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Carey LM. 2023 Sylvia Docker lecture: Ignite your passion, and connect, to make a difference. Aust Occup Ther J 2024; 71:4-17. [PMID: 38234045 DOI: 10.1111/1440-1630.12923] [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: 11/26/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024]
Abstract
Together, we grow our profession of occupational therapy as we engage in understanding and addressing the issues that challenge the people we work with. In this Sylvia Docker Lecture, I will share the collective journeys of myself and other occupational therapists and health professionals who have undertaken (or are currently undertaking) their PhDs and are actively involved in research, to address these challenges. Together, we will explore three themes: understanding the WHY that ignites one's passion; living the journey-the EXPERIENCE; and making a difference-the IMPACT. Stories will be told through the lived experience of those engaged in research as currently enrolled PhD students, emerging researchers, and experienced researchers. These stories will capture the lived experience across individuals, and at different times in the research journey. Stories are summarised and captured using natural language processing. Topics are identified, concept maps visualised, and outputs interpreted in context of related theoretical models. Key topics identified include: the clinical and personal motivators that have ignited the passion in individuals; the value of connecting with others and growing networks; and how one's research has made a difference. The impact of discoveries and outcomes are highlighted, together with the importance of people and networks. Analysis of connections and synthesis over time revealed frequent and strong connections across themes, concepts and topics; with synthesising concepts of passion, networks, knowledge translation, opportunities, supervision and communication emerging and being shaped over time. These collective journeys provide inspiration and pathways to creative careers that have future potential in the growth of the profession of occupational therapy. It is recommended that each occupational therapist take the time to reflect on the 'why' that ignites your passion, your journey and how you can make a difference!
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Affiliation(s)
- Leeanne M Carey
- Department of Community and Clinical Health, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre, Heidelberg, Victoria, Australia
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Sahrizan NSA, Manan HA, Abdul Hamid H, Abdullah JM, Yahya N. Functional Alteration in the Brain Due to Tumour Invasion in Paediatric Patients: A Systematic Review. Cancers (Basel) 2023; 15:cancers15072168. [PMID: 37046828 PMCID: PMC10093754 DOI: 10.3390/cancers15072168] [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: 02/16/2023] [Revised: 03/29/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
Working memory, language and speech abilities, motor skills, and visual abilities are often impaired in children with brain tumours. This is because tumours can invade the brain's functional areas and cause alterations to the neuronal networks. However, it is unclear what the mechanism of tumour invasion is and how various treatments can cause cognitive impairment. Therefore, this study aims to systematically evaluate the effects of tumour invasion on the cognitive, language, motor, and visual abilities of paediatric patients, as well as discuss the alterations and modifications in neuronal networks and anatomy. The electronic database, PubMed, was used to find relevant studies. The studies were systematically reviewed based on the type and location of brain tumours, cognitive assessment, and pre- and post-operative deficits experienced by patients. Sixteen studies were selected based on the inclusion and exclusion criteria following the guidelines from PRISMA. Most studies agree that tumour invasion in the brain causes cognitive dysfunction and alteration in patients. The effects of a tumour on cognition, language, motor, and visual abilities depend on the type of tumour and its location in the brain. The alteration to the neuronal networks is also dependent on the type and location of the tumour. However, the default mode network (DMN) is the most affected network, regardless of the tumour type and location.Furthermore, our findings suggest that different treatment types can also contribute to patients' cognitive function to improve or deteriorate. Deficits that persisted or were acquired after surgery could result from surgical manipulation or the progression of the tumour's growth. Meanwhile, recovery from the deficits indicated that the brain has the ability to recover and reorganise itself.
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Affiliation(s)
- Nur Shaheera Aidilla Sahrizan
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hanani Abdul Manan
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hamzaini Abdul Hamid
- Department of Radiology, Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervency, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Kuala Lumpur 56000, Malaysia
| | - Jafri Malin Abdullah
- Jabatan Neurosains, Pusat Pengajian Sains Perubatan, Jalan Hospital USM, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Brain and Behaviour Cluster, Pusat Pengajian Sains Perubatan, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Department of Neurosciences & Brain Behaviour Cluster, Hospital Universiti Sains Malaysia, Kampus Kesihatan, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
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Lv Q, Zhang J, Pan Y, Liu X, Miao L, Peng J, Song L, Zou Y, Chen X. Somatosensory Deficits After Stroke: Insights From MRI Studies. Front Neurol 2022; 13:891283. [PMID: 35911919 PMCID: PMC9328992 DOI: 10.3389/fneur.2022.891283] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022] Open
Abstract
Somatosensory deficits after stroke are a major health problem, which can impair patients' health status and quality of life. With the developments in human brain mapping techniques, particularly magnetic resonance imaging (MRI), many studies have applied those techniques to unravel neural substrates linked to apoplexy sequelae. Multi-parametric MRI is a vital method for the measurement of stroke and has been applied to diagnose stroke severity, predict outcome and visualize changes in activation patterns during stroke recovery. However, relatively little is known about the somatosensory deficits after stroke and their recovery. This review aims to highlight the utility and importance of MRI techniques in the field of somatosensory deficits and synthesizes corresponding articles to elucidate the mechanisms underlying the occurrence and recovery of somatosensory symptoms. Here, we start by reviewing the anatomic and functional features of the somatosensory system. And then, we provide a discussion of MRI techniques and analysis methods. Meanwhile, we present the application of those techniques and methods in clinical studies, focusing on recent research advances and the potential for clinical translation. Finally, we identify some limitations and open questions of current imaging studies that need to be addressed in future research.
