1
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Kancheva I, van der Salm SMA, Ramsey NF, Vansteensel MJ. Association between lesion location and sensorimotor rhythms in stroke - a systematic review with narrative synthesis. Neurol Sci 2023; 44:4263-4289. [PMID: 37606742 PMCID: PMC10641054 DOI: 10.1007/s10072-023-06982-8] [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: 11/02/2022] [Accepted: 07/26/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Stroke causes alterations in the sensorimotor rhythms (SMRs) of the brain. However, little is known about the influence of lesion location on the SMRs. Understanding this relationship is relevant for the use of SMRs in assistive and rehabilitative therapies, such as Brain-Computer Interfaces (BCIs).. METHODS We reviewed current evidence on the association between stroke lesion location and SMRs through systematically searching PubMed and Embase and generated a narrative synthesis of findings. RESULTS We included 12 articles reporting on 161 patients. In resting-state studies, cortical and pontine damage were related to an overall decrease in alpha (∼8-12 Hz) and increase in delta (∼1-4 Hz) power. In movement paradigm studies, attenuated alpha and beta (∼15-25 Hz) event-related desynchronization (ERD) was shown in stroke patients during (attempted) paretic hand movement, compared to controls. Stronger reductions in alpha and beta ERD in the ipsilesional, compared to contralesional hemisphere, were observed for cortical lesions. Subcortical stroke was found to affect bilateral ERD and ERS, but results were highly variable. CONCLUSIONS Findings suggest a link between stroke lesion location and SMR alterations, but heterogeneity across studies and limited lesion location descriptions precluded a meta-analysis. SIGNIFICANCE Future research would benefit from more uniformly defined outcome measures, homogeneous methodologies, and improved lesion location reporting.
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Affiliation(s)
- Ivana Kancheva
- UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, P.O. Box 85060, 3508 AB, Utrecht, The Netherlands
| | - Sandra M A van der Salm
- UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, P.O. Box 85060, 3508 AB, Utrecht, The Netherlands
| | - Nick F Ramsey
- UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, P.O. Box 85060, 3508 AB, Utrecht, The Netherlands
| | - Mariska J Vansteensel
- UMC Utrecht Brain Center, Department of Neurology & Neurosurgery, University Medical Center Utrecht, P.O. Box 85060, 3508 AB, Utrecht, The Netherlands.
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2
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Kurkin S, Gordleeva S, Savosenkov A, Grigorev N, Smirnov N, Grubov VV, Udoratina A, Maksimenko V, Kazantsev V, Hramov AE. Transcranial Magnetic Stimulation of the Dorsolateral Prefrontal Cortex Increases Posterior Theta Rhythm and Reduces Latency of Motor Imagery. SENSORS (BASEL, SWITZERLAND) 2023; 23:4661. [PMID: 37430576 DOI: 10.3390/s23104661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 07/12/2023]
Abstract
Experiments show activation of the left dorsolateral prefrontal cortex (DLPFC) in motor imagery (MI) tasks, but its functional role requires further investigation. Here, we address this issue by applying repetitive transcranial magnetic stimulation (rTMS) to the left DLPFC and evaluating its effect on brain activity and the latency of MI response. This is a randomized, sham-controlled EEG study. Participants were randomly assigned to receive sham (15 subjects) or real high-frequency rTMS (15 subjects). We performed EEG sensor-level, source-level, and connectivity analyses to evaluate the rTMS effects. We revealed that excitatory stimulation of the left DLPFC increases theta-band power in the right precuneus (PrecuneusR) via the functional connectivity between them. The precuneus theta-band power negatively correlates with the latency of the MI response, so the rTMS speeds up the responses in 50% of participants. We suppose that posterior theta-band power reflects attention modulation of sensory processing; therefore, high power may indicate attentive processing and cause faster responses.
