changes after stroke were not only linked to the initial motor deficit, but also to motor recovery after >3 months post-stroke. Thus, the data revealed a substantial impairment of local effects as well as causal interactions within the motor network early after stroke. Additionally, for severely affected patients with absent motor evoked potentials and identical clinical phenotype, TMS-EEG provided differential response patterns indicative of the individual potential for recovery of function. Thereby, TMS-EEG extends the methodological repertoire in stroke research by allowing the assessment of individual response profiles.
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Affiliation(s)
- Caroline Tscherpel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Sebastian Dern
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Lukas Hensel
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Gereon R Fink
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Christian Grefkes
- Medical Faculty, University of Cologne, and Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
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48
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Szelenberger R, Kostka J, Saluk-Bijak J, Miller E. Pharmacological Interventions and Rehabilitation Approach for Enhancing Brain Self-repair and Stroke Recovery. Curr Neuropharmacol 2020; 18:51-64. [PMID: 31362657 PMCID: PMC7327936 DOI: 10.2174/1570159x17666190726104139] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
Neuroplasticity is a natural process occurring in the brain for the entire life. Stroke is the leading cause of long term disability and a huge medical and financial problem throughout the world. Research conducted over the past decade focused mainly on neuroprotection in the acute phase of stroke while very little studies target the chronic stage. Recovery after stroke depends on the ability of our brain to reestablish the structural and functional organization of neurovascular networks. Combining adjuvant therapies and drugs may enhance the repair processes and restore impaired brain functions. Currently, there are some drugs and rehabilitative strategies that can facilitate brain repair and improve clinical effect even years after stroke onset. Moreover, some of the compounds such as citicoline, fluoxetine, niacin, levodopa, etc. are already in clinical use or are being trialed in clinical issues. Many studies are also testing cell therapies; in our review, we focused on studies where cells have been implemented at the early stage of stroke. Next, we discuss pharmaceutical interventions. In this section, we selected methods of cognitive, behavioral, and physical rehabilitation as well as adjuvant interventions for neuroprotection including noninvasive brain stimulation and extremely low-frequency electromagnetic field. The modern rehabilitation represents a new model of physical interventions with the limited therapeutic window up to six months after stroke. However, previous studies suggest that the time window for stroke recovery is much longer than previously thought. This review attempts to present the progress in neuroprotective strategies, both pharmacological and non-pharmacological that can stimulate the endogenous neuroplasticity in post-stroke patients.
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Affiliation(s)
- Rafał Szelenberger
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Joanna Kostka
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
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Sanders Q, Chan V, Augsburger R, Cramer SC, Reinkensmeyer DJ, Do AH. Feasibility of Wearable Sensing for In-Home Finger Rehabilitation Early After Stroke. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1363-1372. [PMID: 32305930 DOI: 10.1109/tnsre.2020.2988177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Wearable grip sensing shows potential for hand rehabilitation, but few studies have studied feasibility early after stroke. Here, we studied a wearable grip sensor integrated with a musical computer game (MusicGlove). Among the stroke patients admitted to a hospital without limiting complications, 13% had adequate hand function for system use. Eleven subjects used MusicGlove at home over three weeks with a goal of nine hours of use. On average they achieved 4.1 ± 3.2 (SD) hours of use and completed 8627 ± 7500 grips, an amount comparable to users in the chronic phase of stroke measured in a previous study. The rank-order usage data were well fit by distributions that arise in machine failure theory. Users operated the game at high success levels, achieving note-hitting success >75% for 84% of the 1061 songs played. They changed game parameters infrequently (31% of songs), but in a way that logically modulated challenge, consistent with the Challenge Point Hypothesis from motor learning. Thus, a therapy based on wearable grip sensing was feasible for home rehabilitation, but only for a fraction of subacute stroke subjects. Subjects made usage decisions consistent with theoretical models of machine failure and motor learning.
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50
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Aswendt M, Pallast N, Wieters F, Baues M, Hoehn M, Fink GR. Lesion Size- and Location-Dependent Recruitment of Contralesional Thalamus and Motor Cortex Facilitates Recovery after Stroke in Mice. Transl Stroke Res 2020; 12:87-97. [PMID: 32166716 PMCID: PMC7803721 DOI: 10.1007/s12975-020-00802-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/06/2020] [Accepted: 03/03/2020] [Indexed: 01/01/2023]
Abstract
Brain lesions caused by cerebral ischemia or hemorrhage lead to a local breakdown of energy homeostasis followed by irreversible cell death and long-term impairment. Importantly, local brain lesions also generate remote functional and structural disturbances, which contribute to the behavioral deficit but also impact the recovery of function. While spontaneous recovery has been associated with endogenous repair mechanisms at the vascular, neural, and immune cell levels, the impact of structural plasticity on sensory-motor dysfunction and recovery thereof remains to be elucidated by longitudinal imaging in a mouse model. Here, we applied behavioral assessments, in vivo fiber tracking, and histological validation in a photothrombotic stroke mouse model. Atlas-based whole-brain structural connectivity analysis and ex vivo histology revealed secondary neurodegeneration in the ipsilesional brain areas, mostly in the dorsal sensorimotor area of the thalamus. Furthermore, we describe for the first time a lesion size-dependent increase in structural connectivity between the contralesional primary motor cortex and thalamus with the ipsilesional cortex. The involvement of the contralesional hemisphere was associated with improved functional recovery relative to lesion size. This study highlights the importance of in vivo fiber tracking and the role of the contralesional hemisphere during spontaneous functional improvement as a potential novel stroke biomarker and therapeutic targets.
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Affiliation(s)
- Markus Aswendt
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany. .,Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany.
| | - Niklas Pallast
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany
| | - Frederique Wieters
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany
| | - Mayan Baues
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany
| | - Mathias Hoehn
- Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany.,Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital Cologne, Kerpener Strasse, 62 50937, Cologne, Germany.,Cognitive Neuroscience, Research Center Juelich, Institute of Neuroscience and Medicine (INM-3), Juelich, Germany
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