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Affiliation(s)
- Qiuyi Lv
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Junning Zhang
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Yuxing Pan
- Institute of Neuroscience, Chinese Academy of Science, Shanghai, China
| | - Xiaodong Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | | | - Jing Peng
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Lei Song
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yihuai Zou
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Xing Chen
- Department of Neurology and Stroke Center, Dongzhimen Hospital, The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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Inamdar MA, Raghavendra U, Gudigar A, Chakole Y, Hegde A, Menon GR, Barua P, Palmer EE, Cheong KH, Chan WY, Ciaccio EJ, Acharya UR. A Review on Computer Aided Diagnosis of Acute Brain Stroke. SENSORS (BASEL, SWITZERLAND) 2021; 21:8507. [PMID: 34960599 PMCID: PMC8707263 DOI: 10.3390/s21248507] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 01/01/2023]
Abstract
Amongst the most common causes of death globally, stroke is one of top three affecting over 100 million people worldwide annually. There are two classes of stroke, namely ischemic stroke (due to impairment of blood supply, accounting for ~70% of all strokes) and hemorrhagic stroke (due to bleeding), both of which can result, if untreated, in permanently damaged brain tissue. The discovery that the affected brain tissue (i.e., 'ischemic penumbra') can be salvaged from permanent damage and the bourgeoning growth in computer aided diagnosis has led to major advances in stroke management. Abiding to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we have surveyed a total of 177 research papers published between 2010 and 2021 to highlight the current status and challenges faced by computer aided diagnosis (CAD), machine learning (ML) and deep learning (DL) based techniques for CT and MRI as prime modalities for stroke detection and lesion region segmentation. This work concludes by showcasing the current requirement of this domain, the preferred modality, and prospective research areas.
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Affiliation(s)
- Mahesh Anil Inamdar
- Department of Mechatronics, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India;
| | - Udupi Raghavendra
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (Y.C.)
| | - Anjan Gudigar
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (Y.C.)
| | - Yashas Chakole
- Department of Instrumentation and Control Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India; (A.G.); (Y.C.)
| | - Ajay Hegde
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (A.H.); (G.R.M.)
| | - Girish R. Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India; (A.H.); (G.R.M.)
| | - Prabal Barua
- School of Management & Enterprise, University of Southern Queensland, Toowoomba, QLD 4350, Australia;
- Faculty of Engineering and Information Technology, University of Technology, Sydney, NSW 2007, Australia
- Cogninet Brain Team, Cogninet Australia, Sydney, NSW 2010, Australia
| | - Elizabeth Emma Palmer
- School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia;
| | - Kang Hao Cheong
- Science, Mathematics and Technology Cluster, Singapore University of Technology and Design, Singapore 487372, Singapore;
| | - Wai Yee Chan
- Department of Biomedical Imaging, Research Imaging Centre, University of Malaya, Kuala Lumpur 59100, Malaysia;
| | - Edward J. Ciaccio
- Department of Medicine, Columbia University, New York, NY 10032, USA;
| | - U. Rajendra Acharya
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia;
- School of Engineering, Ngee Ann Polytechnic, Singapore 599489, Singapore
- Department of Biomedical Engineering, School of Science and Technology, SUSS University, Singapore 599491, Singapore
- Department of Biomedical Informatics and Medical Engineering, Asia University, Taichung 41354, Taiwan
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Liang X, Koh CL, Yeh CH, Goodin P, Lamp G, Connelly A, Carey LM. Predicting Post-Stroke Somatosensory Function from Resting-State Functional Connectivity: A Feasibility Study. Brain Sci 2021; 11:brainsci11111388. [PMID: 34827387 PMCID: PMC8615819 DOI: 10.3390/brainsci11111388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 12/02/2022] Open
Abstract
Accumulating evidence shows that brain functional deficits may be impacted by damage to remote brain regions. Recent advances in neuroimaging suggest that stroke impairment can be better predicted based on disruption to brain networks rather than from lesion locations or volumes only. Our aim was to explore the feasibility of predicting post-stroke somatosensory function from brain functional connectivity through the application of machine learning techniques. Somatosensory impairment was measured using the Tactile Discrimination Test. Functional connectivity was employed to model the global brain function. Behavioral measures and MRI were collected at the same timepoint. Two machine learning models (linear regression and support vector regression) were chosen to predict somatosensory impairment from disrupted networks. Along with two feature pools (i.e., low-order and high-order functional connectivity, or low-order functional connectivity only) engineered, four predictive models were built and evaluated in the present study. Forty-three chronic stroke survivors participated this study. Results showed that the regression model employing both low-order and high-order functional connectivity can predict outcomes based on correlation coefficient of r = 0.54 (p = 0.0002). A machine learning predictive approach, involving high- and low-order modelling, is feasible for the prediction of residual somatosensory function in stroke patients using functional brain networks.
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Affiliation(s)
- Xiaoyun Liang
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
- Victorian Infant Brain Studies (VIBeS) Group, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Correspondence:
| | - Chia-Lin Koh
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan
| | - Chun-Hung Yeh
- Imaging Division, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-H.Y.); (A.C.)
- Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33305, Taiwan
| | - Peter Goodin
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
| | - Gemma Lamp
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
- Department of Psychology and Counselling, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Alan Connelly
- Imaging Division, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-H.Y.); (A.C.)
| | - Leeanne M. Carey
- Neurorehabilitation and Recovery, Florey Institute of Neuroscience and Mental Health, Melbourne, VIC 3084, Australia; (C.-L.K.); (P.G.); (G.L.); (L.M.C.)
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
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Koh CL, Yeh CH, Liang X, Vidyasagar R, Seitz RJ, Nilsson M, Connelly A, Carey LM. Structural Connectivity Remote From Lesions Correlates With Somatosensory Outcome Poststroke. Stroke 2021; 52:2910-2920. [PMID: 34134504 DOI: 10.1161/strokeaha.120.031520] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Chia-Lin Koh
- Neurorehabilitation and Recovery (C.-L.K., X.L., R.V., R.J.S., L.M.C.), Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health, and Engineering, La Trobe University, Bundoora, Victoria, Australia (C.-L.K., M.N., L.M.C.).,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia (C.-L.K., C.-H.Y., X.L., R.V., M.N., A.C., L.M.C.).,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C.-L.K.)
| | - Chun-Hung Yeh
- Imaging Division (C.-H.Y., A.C.), Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia (C.-L.K., C.-H.Y., X.L., R.V., M.N., A.C., L.M.C.).,Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.-H.Y.).,Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Taoyuan, Taiwan (C.-H.Y.)
| | - Xiaoyun Liang
- Neurorehabilitation and Recovery (C.-L.K., X.L., R.V., R.J.S., L.M.C.), Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia (C.-L.K., C.-H.Y., X.L., R.V., M.N., A.C., L.M.C.).,Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Victoria, Australia (X.L.)