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Affiliation(s)
- Semen Kurkin
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
| | - Susanna Gordleeva
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Andrey Savosenkov
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Nikita Grigorev
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Nikita Smirnov
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
| | - Vadim V Grubov
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
| | - Anna Udoratina
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Vladimir Maksimenko
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Victor Kazantsev
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
| | - Alexander E Hramov
- Baltic Center for Neurotechnology and Artificial Intelligence, Immanuel Kant Baltic Federal University, 236016 Kaliningrad, Russia
- Neurodynamics and Cognitive Technology Laboratory, Lobachevsky State University of Nizhny Novgorod, 603105 Nizhniy Novgorod, Russia
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3
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Martel M, Glover S. TMS over dorsolateral prefrontal cortex affects the timing of motor imagery but not overt action: Further support for the motor-cognitive model. Behav Brain Res 2023; 437:114125. [PMID: 36167217 DOI: 10.1016/j.bbr.2022.114125] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/08/2022] [Accepted: 09/23/2022] [Indexed: 11/27/2022]
Abstract
The Motor-Cognitive model suggests a functional dissociation between motor imagery and overt action, in contrast to the Functional Equivalence view of common processes between the two behaviours. According to the Motor-Cognitive model, motor imagery differs from overt action primarily through the use of executive resources to monitor and elaborate a motor image during execution, which can result in a lack of correspondence between motor imagery and its overt action counterpart. The present study examined the importance of executive resources in motor imagery by using TMS to impair the function of the dorsolateral prefrontal cortex while measuring the time to complete imagined versus overt actions. In two experiments, TMS over the dorsolateral prefrontal cortex slowed motor imagery but did not affect overt actions. TMS over the same region also interfered with performance of a mental calculation task, though it did not reliably affect less demanding cognitive tasks also thought to rely on executive functions. Taken together, these results were consistent with the Motor-Cognitive model but not with the idea of functional equivalence. The implications of these results for the theoretical understanding of motor imagery, and potential applications of the Motor-Cognitive model to the use of motor imagery in training and rehabilitation, are discussed.
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Affiliation(s)
- Marie Martel
- Department of Psychology, Royal Holloway University of London, UK.
| | - Scott Glover
- Department of Psychology, Royal Holloway University of London, UK
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4
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Stewart JC, Baird JF, Lewis AF, Fritz SL, Fridriksson J. Effect of behavioral practice targeted at the motor action selection network after stroke. Eur J Neurosci 2022; 56:4469-4485. [PMID: 35781898 PMCID: PMC9380182 DOI: 10.1111/ejn.15754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 06/11/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Abstract
Motor action selection engages a network of frontal and parietal brain regions. After stroke, individuals activate a similar network, however, activation is higher, especially in the contralesional hemisphere. The current study examined the effect of practice on action selection performance and brain activation after stroke. Sixteen individuals with chronic stroke (Upper Extremity Fugl-Meyer motor score range: 18-61) moved a joystick with the more-impaired hand in two conditions: Select (externally cued choice; move right or left based on an abstract rule) and Execute (simple response; move same direction every trial). On Day 1, reaction time (RT) was longer in Select compared to Execute which corresponded to increased activation primarily in regions in the contralesional action selection network including dorsal premotor, supplementary motor, anterior cingulate and parietal cortices. After four days of practice, behavioral performance improved (decreased RT) and only contralesional parietal cortex significantly increased during Select. Higher brain activation on Day 1 in the bilateral action selection network, dorsolateral prefrontal cortex, and contralesional sensory cortex predicted better performance on Day 4. Overall, practice led to improved action selection performance and reduced brain activation. Systematic changes in practice conditions may allow the targeting of specific components of the motor network during rehabilitation after stroke.
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Affiliation(s)
- Jill Campbell Stewart
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Jessica F Baird
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Allison F Lewis
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Stacy L Fritz
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Julius Fridriksson
- Department of Communication Sciences & Disorders, University of South Carolina, Columbia, South Carolina
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5
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Li X, Wang L, Miao S, Yue Z, Tang Z, Su L, Zheng Y, Wu X, Wang S, Wang J, Dou Z. Sensorimotor Rhythm-Brain Computer Interface With Audio-Cue, Motor Observation and Multisensory Feedback for Upper-Limb Stroke Rehabilitation: A Controlled Study. Front Neurosci 2022; 16:808830. [PMID: 35360158 PMCID: PMC8962957 DOI: 10.3389/fnins.2022.808830] [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: 11/04/2021] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Abstract
Several studies have shown the positive clinical effect of brain computer interface (BCI) training for stroke rehabilitation. This study investigated the efficacy of the sensorimotor rhythm (SMR)-based BCI with audio-cue, motor observation and multisensory feedback for post-stroke rehabilitation. Furthermore, we discussed the interaction between training intensity and training duration in BCI training. Twenty-four stroke patients with severe upper limb (UL) motor deficits were randomly assigned to two groups: 2-week SMR-BCI training combined with conventional treatment (BCI Group, BG, n = 12) and 2-week conventional treatment without SMR-BCI intervention (Control Group, CG, n = 12). Motor function was measured using clinical measurement scales, including Fugl-Meyer Assessment-Upper Extremities (FMA-UE; primary outcome measure), Wolf Motor Functional Test (WMFT), and Modified Barthel Index (MBI), at baseline (Week 0), post-intervention (Week 2), and follow-up week (Week 4). EEG data from patients allocated to the BG was recorded at Week 0 and Week 2 and quantified by mu suppression means event-related desynchronization (ERD) in mu rhythm (8–12 Hz). All functional assessment scores (FMA-UE, WMFT, and MBI) significantly improved at Week 2 for both groups (p < 0.05). The BG had significantly higher FMA-UE and WMFT improvement at Week 4 compared to the CG. The mu suppression of bilateral hemisphere both had a positive trend with the motor function scores at Week 2. This study proposes a new effective SMR-BCI system and demonstrates that the SMR-BCI training with audio-cue, motor observation and multisensory feedback, together with conventional therapy may promote long-lasting UL motor improvement. Clinical Trial Registration: [http://www.chictr.org.cn], identifier [ChiCTR2000041119].