| | - Rishma Vidyasagar
- Neurorehabilitation and Recovery (C.-L.K., X.L., R.V., R.J.S., L.M.C.), Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia (C.-L.K., C.-H.Y., X.L., R.V., M.N., A.C., L.M.C.)
| | - Rüdiger J Seitz
- Neurorehabilitation and Recovery (C.-L.K., X.L., R.V., R.J.S., L.M.C.), Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany (R.J.S.)
| | - Michael Nilsson
- Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health, and Engineering, La Trobe University, Bundoora, Victoria, Australia (C.-L.K., M.N., L.M.C.).,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia (C.-L.K., C.-H.Y., X.L., R.V., M.N., A.C., L.M.C.).,School of Biomedical Sciences and Pharmacy and Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan, NSW, Australia (M.N.)
| | - Alan Connelly
- Imaging Division (C.-H.Y., A.C.), Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia (C.-L.K., C.-H.Y., X.L., R.V., M.N., A.C., L.M.C.)
| | - Leeanne M Carey
- Neurorehabilitation and Recovery (C.-L.K., X.L., R.V., R.J.S., L.M.C.), Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.,Occupational Therapy, School of Allied Health, Human Services and Sport, College of Science, Health, and Engineering, La Trobe University, Bundoora, Victoria, Australia (C.-L.K., M.N., L.M.C.).,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia (C.-L.K., C.-H.Y., X.L., R.V., M.N., A.C., L.M.C.)
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Correlated Resting-State Functional MRI Activity of Frontostriatal, Thalamic, Temporal, and Cerebellar Brain Regions Differentiates Stroke Survivors with High Compared to Low Depressive Symptom Scores. Neural Plast 2019; 2019:2357107. [PMID: 31467520 PMCID: PMC6701282 DOI: 10.1155/2019/2357107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 05/11/2019] [Accepted: 05/29/2019] [Indexed: 01/04/2023] Open
Abstract
Background One in three survivors of stroke experience poststroke depression (PSD). PSD has been linked with poorer recovery of function and cognition, yet our understanding of potential mechanisms is currently limited. Alterations in resting-state functional MRI have been investigated to a limited extent. Fluctuations in low frequency signal are reported, but it is unknown if interactions are present between the level of depressive symptom score and intrinsic brain activity in varying brain regions. Objective To investigate potential interaction effects between whole-brain resting-state activity and depressive symptoms in stroke survivors with low and high levels of depressive symptoms. Methods A cross-sectional analysis of 63 stroke survivors who were assessed at 3 months poststroke for depression, using the Montgomery–Åsberg Depression Rating Scale (MÅDRS-SIGMA), and for brain activity using fMRI. A MÅDRS-SIGMA score of >8 was classified as high depressive symptoms. Fractional amplitude of frequency fluctuations (fALFF) data across three frequency bands (broadband, i.e., ~0.01–0.08; subbands, i.e., slow-5: ~0.01–0.027 Hz, slow-4: 0.027–0.07) was examined. Results Of the 63 stroke survivors, 38 were classified as “low-depressive symptoms” and 25 as “high depressive symptoms.” Six had a past history of depression. We found interaction effects across frequency bands in several brain regions that differentiated the two groups. The broadband analysis revealed interaction effects in the left insula and the left superior temporal lobe. The subband analysis showed contrasting fALFF response between the two groups in the left thalamus, right caudate, and left cerebellum. Across the three frequency bands, we found contrasting fALFF response in areas within the fronto-limbic-thalamic network and cerebellum. Conclusions We provide evidence that fALFF is sensitive to changes in poststroke depressive symptom severity and implicates frontostriatal and cerebellar regions, consistent with previous studies. The use of multiband analysis could be an effective method to examine neural correlates of depression after stroke. The START-PrePARE trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12610000987066.
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Carey L, Walsh A, Adikari A, Goodin P, Alahakoon D, De Silva D, Ong KL, Nilsson M, Boyd L. Finding the Intersection of Neuroplasticity, Stroke Recovery, and Learning: Scope and Contributions to Stroke Rehabilitation. Neural Plast 2019; 2019:5232374. [PMID: 31191637 PMCID: PMC6525913 DOI: 10.1155/2019/5232374] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/04/2019] [Accepted: 03/24/2019] [Indexed: 11/17/2022] Open
Abstract
Aim Neural plastic changes are experience and learning dependent, yet exploiting this knowledge to enhance clinical outcomes after stroke is in its infancy. Our aim was to search the available evidence for the core concepts of neuroplasticity, stroke recovery, and learning; identify links between these concepts; and identify and review the themes that best characterise the intersection of these three concepts. Methods We developed a novel approach to identify the common research topics among the three areas: neuroplasticity, stroke recovery, and learning. A concept map was created a priori, and separate searches were conducted for each concept. The methodology involved three main phases: data collection and filtering, development of a clinical vocabulary, and the development of an automatic clinical text processing engine to aid the process and identify the unique and common topics. The common themes from the intersection of the three concepts were identified. These were then reviewed, with particular reference to the top 30 articles identified as intersecting these concepts. Results The search of the three concepts separately yielded 405,636 publications. Publications were filtered to include only human studies, generating 263,751 publications related to the concepts of neuroplasticity (n = 6,498), stroke recovery (n = 79,060), and learning (n = 178,193). A cluster concept map (network graph) was generated from the results; indicating the concept nodes, strength of link between nodes, and the intersection between all three concepts. We identified 23 common themes (topics) and the top 30 articles that best represent the intersecting themes. A time-linked pattern emerged. Discussion and Conclusions Our novel approach developed for this review allowed the identification of the common themes/topics that intersect the concepts of neuroplasticity, stroke recovery, and learning. These may be synthesised to advance a neuroscience-informed approach to stroke rehabilitation. We also identified gaps in available literature using this approach. These may help guide future targeted research.
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Affiliation(s)
- Leeanne Carey
- Occupational Therapy, School of Allied Health, Human Sciences and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC 3084, Australia
| | - Alistair Walsh
- Occupational Therapy, School of Allied Health, Human Sciences and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC 3084, Australia
| | - Achini Adikari
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Peter Goodin
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg VIC 3084, Australia
- Department of Medicine and Neurology, Melbourne Brain Centre, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Damminda Alahakoon
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Daswin De Silva
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Kok-Leong Ong
- Research Centre for Data Analytics and Cognition, La Trobe University, Bundoora, VIC 3086, Australia
| | - Michael Nilsson
- Occupational Therapy, School of Allied Health, Human Sciences and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Australia
- Faculty of Health and Medicine and Centre for Rehab Innovations, The University of Newcastle, Callaghan NSW 2308, Australia
- LKC School of Medicine, Nanyang Technological University (NTU), 308232, Singapore
| | - Lara Boyd
- Djavad Mowafaghian Centre for Brain Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada V6T 1Z3
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Ten Brink AF, Biesbroek JM, Oort Q, Visser-Meily JMA, Nijboer TCW. Peripersonal and extrapersonal visuospatial neglect in different frames of reference: A brain lesion-symptom mapping study. Behav Brain Res 2018; 356:504-515. [PMID: 29940260 DOI: 10.1016/j.bbr.2018.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/28/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Visuospatial neglect can occur in peripersonal and extrapersonal space. The dorsal visual pathway is hypothesized to be associated with peripersonal, and the ventral pathway with extrapersonal neglect. We aimed to evaluate neural substrates of peripersonal versus extrapersonal neglect, separately for egocentric and allocentric frames of reference. METHODS This was a retrospective study, including stroke patients admitted for inpatient rehabilitation. Approximately 1 month post-stroke onset, computerized cancellation (egocentric) and bisection tasks (egocentric and allocentric) were administered at 30 cm and 120 cm. We collected CT or MRI scans and performed voxel-based lesion-symptom mapping for the cancellation, and subtraction analyses for the line bisection task. RESULTS We included 98 patients for the cancellation and 129 for the bisection analyses. The right parahippocampal gyrus, hippocampus, and thalamus were associated with egocentric peripersonal neglect as measured with cancellation. These areas were also associated with extrapersonal neglect, together with the right superior parietal lobule, angular gyrus, supramarginal gyrus, lateral occipital cortex, planum temporale and superior temporal gyrus. Lesions in the right parietal, temporal and frontal areas were associated with both peripersonal and extrapersonal egocentric neglect as measured with bisection. For allocentric neglect no clear pattern of associated brain regions was observed. DISCUSSION We found right hemispheric anatomical correlates for peripersonal and extrapersonal neglect. However, no brain areas were uniquely associated with peripersonal neglect, meaning we could not conclusively verify the ventral/dorsal hypothesis. Several areas were uniquely associated with egocentric extrapersonal neglect, suggesting that these brain areas can be specifically involved in extrapersonal, but not in peripersonal, attention processes.
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Affiliation(s)
- Antonia F Ten Brink
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - J Matthijs Biesbroek
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Quirien Oort
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Tanja C W Nijboer
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands.
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10
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Alteration and Role of Interhemispheric and Intrahemispheric Connectivity in Motor Network After Stroke. Brain Topogr 2018; 31:708-719. [DOI: 10.1007/s10548-018-0644-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/12/2018] [Indexed: 01/25/2023]
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Altered functional connectivity differs in stroke survivors with impaired touch sensation following left and right hemisphere lesions. NEUROIMAGE-CLINICAL 2018; 18:342-355. [PMID: 29487791 PMCID: PMC5814381 DOI: 10.1016/j.nicl.2018.02.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/18/2018] [Accepted: 02/07/2018] [Indexed: 12/15/2022]
Abstract
One in two survivors experience impairment in touch sensation after stroke. The nature of this impairment is likely associated with changes associated with the functional somatosensory network of the brain; however few studies have examined this. In particular, the impact of lesioned hemisphere has not been investigated. We examined resting state functional connectivity in 28 stroke survivors, 14 with left hemisphere and 14 with right hemisphere lesion, and 14 healthy controls. Contra-lesional hands showed significantly decreased touch discrimination. Whole brain functional connectivity (FC) data was extracted from four seed regions, i.e. primary (S1) and secondary (S2) somatosensory cortices in both hemispheres. Whole brain FC maps and Laterality Indices (LI) were calculated for subgroups. Inter-hemispheric FC was greater in healthy controls compared to the combined stroke cohort from the left S1 seed and bilateral S2 seeds. The left lesion subgroup showed decreased FC, relative to controls, from left ipsi-lesional S1 to contra-lesional S1 and to distributed temporal, occipital and parietal regions. In comparison, the right lesion group showed decreased connectivity from contra-lesional left S1 and bilateral S2 to ipsi-lesional parietal operculum (S2), and to occipital and temporal regions. The right lesion group also showed increased intra-hemispheric FC from ipsi-lesional right S1 to inferior parietal regions compared to controls. In comparison to the left lesion group, those with right lesion showed greater intra-hemispheric connectivity from left S1 to left parietal and occipital regions and from right S1 to right angular and parietal regions. Laterality Indices were significantly greater for stroke subgroups relative to matched controls for contra-lesional S1 (left lesion group) and contra-lesional S2 (both groups). We provide evidence of altered functional connectivity within the somatosensory network, across both hemispheres, and to other networks in stroke survivors with impaired touch sensation. Hemisphere of lesion was associated with different patterns of altered functional connectivity within the somatosensory network and with related function was associated with different patterns of altered functional connectivity within the somatosensory network and with related functional networks. Examined somatosensory resting functional connectivity (RSFC) in left/right lesion stroke patients and/healthy controls. Seed based voxel wise (SB) and laterality index (LI) analyses were used. Left lesion SB results showed decreased RSFC in somatosensory and attention regions vs. controls/right lesion patients. Right lesion patients showed increased RSFC compared to controls and left lesion patients to inferior parietal areas. LI results showed increased laterality in both left and right lesion groups between the somatosensory seeds. This suggests RSFC may differ depending on laterality of lesion damage, with altered connectivity profiles between networks.