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Affiliation(s)
- Xin Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lu Wang
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Si Miao
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zan Yue
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Zhiming Tang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liujie Su
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yadan Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiangzhen Wu
- Department of Rehabilitation Medicine, Shenzhen Hengsheng Hospital, Shenzhen, China
| | - Shan Wang
- Air Force Medical Center, PLA, Beijing, China
- *Correspondence: Shan Wang,
| | - Jing Wang
- Institute of Robotics and Intelligent Systems, School of Mechanical Engineering, Xi’an Jiaotong University, Xi’an, China
- Jing Wang,
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Zulin Dou,
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6
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Hu M, Cheng HJ, Ji F, Chong JSX, Lu Z, Huang W, Ang KK, Phua KS, Chuang KH, Jiang X, Chew E, Guan C, Zhou JH. Brain Functional Changes in Stroke Following Rehabilitation Using Brain-Computer Interface-Assisted Motor Imagery With and Without tDCS: A Pilot Study. Front Hum Neurosci 2021; 15:692304. [PMID: 34335210 PMCID: PMC8322606 DOI: 10.3389/fnhum.2021.692304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been proven effective in post-stroke motor function enhancement, yet whether the combination of MI-BCI and tDCS may further benefit the rehabilitation of motor functions remains unknown. This study investigated brain functional activity and connectivity changes after a 2 week MI-BCI and tDCS combined intervention in 19 chronic subcortical stroke patients. Patients were randomized into MI-BCI with tDCS group and MI-BCI only group who underwent 10 sessions of 20 min real or sham tDCS followed by 1 h MI-BCI training with robotic feedback. We derived amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) from resting-state functional magnetic resonance imaging (fMRI) data pre- and post-intervention. At baseline, stroke patients had lower ALFF in the ipsilesional somatomotor network (SMN), lower ReHo in the contralesional insula, and higher ALFF/Reho in the bilateral posterior default mode network (DMN) compared to age-matched healthy controls. After the intervention, the MI-BCI only group showed increased ALFF in contralesional SMN and decreased ALFF/Reho in the posterior DMN. In contrast, no post-intervention changes were detected in the MI-BCI + tDCS group. Furthermore, higher increases in ALFF/ReHo/FC measures were related to better motor function recovery (measured by the Fugl-Meyer Assessment scores) in the MI-BCI group while the opposite association was detected in the MI-BCI + tDCS group. Taken together, our findings suggest that brain functional re-normalization and network-specific compensation were found in the MI-BCI only group but not in the MI-BCI + tDCS group although both groups gained significant motor function improvement post-intervention with no group difference. MI-BCI and tDCS may exert differential or even opposing impact on brain functional reorganization during post-stroke motor rehabilitation; therefore, the integration of the two strategies requires further refinement to improve efficacy and effectiveness.