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Hakon J, Quattromani MJ, Sjölund C, Tomasevic G, Carey L, Lee JM, Ruscher K, Wieloch T, Bauer AQ. Multisensory stimulation improves functional recovery and resting-state functional connectivity in the mouse brain after stroke. NEUROIMAGE-CLINICAL 2017; 17:717-730. [PMID: 29264113 PMCID: PMC5726755 DOI: 10.1016/j.nicl.2017.11.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/27/2017] [Accepted: 11/23/2017] [Indexed: 10/25/2022]
Abstract
Stroke causes direct structural damage to local brain networks and indirect functional damage to distant brain regions. Neuroplasticity after stroke involves molecular changes within perilesional tissue that can be influenced by regions functionally connected to the site of injury. Spontaneous functional recovery can be enhanced by rehabilitative strategies, which provides experience-driven cell signaling in the brain that enhances plasticity. Functional neuroimaging in humans and rodents has shown that spontaneous recovery of sensorimotor function after stroke is associated with changes in resting-state functional connectivity (RS-FC) within and across brain networks. At the molecular level, GABAergic inhibitory interneurons can modulate brain plasticity in peri-infarct and remote brain regions. Among this cell-type, a decrease in parvalbumin (PV)-immunoreactivity has been associated with improved behavioral outcome. Subjecting rodents to multisensory stimulation through exposure to an enriched environment (EE) enhances brain plasticity and recovery of function after stroke. Yet, how multisensory stimulation relates to RS-FC has not been determined. In this study, we investigated the effect of EE on recovery of RS-FC and behavior in mice after stroke, and if EE-related changes in RS-FC were associated with levels of PV-expressing neurons. Photothrombotic stroke was induced in the sensorimotor cortex. Beginning 2 days after stroke, mice were housed in either standard environment (STD) or EE for 12 days. Housing in EE significantly improved lost tactile-proprioceptive function compared to mice housed in STD environment. RS-FC in the mouse was measured by optical intrinsic signal imaging 14 days after stroke or sham surgery. Stroke induced a marked reduction in RS-FC within several perilesional and remote brain regions. EE partially restored interhemispheric homotopic RS-FC between spared motor regions, particularly posterior secondary motor. Compared to mice housed in STD cages, EE exposure lead to increased RS-FC between posterior secondary motor regions and contralesional posterior parietal and retrosplenial regions. The increased regional RS-FC observed in EE mice after stroke was significantly correlated with decreased PV-immunoreactivity in the contralesional posterior motor region. In conclusion, experimental stroke and subsequent housing in EE induces dynamic changes in RS-FC in the mouse brain. Multisensory stimulation associated with EE enhances RS-FC among distinct brain regions relevant for recovery of sensorimotor function and controlled movements that may involve PV/GABA interneurons. Our results indicate that targeting neural circuitry involving spared motor regions across hemispheres by neuromodulation and multimodal sensory stimulation could improve rehabilitation after stroke.
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Key Words
- EE, enriched environment
- Enriched environment
- GSR, global signal regression
- M1, primary motor cortex
- M2, secondary motor cortex
- M2p, posterior secondary motor cortex
- MSR, multiple signal regression
- NDc, interhemispheric (contralateral) node degree
- NDi, intrahemispheric node degree
- Optical imaging
- PP, posterior parietal cortex
- PV, parvalbumin
- Parvalbumin
- ROI, region of interest
- RS, retrosplenial cortex
- RS-FC, resting-state functional connectivity
- Recovery
- Resting-state functional connectivity
- SFL, somatosensory forelimb cortex
- STD, standard environment
- Stroke
- VIS, visual cortex
- fcOIS, functional connectivity optical intrinsic signal imaging
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Affiliation(s)
- Jakob Hakon
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184 Lund, Sweden.
| | - Miriana Jlenia Quattromani
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184 Lund, Sweden
| | - Carin Sjölund
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184 Lund, Sweden
| | - Gregor Tomasevic
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184 Lund, Sweden; Department of Neurosurgery, University Hospital of Lund, Lund, Sweden
| | - Leeanne Carey
- School of Allied Health, La Trobe University, Melbourne, Vic., Australia; Neurorehabilitation and Recovery Laboratory, Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia
| | - Jin-Moo Lee
- Department of Radiology, Washington University, Saint Louis, MO 63110, USA; Department of Neurology, Washington University, Saint Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University, Saint Louis, MO 63110, USA
| | - Karsten Ruscher
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184 Lund, Sweden
| | - Tadeusz Wieloch
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, BMC A13, 22184 Lund, Sweden
| | - Adam Q Bauer
- Department of Radiology, Washington University, Saint Louis, MO 63110, USA
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Ten Brink AF, Visser-Meily JMA, Schut MJ, Kouwenhoven M, Eijsackers ALH, Nijboer TCW. Prism Adaptation in Rehabilitation? No Additional Effects of Prism Adaptation on Neglect Recovery in the Subacute Phase Poststroke: A Randomized Controlled Trial. Neurorehabil Neural Repair 2017; 31:1017-1028. [DOI: 10.1177/1545968317744277] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Patients with neglect ignore or respond slower to contralesional stimuli. Neglect negatively influences independence in activities of daily living (ADL). Prism adaptation (PA) is one of the most frequently studied treatments, yet there is little evidence regarding positive effects on neglect behavior in ADL. Objective. To assess whether PA in the subacute phase ameliorates neglect in situations of varying complexity. Methods. A total of 70 neglect patients admitted for inpatient stroke rehabilitation received either PA or sham adaptation (SA) for 2 weeks, with full access to standard treatment. There were 7 time-dependent measurements (baseline and 1-4, 6, and 14 weeks after start of treatment). The primary outcome was change of neglect as observed during basic ADL with the Catherine Bergego Scale (CBS). Secondary outcomes were changes in performance on a dynamic multitask (ie, the Mobility Assessment Course [MAC]) and a static paper-and-pencil task (ie, a shape cancellation task [SC]). Results. In all, 34 patients received PA and 35 SA. There were significant time-dependent improvements in performance as measured with the CBS, MAC, and SC (all F > 15.57; P < .001). There was no significant difference in magnitude of improvement between groups on the CBS, MAC, and SC (all F < 2.54; P > .113]. Conclusions. No beneficial effects of PA over SA in the subacute phase poststroke were observed, which was comparable for situations of varying complexity. Heterogeneity of the syndrome, time post–stroke onset, and the content of treatment as usual are discussed. Basic knowledge on subtypes and recovery patterns would aid the development of tailored treatment.