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Affiliation(s)
- Mengjiao Hu
- NTU Institute for Health Technologies, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore, Singapore.,Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsiao-Ju Cheng
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Fang Ji
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joanna Su Xian Chong
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhongkang Lu
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Kai Keng Ang
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore.,School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Kok Soon Phua
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Kai-Hsiang Chuang
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, Singapore, Singapore.,Queensland Brain Institute and Centre for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - Xudong Jiang
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Effie Chew
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Cuntai Guan
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Juan Helen Zhou
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore.,Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore
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7
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Wu J, Dodakian L, See J, Burke Quinlan E, Meng L, Abraham J, Wong EC, Le V, McKenzie A, Cramer SC. Gains Across WHO Dimensions of Function After Robot-Based Therapy in Stroke Subjects. Neurorehabil Neural Repair 2020; 34:1150-1158. [PMID: 33084499 DOI: 10.1177/1545968320956648] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies examining the effects of therapeutic interventions after stroke often focus on changes in loss of body function/structure (impairment). However, improvements in activities limitations and participation restriction are often higher patient priorities, and the relationship that these measures have with loss of body function/structure is unclear. OBJECTIVE This study measured gains across WHO International Classification of Function (ICF) dimensions and examined their interrelationships. METHODS Subjects were recruited 11 to 26 weeks after hemiparetic stroke. Over a 3-week period, subjects received 12 sessions of intensive robot-based therapy targeting the distal arm. Each subject was assessed at baseline and at 1 month after end of therapy. RESULTS At baseline, subjects (n = 40) were 134.7 ± 32.4 (mean ± SD) days poststroke and had moderate-severe arm motor deficits (arm motor Fugl-Meyer score of 35.6 ± 14.4) that were stable. Subjects averaged 2579 thumb movements and 1298 wrist movements per treatment session. After robot therapy, there was significant improvement in measures of body function/structure (Fugl-Meyer score) and activity limitations (Action Research Arm Test, Barthel Index, and Stroke Impact Scale-Hand), but not participation restriction (Stroke Specific Quality of Life Scale). Furthermore, while the degree of improvement in loss of body function/structure was correlated with improvement in activity limitations, neither improvement in loss of body function/structure nor improvement in activity limitations was correlated with change in participation restriction. CONCLUSIONS After a 3-week course of robotic therapy, there was improvement in body function/structure and activity limitations but no reduction in participation restriction.
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Affiliation(s)
- Jennifer Wu
- University of California, Irvine, Orange, CA, USA
| | | | - Jill See
- University of California, Irvine, Orange, CA, USA
| | - Erin Burke Quinlan
- University of California, Irvine, Orange, CA, USA.,Institute of Psychiatry, Psychology, & Neuroscience and King's College London, London, England, UK
| | - Lisa Meng
- University of California, Irvine, Orange, CA, USA
| | - Jeby Abraham
- University of California, Irvine, Orange, CA, USA.,Tripler Army Medical Center, Honolulu, HI, USA
| | - Ellen C Wong
- University of California, Los Angeles, and California Rehabilitation Institute, Los Angeles, CA, USA
| | - Vu Le
- University of California, Irvine, Orange, CA, USA
| | | | - Steven C Cramer
- University of California, Irvine, Orange, CA, USA.,University of California, Los Angeles, and California Rehabilitation Institute, Los Angeles, CA, USA
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8
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Stewart JC, Handlery K, Baird JF, Blanck EL, Pathak G, Fritz SL. Targeted Engagement of the Action Selection Network during Task-Oriented Arm Training after Stroke. Neural Plast 2020; 2020:8814158. [PMID: 33029117 PMCID: PMC7530513 DOI: 10.1155/2020/8814158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/07/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022] Open
Abstract
Action selection (AS), or selection of an action from a set of alternatives, is an important movement preparation process that engages a frontal-parietal network. The addition of AS demands to arm training after stroke could be used to engage this motor planning process and the neural network that supports it. The purpose of this case series is to describe the feasibility and outcomes associated with task-oriented arm training aimed at engaging the AS behavioral process and the related neural network in three individuals with chronic stroke. Three participants with mild to moderate motor deficits completed 13 to 15 sessions of task-oriented arm training that included AS cues for each movement repetition; cues dictated movement direction, height, or distance. Before and after training, individuals completed an AS brain-behavior probe during functional MRI. AS behavioral performance improved after training (increased accuracy, decreased reaction time) in all participants while brain activation in the AS network (dorsal premotor, parietal, dorsolateral prefrontal cortices) decreased in two participants. Gains in motor function were also found in all three participants, especially on patient-reported measures of perceived difficulty and confidence to complete upper extremity functional tasks. It was feasible to target the AS behavioral process and the related neural network through the addition of AS demands to functional, task-oriented arm training in three individuals with mild to moderate motor dysfunction poststroke.
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Affiliation(s)
- Jill Campbell Stewart
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly Street, Room 301D, SC, 29208 Columbia, USA
| | - Kaci Handlery
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly Street, Room 301D, SC, 29208 Columbia, USA
| | - Jessica F. Baird
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Erika L. Blanck
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC 29208, USA
| | - Geetanjali Pathak
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Stacy L. Fritz
- Physical Therapy Program, Department of Exercise Science, University of South Carolina, 921 Assembly Street, Room 301D, SC, 29208 Columbia, USA
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9
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Wang X, Wang H, Xiong X, Sun C, Zhu B, Xu Y, Fan M, Tong S, Sun L, Guo X. Motor Imagery Training After Stroke Increases Slow-5 Oscillations and Functional Connectivity in the Ipsilesional Inferior Parietal Lobule. Neurorehabil Neural Repair 2020; 34:321-332. [PMID: 32102610 DOI: 10.1177/1545968319899919] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Reorganization in motor areas have been suggested after motor imagery training (MIT). However, motor imagery involves a large-scale brain network, in which many regions, andnot only the motor areas, potentially constitute the neural substrate for MIT. Objective. This study aimed to identify the targets for MIT in stroke rehabilitation from a voxel-based whole brain analysis of resting-state functional magnetic resonance imaging (fMRI). Methods. Thirty-four chronic stroke patients were recruited and randomly assigned to either an MIT group or a control group. The MIT group received a 4-week treatment of MIT plus conventional rehabilitation therapy (CRT), whereas the control group only received CRT. Before and after intervention, the Fugl-Meyer Assessment Upper Limb subscale (FM-UL) and resting-state fMRI were collected. The fractional amplitude of low-frequency fluctuations (fALFF) in the slow-5 band (0.01-0.027 Hz) was calculated across the whole brain to identify brain areas with distinct changes between 2 groups. These brain areas were then targeted as seeds to perform seed-based functional connectivity (FC) analysis. Results. In comparison with the control group, the MIT group exhibited more improvements in FM-UL and increased slow-5 fALFF in the ipsilesional inferior parietal lobule (IPL). The change of the slow-5 oscillations in the ipsilesional IPL was positively correlated with the improvement of FM-UL. The MIT group also showed distinct alternations in FCs of the ipsilesional IPL, which were correlated with the improvement of FM-UL. Conclusions. The rehabilitation efficiency of MIT was associated with increased slow-5 oscillations and altered FC in the ipsilesional IPL. Clinical Trial Registration. http://www.chictr.org.cn . Unique Identifier. ChiCTR-TRC-08003005.
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Affiliation(s)
- Xu Wang
- Shanghai Jiaotong University, Shanghai, China
| | - Hewei Wang
- Huashan Hospital Fudan University, Shanghai, China
| | - Xin Xiong
- Shanghai Jiaotong University, Shanghai, China
| | - Changhui Sun
- Huashan North Hospital Fudan University, Shanghai, China
| | - Bing Zhu
- Huashan Hospital Fudan University, Shanghai, China
| | - Yiming Xu
- Huashan Hospital Fudan University, Shanghai, China
| | - Mingxia Fan
- East China Normal University, Shanghai, China
| | | | - Limin Sun
- Huashan Hospital Fudan University, Shanghai, China
| | - Xiaoli Guo
- Shanghai Jiaotong University, Shanghai, China
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10
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Santoro S, Lo Buono V, Corallo F, Cartella E, Micchia K, Palmeri R, Arcadi FA, Bramanti A, Marino S. Motor imagery in stroke patients: a descriptive review on a multidimensional ability. Int J Neurosci 2019; 129:821-832. [DOI: 10.1080/00207454.2019.1567509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Simona Santoro
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Department of Neurobioimaging, Messina, Italy
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Department of Neurobioimaging, Messina, Italy
| | - Francesco Corallo
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Department of Neurobioimaging, Messina, Italy
| | - Emanuele Cartella
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Department of Neurobioimaging, Messina, Italy
| | - Katia Micchia
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Department of Neurobioimaging, Messina, Italy
| | - Rosanna Palmeri
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Department of Neurobioimaging, Messina, Italy
| | | | - Alessia Bramanti
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Department of Neurobioimaging, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Department of Neurobioimaging, Messina, Italy
- Department of Biomedical and Dental Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
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11
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Schulz R, Runge CG, Bönstrup M, Cheng B, Gerloff C, Thomalla G, Hummel FC. Prefrontal-Premotor Pathways and Motor Output in Well-Recovered Stroke Patients. Front Neurol 2019; 10:105. [PMID: 30837935 PMCID: PMC6382735 DOI: 10.3389/fneur.2019.00105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022] Open
Abstract
Structural brain imaging has continuously furthered our knowledge how different pathways of the human motor system contribute to residual motor output in stroke patients. Tract-related microstructure of pathways between primary and premotor areas has been found to critically influence motor output. The motor network is not restricted in connectivity to motor and premotor areas but these brain regions are densely interconnected with prefrontal regions such as the dorsolateral (DLPFC) and ventrolateral (VLPFC) prefrontal cortex. So far, the available data about the topography of such direct pathways and their microstructural properties in humans are sparse. To what extent prefrontal-premotor connections might also relate to residual motor outcome after stroke is still an open question. The present study was designed to address this issue of structural connectivity of prefrontal-premotor pathways in 26 healthy, older participants (66 ± 10 years old, 15 male) and 30 well-recovered chronic stroke patients (64 ± 10 years old, 21 males). Probabilistic tractography was used to reconstruct direct fiber tracts between DLPFC and VLPFC and three premotor areas (dorsal and ventral premotor cortex and the supplementary motor area). Direct connections between DLPFC/VLPFC and the primary motor cortex were also tested. Tract-related microstructure was estimated for each specific tract by means of fractional anisotropy and alternative diffusion metrics. These measures were compared between the groups and related to residual motor outcome in the stroke patients. Direct prefrontal-premotor trajectories were successfully traceable in both groups. Similar in gross anatomic topography, stroke patients presented only marginal microstructural alterations of these tracts, predominantly of the affected hemisphere. However, there was no clear evidence for a significant association between tract-related microstructure of prefrontal-premotor connections and residual motor functions in the present group of well-recovered stroke patients. Direct prefrontal-motor connections between DLPFC/VLPFC and the primary motor cortex could not be reconstructed in the present healthy participants and stroke patients.