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Affiliation(s)
- Antonia F. Ten Brink
- University Medical Center Utrecht, Netherlands
- De Hoogstraat Rehabilitation, Utrecht, Netherlands
| | | | | | | | | | - Tanja C. W. Nijboer
- University Medical Center Utrecht, Netherlands
- Utrecht University, Netherlands
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Efficient multi-scale 3D CNN with fully connected CRF for accurate brain lesion segmentation. Med Image Anal 2016; 36:61-78. [PMID: 27865153 DOI: 10.1016/j.media.2016.10.004] [Citation(s) in RCA: 1335] [Impact Index Per Article: 166.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/09/2016] [Accepted: 10/12/2016] [Indexed: 12/13/2022]
Abstract
We propose a dual pathway, 11-layers deep, three-dimensional Convolutional Neural Network for the challenging task of brain lesion segmentation. The devised architecture is the result of an in-depth analysis of the limitations of current networks proposed for similar applications. To overcome the computational burden of processing 3D medical scans, we have devised an efficient and effective dense training scheme which joins the processing of adjacent image patches into one pass through the network while automatically adapting to the inherent class imbalance present in the data. Further, we analyze the development of deeper, thus more discriminative 3D CNNs. In order to incorporate both local and larger contextual information, we employ a dual pathway architecture that processes the input images at multiple scales simultaneously. For post-processing of the network's soft segmentation, we use a 3D fully connected Conditional Random Field which effectively removes false positives. Our pipeline is extensively evaluated on three challenging tasks of lesion segmentation in multi-channel MRI patient data with traumatic brain injuries, brain tumours, and ischemic stroke. We improve on the state-of-the-art for all three applications, with top ranking performance on the public benchmarks BRATS 2015 and ISLES 2015. Our method is computationally efficient, which allows its adoption in a variety of research and clinical settings. The source code of our implementation is made publicly available.
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Carey LM, Abbott DF, Lamp G, Puce A, Seitz RJ, Donnan GA. Same Intervention-Different Reorganization: The Impact of Lesion Location on Training-Facilitated Somatosensory Recovery After Stroke. Neurorehabil Neural Repair 2016; 30:988-1000. [PMID: 27325624 DOI: 10.1177/1545968316653836] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The brain may reorganize to optimize stroke recovery. Yet relatively little is known about neural correlates of training-facilitated recovery, particularly after loss of body sensations. OBJECTIVE Our aim was to characterize changes in brain activation following clinically effective touch discrimination training in stroke patients with somatosensory loss after lesions of primary/secondary somatosensory cortices or thalamic/capsular somatosensory regions using functional magnetic resonance imaging (fMRI). METHODS Eleven stroke patients with somatosensory loss, 7 with lesions involving primary (S1) and/or secondary (S2) somatosensory cortex (4 male, 58.7 ± 13.3 years) and 4 with lesions primarily involving somatosensory thalamus and/or capsular/white matter regions (2 male, 58 ± 8.6 years) were studied. Clinical and MRI testing occurred at 6 months poststroke (preintervention), and following 15 sessions of clinically effective touch discrimination training (postintervention). RESULTS Improved touch discrimination of a magnitude similar to previous clinical studies and approaching normal range was found. Patients with thalamic/capsular somatosensory lesions activated preintervention in left ipsilesional supramarginal gyrus, and postintervention in ipsilesional insula and supramarginal gyrus. In contrast, those with S1/S2 lesions did not show common activation preintervention, only deactivation in contralesional superior parietal lobe, including S1, and cingulate cortex postintervention. The S1/S2 group did, however, show significant change over time involving ipsilesional precuneus. This change was greater than for the thalamic/capsular group (P = .012; d = -2.43; CI = -0.67 to -3.76). CONCLUSION Different patterns of change in activation are evident following touch discrimination training with thalamic/capsular lesions compared with S1/S2 cortical somatosensory lesions, despite common training and similar improvement.
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Affiliation(s)
- Leeanne M Carey
- La Trobe University, Bundoora, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - David F Abbott
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gemma Lamp
- La Trobe University, Bundoora, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Aina Puce
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia Indiana University, Bloomington, IN, USA
| | - Rüdiger J Seitz
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia LVR-Klinikum Düsseldorf, Düsseldorf, Germany University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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Nagpal A, Kremer KL, Hamilton-Bruce MA, Kaidonis X, Milton AG, Levi C, Shi S, Carey L, Hillier S, Rose M, Zacest A, Takhar P, Koblar SA. TOOTH (The Open study Of dental pulp stem cell Therapy in Humans): Study protocol for evaluating safety and feasibility of autologous human adult dental pulp stem cell therapy in patients with chronic disability after stroke. Int J Stroke 2016; 11:575-85. [PMID: 27030504 DOI: 10.1177/1747493016641111] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 12/11/2015] [Indexed: 12/24/2022]
Abstract
RATIONALE Stroke represents a significant global disease burden. As of 2015, there is no chemical or biological therapy proven to actively enhance neurological recovery during the chronic phase post-stroke. Globally, cell-based therapy in stroke is at the stage of clinical translation and may improve neurological function through various mechanisms such as neural replacement, neuroprotection, angiogenesis, immuno-modulation, and neuroplasticity. Preclinical evidence in a rodent model of middle cerebral artery ischemic stroke as reported in four independent studies indicates improvement in neurobehavioral function with adult human dental pulp stem cell therapy. Human adult dental pulp stem cells present an exciting potential therapeutic option for improving post-stroke disability. AIMS TOOTH (The Open study Of dental pulp stem cell Therapy in Humans) will investigate the use of autologous stem cell therapy for stroke survivors with chronic disability, with the following objectives: (a) determine the maximum tolerable dose of autologous dental pulp stem cell therapy; (b) define that dental pulp stem cell therapy at the maximum tolerable dose is safe and feasible in chronic stroke; and (c) estimate the parameters of efficacy required to design a future Phase 2/3 clinical trial. METHODS AND DESIGN TOOTH is a Phase 1, open-label, single-blinded clinical trial with a pragmatic design that comprises three stages: Stage 1 will involve the selection of 27 participants with middle cerebral artery ischemic stroke and the commencement of autologous dental pulp stem cell isolation, growth, and testing in sequential cohorts (n = 3). Stage 2 will involve the transplantation of dental pulp stem cell in each cohort of participants with an ascending dose and subsequent observation for a 6-month period for any dental pulp stem cell-related adverse events. Stage 3 will investigate the neurosurgical intervention of the maximum tolerable dose of autologous dental pulp stem cell followed by 9 weeks of intensive task-specific rehabilitation. Advanced magnetic resonance and positron emission tomography neuro-imaging, and clinical assessment will be employed to probe any change afforded by stem cell therapy in combination with rehabilitation. SAMPLE SIZE ESTIMATES Nine participants will step-wise progress in Stage 2 to a dose of up to 10 million dental pulp stem cell, employing a cumulative 3 + 3 statistical design with low starting stem cell dose and subsequent dose escalation, assuming that an acceptable probability of dose-limiting complications is between 1 in 6 (17%) and 1 in 3 (33%) of patients. In Stage 3, another 18 participants will receive an intracranial injection with the maximum tolerable dose of dental pulp stem cell. OUTCOMES The primary outcomes to be measured are safety and feasibility of intracranial administration of autologous human adult DPSC in patients with chronic stroke and determination of the maximum tolerable dose in human subjects. Secondary outcomes include estimation of the measures of effectiveness required to design a future Phase 2/3 clinical trial.