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Affiliation(s)
- Robert Schulz
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Clemens G Runge
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Marlene Bönstrup
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Human Cortical Physiology and Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Bastian Cheng
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland.,Defitech Chair of Clinical Neuroengineering, Clinique Romande de Réadaptation, Center for Neuroprosthetics and Brain Mind Institute, Swiss Federal Institute of Technology Valais (EPFL Valais), Sion, Switzerland.,Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
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12
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Hu M, Ji F, Lu Z, Huang W, Khosrowabadi R, Zhao L, Ang KK, Phua KS, Nasrallah FA, Chuang KH, Stephenson MC, Totman J, Jiang X, Chew E, Guan C, Zhou J. Differential Amplitude of Low-Frequency Fluctuations in brain networks after BCI Training with and without tDCS in Stroke. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1050-1053. [PMID: 30440571 DOI: 10.1109/embc.2018.8512395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Mapping the brain alterations post stroke and post intervention is important for rehabilitation therapy development. Previous work has shown changes in functional connectivity based on resting-state fMRI, structural connectivity derived from diffusion MRI and perfusion as a result of brain-computer interface-assisted motor imagery (MI-BCI) and transcranial direct current stimulation (tDCS) in upper-limb stroke rehabilitation. Besides functional connectivity, regional amplitude of local low-frequency fluctuations (ALFF) may provide complementary information on the underlying neural mechanism in disease. Yet, findings on spontaneous brain activity during resting-state in stroke patients after intervention are limited and inconsistent. Here, we sought to investigate the different brain alteration patterns induced by tDCS compared to MI-BCI for upper-limb rehabilitation in chronic stroke patients using resting-state fMRI-based ALFF method. Our results suggested that stroke patients have lower ALFF in the ipsilesional somatomotor network compared to controls at baseline. Increased ALFF at contralesional somatomotor network and alterations in higher-level cognitive networks such as the default mode network (DMN) and salience networks accompany motor recovery after intervention; though the MI-BCI alone group and MI-BCI combined with tDCS group exhibit differential patterns.
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13
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van Dokkum LEH, le Bars E, Mottet D, Bonafé A, Menjot de Champfleur N, Laffont I. Modified Brain Activations of the Nondamaged Hemisphere During Ipsilesional Upper-Limb Movement in Persons With Initial Severe Motor Deficits Poststroke. Neurorehabil Neural Repair 2017; 32:34-45. [PMID: 29276841 DOI: 10.1177/1545968317746783] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poststroke, the ipsilesional upper limb shows slight but substantial and long-term motor deficits. OBJECTIVE To define brain activation patterns during a gross motor flexion/extension task of the ipsilesional elbow early poststroke before and after rehabilitation, in relation to the corresponding kinematic characteristics at each time point. METHOD Simultaneous analysis of kinematic features (amplitude, frequency, smoothness, and trajectory of movement) and of corresponding functional magnetic resonance imaging activations (block-design). A total of 21 persons with subacute initial severe stroke (Fugl-Meyer score <30/66) participated twice: within the first 2 months poststroke (V0) and after 6 weeks of rehabilitation (V1). Results at both time points were compared with activation patterns and kinematics of 13 healthy controls. RESULTS Compared with controls ( a) movements of the ipsilesional upper-limb poststroke were smaller (V0 + V1) and less smooth (V0 + V1) and ( b) participants poststroke showed additional recruitment of the contralesional middle temporal gyrus (V0) and rolandic opercularis involved in movement visualization (V0 + V1), whereas they lacked activation of the supramarginal gyrus (V0 + V1). Over time, participants poststroke showed an extended activation of the contralesional sensorimotor cortex at V0. CONCLUSION Movements of the ipsilesional upper limb within an initially severe stroke group were not only atypical in motor outcome, but seemed to be controlled differently. Together the observed changes pointed toward an overall disturbance of the bihemispheric motor network poststroke, marked by ( a) a possible despecialization of the nondamaged hemisphere and ( b) the employment of alternative control strategies to ensure optimal task execution.
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Affiliation(s)
- Liesjet E H van Dokkum
- 1 Montpellier University Hospital, Montpellier, France.,2 Charles Coulomb Laboratory, Montpellier University, Montpellier, France
| | | | - Denis Mottet
- 3 EuroMov, of Montpellier University, Montpellier, France
| | - Alain Bonafé
- 1 Montpellier University Hospital, Montpellier, France
| | | | - Isabelle Laffont
- 1 Montpellier University Hospital, Montpellier, France.,3 EuroMov, of Montpellier University, Montpellier, France
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14
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Fu CH, Li KS, Ning YZ, Tan ZJ, Zhang Y, Liu HW, Han X, Zou YH. Altered effective connectivity of resting state networks by acupuncture stimulation in stroke patients with left hemiplegia: A multivariate granger analysis. Medicine (Baltimore) 2017; 96:e8897. [PMID: 29382021 PMCID: PMC5709020 DOI: 10.1097/md.0000000000008897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to explore the response feature of resting-state networks (RSNs) of stroke patients with left hemiplegia by acupuncture stimulation.Nineteen stroke patients with left hemiplegia and 17 controls were recruited in this study. Resting-state functional magnetic resonance imaging data before and after acupuncture were acquired using magnetic scanning. The independent component analysis (ICA) was employed to extract RSNs related to motion, sensation, cognition, and execution, including sensorimotor network (SMN), left and right frontoparietal network (LFPN and RFPN), anterior and posterior default mode network (aDMN, pDMN), visual network (VN), and salience network (SN). Granger causality method was used to explore how acupuncture stimulation affects the causality between intrinsic RSNs in stroke patients. Compared with healthy subjects, stroke patients presented the more complex effective connectivity. Before acupuncture stimulation, LFPN inputted most information from other networks while DMN outputted most information to other networks; however, the above results were reversal by acupuncture. In addition, we found aDMN reside in between SMN and LFPN after acupuncture.The finding suggested that acupuncture probably integrated the effective connectivity internetwork by modulating multiple networks and transferring information between LFPN and SMN by DMN as the relay station.
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Affiliation(s)
- Cai-Hong Fu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
- Shunyi Hospital Affiliated to Beijing Hospital of Traditional Chinese Medicine
| | - Kuang-Shi Li
- Department of Emergency, Beijing GuLou Hospital of Traditional Chinese Medicine
| | - Yan-Zhe Ning
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University
| | - Zhong-Jian Tan
- Department of Radiology, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yong Zhang
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Hong-Wei Liu
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
- Shunyi Hospital Affiliated to Beijing Hospital of Traditional Chinese Medicine
| | - Xiao Han
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yi-Huai Zou
- Department of Neurology and Stroke Center, Dongzhimen Hospital, the First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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15
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Cassidy JM, Cramer SC. Spontaneous and Therapeutic-Induced Mechanisms of Functional Recovery After Stroke. Transl Stroke Res 2016; 8:33-46. [PMID: 27109642 DOI: 10.1007/s12975-016-0467-5] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/13/2016] [Accepted: 04/18/2016] [Indexed: 01/05/2023]
Abstract
With increasing rates of survival throughout the past several years, stroke remains one of the leading causes of adult disability. Following the onset of stroke, spontaneous mechanisms of recovery at the cellular, molecular, and systems levels ensue. The degree of spontaneous recovery is generally incomplete and variable among individuals. Typically, the best recovery outcomes entail the restitution of function in injured but surviving neural matter. An assortment of restorative therapies exists or is under development with the goal of potentiating restitution of function in damaged areas or in nearby ipsilesional regions by fostering neuroplastic changes, which often rely on mechanisms similar to those observed during spontaneous recovery. Advancements in stroke rehabilitation depend on the elucidation of both spontaneous and therapeutic-driven mechanisms of recovery. Further, the implementation of neural biomarkers in research and clinical settings will enable a multimodal approach to probing brain state and predicting the extent of post-stroke functional recovery. This review will discuss spontaneous and therapeutic-induced mechanisms driving post-stroke functional recovery while underscoring several potential restorative therapies and biomarkers.