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Affiliation(s)
- Anjali Nagpal
- School of Medicine, The University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Karlea L Kremer
- School of Medicine, The University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Monica A Hamilton-Bruce
- Neurology Department, The Queen Elizabeth Hospital, Woodville, South Australia School of Medicine, University of Adelaide, Adelaide, South Australia
| | - Xenia Kaidonis
- School of Medicine, The University of Adelaide, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Austin G Milton
- Neurology Department, The Queen Elizabeth Hospital, Woodville, South Australia
| | - Christopher Levi
- Hunter Medical Research Institute, University of Newcastle, New South Wales, Australia
| | - Songtao Shi
- School of Dental Medicine, University of Pennsylvania, Philadelphia, USA
| | - Leeanne Carey
- Neurorehabilitation and Recovery research group, Stroke Division, Florey Institute of Neuroscience and Mental Health La Trobe University, Melbourne, Victoria, Australia School of Allied Health, La Trobe University, Melbourne, Australia
| | - Susan Hillier
- Health Sciences Divisional Office School of Health Sciences, University of South Australia, Adelaide, South Australia
| | - Miranda Rose
- School of Allied Health, La Trobe University, Melbourne, Australia
| | - Andrew Zacest
- Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia
| | - Parabjit Takhar
- Molecular Imaging and Therapy Research Unit, South Australian Health and Medical Research Institute, Adelaide, South Australia
| | - Simon A Koblar
- School of Medicine, University of Adelaide, Adelaide, South Australia SAHMRI & Basil Hetzel Institute, The Queen Elizabeth Hospital, Woodville, South Australia
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Bannister LC, Crewther SG, Gavrilescu M, Carey LM. Improvement in Touch Sensation after Stroke is Associated with Resting Functional Connectivity Changes. Front Neurol 2015; 6:165. [PMID: 26284024 PMCID: PMC4521505 DOI: 10.3389/fneur.2015.00165] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/07/2015] [Indexed: 12/24/2022] Open
Abstract
Background Distributed brain networks are known to be involved in facilitating behavioral improvement after stroke, yet few, if any, studies have investigated the relationship between improved touch sensation after stroke and changes in functional brain connectivity. Objective We aimed to identify how recovery of somatosensory function in the first 6 months after stroke was associated with functional network changes as measured using resting-state connectivity analysis of functional magnetic resonance imaging (fMRI) data. Methods Ten stroke survivors underwent clinical testing and resting-state fMRI scans at 1 and 6 months post-stroke. Ten age-matched healthy participants were included as controls. Results Patients demonstrated a wide range of severity of touch impairment 1 month post-stroke, followed by variable improvement over time. In the stroke group, significantly stronger interhemispheric functional correlations between regions of the somatosensory system, and with visual and frontal areas, were found at 6 months than at 1 month post-stroke. Clinical improvement in touch discrimination was associated with stronger correlations at 6 months between contralesional secondary somatosensory cortex (SII) and inferior parietal cortex and middle temporal gyrus, and between contralesional thalamus and cerebellum. Conclusion The strength of connectivity between somatosensory regions and distributed brain networks, including vision and attention networks, may change over time in stroke survivors with impaired touch discrimination. Connectivity changes from contralesional SII and contralesional thalamus are associated with improved touch sensation at 6 months post-stroke. These functional connectivity changes could represent future targets for therapy.
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Affiliation(s)
- Louise C Bannister
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health , Melbourne, VIC , Australia ; School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University , Melbourne, VIC , Australia ; Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University , Melbourne, VIC , Australia
| | - Sheila G Crewther
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University , Melbourne, VIC , Australia
| | - Maria Gavrilescu
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health , Melbourne, VIC , Australia ; Defence Science and Technology Organisation , Melbourne, VIC , Australia
| | - Leeanne M Carey
- Neurorehabilitation and Recovery, Stroke Division, Florey Institute of Neuroscience and Mental Health , Melbourne, VIC , Australia ; Occupational Therapy, School of Allied Health, College of Science, Health and Engineering, La Trobe University , Melbourne, VIC , Australia ; Florey Department of Neuroscience and Mental Health, The University of Melbourne , Melbourne, VIC , Australia
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Hubbard IJ, Carey LM, Budd TW, Levi C, McElduff P, Hudson S, Bateman G, Parsons MW. A Randomized Controlled Trial of the Effect of Early Upper-Limb Training on Stroke Recovery and Brain Activation. Neurorehabil Neural Repair 2014; 29:703-13. [DOI: 10.1177/1545968314562647] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Upper-limb (UL) dysfunction is experienced by up to 75% of patients poststroke. The greatest potential for functional improvement is in the first month. Following reperfusion, evidence indicates that neuroplasticity is the mechanism that supports this recovery. Objective. This preliminary study hypothesized increased activation of putative motor areas in those receiving intensive, task-specific UL training in the first month poststroke compared with those receiving standard care. Methods. This was a single-blinded, longitudinal, randomized controlled trial in adult patients with an acute, first-ever ischemic stroke; 23 participants were randomized to standard care (n = 12) or an additional 30 hours of task-specific UL training in the first month poststroke beginning week 1. Patients were assessed at 1 week, 1 month, and 3 months poststroke. The primary outcome was change in brain activation as measured by functional magnetic resonance imaging. Results. When compared with the standard-care group, the intensive-training group had increased brain activation in the anterior cingulate and ipsilesional supplementary motor areas and a greater reduction in the extent of activation ( P = .02) in the contralesional cerebellum. Intensive training was associated with a smaller deviation from mean recovery at 1 month (Pr>F0 = 0.017) and 3 months (Pr>F = 0.006), indicating more consistent and predictable improvement in motor outcomes. Conclusion. Early, more-intensive, UL training was associated with greater changes in activation in putative motor (supplementary motor area and cerebellum) and attention (anterior cingulate) regions, providing support for the role of these regions and functions in early recovery poststroke.
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Affiliation(s)
| | | | | | - Christopher Levi
- University of Newcastle, NSW, Australia
- Hunter New England Local Health District, Newcastle, NSW, Australia
| | | | - Steven Hudson
- Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Grant Bateman
- Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Mark W. Parsons
- University of Newcastle, NSW, Australia
- Hunter New England Local Health District, Newcastle, NSW, Australia
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Hubbard IJ, Carey LM, Budd TW, Parsons MW. Reorganizing therapy: changing the clinical approach to upper limb recovery post-stroke. Occup Ther Int 2014; 22:28-35. [PMID: 25327458 DOI: 10.1002/oti.1381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 08/14/2014] [Accepted: 09/05/2014] [Indexed: 11/06/2022] Open
Abstract
Stroke is the leading cause of adult disability, and as a consequence, most therapists will provide health care to patients with stroke during their professional careers. An increasing number of studies are investigating the association between upper limb recovery and changes in brain activation patterns following stroke. In this review, we explore the translational implications of this research for health professionals working in stroke recovery. We argue that in light of the most recent evidence, therapists should consider how best to take full advantage of the brain's natural ability to reorganize, when prescribing and applying interventions to those with a stroke-affected upper limb. The authors propose that stroke is a brain-based problem that needs a brain-based solution. This review addresses two topics, anticipating recovery and maximizing recovery. It proposes five practice-ready recommendations that are based on the evidence reviewed. The over-riding aim of this review and discussion is to challenge therapists to reconsider the health care they prescribe and apply to people with a stroke-affected upper limb.
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Affiliation(s)
- Isobel J Hubbard
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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Lesion segmentation from multimodal MRI using random forest following ischemic stroke. Neuroimage 2014; 98:324-35. [DOI: 10.1016/j.neuroimage.2014.04.056] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 03/26/2014] [Accepted: 04/21/2014] [Indexed: 11/17/2022] Open
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Nijboer TCW, Kollen BJ, Kwakkel G. The impact of recovery of visuo-spatial neglect on motor recovery of the upper paretic limb after stroke. PLoS One 2014; 9:e100584. [PMID: 24950224 PMCID: PMC4065089 DOI: 10.1371/journal.pone.0100584] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 05/28/2014] [Indexed: 11/18/2022] Open
Abstract
The aim of the current study was to investigate the longitudinal relationship between improvements of synergism and strength of the upper paretic limb and severity of visuo-spatial neglect during the first 52 weeks post-stroke. The longitudinal association between severity of VSN and motor impairment using Fugl Meyer motor score and Motricity Index of the arm was measured in an intensive repeated measurement design including 18 measurement sessions for each subject. Neglect was assessed using the letter cancellation test applied in a prospective cohort of 101 ischemic, first-ever, hemispheric stroke patients. All time-dependent measures were taken weekly, starting within 14 days post-stroke. From week 10 to 20 biweekly measurements are obtained. The longitudinal relationship of (bi)weekly time on improvement of motor functions and severity of neglect was investigated using random coefficient analysis and trend analyses. Fifty-one of the 101 stroke patients showed neglect at stroke onset. Less improvement of synergism and strength of the upper paretic limb was associated with more severe neglect. This association was most pronounced in the first 10 weeks post-stroke. The seemingly suppressive effect of neglect on upper-limb motor recovery appears to take place mainly during spontaneous neurological recovery of first 10 weeks post-stroke. This finding suggests that damage to large-scale white matter tracts of especially the perceptual-attention networks suppress recovery of other networks at distance in the brain suggesting a common underlying mechanism.
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Affiliation(s)
- Tanja C. W. Nijboer
- Utrecht University, Experimental Psychology, Utrecht, the Netherlands
- Rudolf Magnus Institute of Neuroscience and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and de Hoogstraat Rehabilitation Center, Utrecht, the Netherlands
- * E-mail:
| | - Boudewijn J. Kollen
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Gert Kwakkel
- VU University Medical Center, Department of Rehabilitation Medicine, Research Institute MOVE, Amsterdam, the Netherlands
- Department of Neurorehabilitation, Centre of Rehabilitation and and Rheumatology READE, Amsterdam, the Netherlands
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Palmer S, Carey LM. Biologically reliable white matter fiber tractography: issues and solutions. FUTURE NEUROLOGY 2013. [DOI: 10.2217/fnl.13.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Evaluation of: Farquharson S, Tournier JD, Calamante F et al. White matter fiber tractography: why we need to move beyond DTI. J. Neurosurg. 118, 1367–1377 (2013). This study reports on the limitations of diffusion tensor imaging (DTI) to generate fiber orientations and white matter fiber pathways, and the practical consequences for neurosurgical assessment. DTI and constrained spherical deconvolution, a higher-order method for generating fiber orientations that addresses the issue of crossing fibers, were systematically applied to the diffusion-weighted data from 45 healthy controls and ten patients undergoing presurgical imaging assessment. A comparison of the two methods indicated that DTI substantially underestimates the extent of the corticospinal tracts leading to the sensorimotor cortices. In the clinical cases, where tractography is used to assess the risk of neurological deficit from surgery, constrained spherical deconvolution and DTI demonstrated very different apparent safety margins of resection. It is argued that DTI, the most widely used clinical tractography method, provides systematically unreliable and clinically misleading information. The higher-order tractography model, constrained spherical deconvolution, provides a reasonable solution to these problems within a clinically feasible timeframe.
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Affiliation(s)
- Susan Palmer
- Neurorehabilitation & Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne Brain Centre – Austin Campus, 245 Burgundy Street, Heidelberg, Victoria 3084, Australia
| | - Leeanne M Carey
- Department of Occupational Therapy, LaTrobe University, Bundoora, Australia
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