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Affiliation(s)
- Jessica M Cassidy
- Department of Neurology, University of California, Irvine Medical Center, 200 S. Manchester Ave, Suite 206, Orange, CA, 92868-4280, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Irvine Medical Center, 200 S. Manchester Ave, Suite 206, Orange, CA, 92868-4280, USA. .,Department of Anatomy & Neurobiology, University of California, Irvine, Irvine, CA, 92697, USA. .,Department of Physical Medicine & Rehabilitation, University of California, Irvine Medical Center, 200 S. Manchester Ave, Suite 210, Orange, CA, 92868-5397, USA. .,Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, 845 Health Sciences Rd, Irvine, 92697, CA, USA.
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16
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Poiroux E, Cavaro-Ménard C, Leruez S, Lemée JM, Richard I, Dinomais M. What Do Eye Gaze Metrics Tell Us about Motor Imagery? PLoS One 2015; 10:e0143831. [PMID: 26605915 PMCID: PMC4659676 DOI: 10.1371/journal.pone.0143831] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/10/2015] [Indexed: 11/18/2022] Open
Abstract
Many of the brain structures involved in performing real movements also have increased activity during imagined movements or during motor observation, and this could be the neural substrate underlying the effects of motor imagery in motor learning or motor rehabilitation. In the absence of any objective physiological method of measurement, it is currently impossible to be sure that the patient is indeed performing the task as instructed. Eye gaze recording during a motor imagery task could be a possible way to "spy" on the activity an individual is really engaged in. The aim of the present study was to compare the pattern of eye movement metrics during motor observation, visual and kinesthetic motor imagery (VI, KI), target fixation, and mental calculation. Twenty-two healthy subjects (16 females and 6 males), were required to perform tests in five conditions using imagery in the Box and Block Test tasks following the procedure described by Liepert et al. Eye movements were analysed by a non-invasive oculometric measure (SMI RED250 system). Two parameters describing gaze pattern were calculated: the index of ocular mobility (saccade duration over saccade + fixation duration) and the number of midline crossings (i.e. the number of times the subjects gaze crossed the midline of the screen when performing the different tasks). Both parameters were significantly different between visual imagery and kinesthesic imagery, visual imagery and mental calculation, and visual imagery and target fixation. For the first time we were able to show that eye movement patterns are different during VI and KI tasks. Our results suggest gaze metric parameters could be used as an objective unobtrusive approach to assess engagement in a motor imagery task. Further studies should define how oculomotor parameters could be used as an indicator of the rehabilitation task a patient is engaged in.
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Affiliation(s)
- Elodie Poiroux
- LUNAM, Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), EA 7315 F-49000, Angers, France
- LUNAM, Université d’Angers, Département de Médecine Physique et de Réadaptation, CHU d’Angers, 4 rue Larrey, 49933, Angers, Cedex 9, France
| | - Christine Cavaro-Ménard
- LUNAM, Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), EA 7315 F-49000, Angers, France
| | - Stéphanie Leruez
- LUNAM, Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), EA 7315 F-49000, Angers, France
- LUNAM, Université d’Angers, Département d’Ophtalmologie, CHU d’Angers, 4 rue Larrey, 49933, Angers, Cedex 9, France
| | - Jean Michel Lemée
- LUNAM, Université d’Angers, Département de Neurochirurgie, CHU d’Angers, 4 rue Larrey, 49933, Angers, Cedex 9, France
- LUNAM, Université d’Angers, INSERM U1066 « Micro- et nano-médecines biomimétiques », bâtiment IRIS 3e étage, CHU d’Angers, 4 rue Larrey, 49933, Angers, Cedex 9, France
| | - Isabelle Richard
- LUNAM, Université d’Angers, Département de Médecine Physique et de Réadaptation, CHU d’Angers, 4 rue Larrey, 49933, Angers, Cedex 9, France
- LUNAM, Université d’Angers, Laboratoire d’épidémiologie, ergonomie et santé au travail, EA 4626 F-49000, Angers, France
| | - Mickael Dinomais
- LUNAM, Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS), EA 7315 F-49000, Angers, France
- LUNAM, Université d’Angers, Département de Médecine Physique et de Réadaptation, CHU d’Angers, 4 rue Larrey, 49933, Angers, Cedex 9, France
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17
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Pichiorri F, Morone G, Petti M, Toppi J, Pisotta I, Molinari M, Paolucci S, Inghilleri M, Astolfi L, Cincotti F, Mattia D. Brain-computer interface boosts motor imagery practice during stroke recovery. Ann Neurol 2015; 77:851-65. [PMID: 25712802 DOI: 10.1002/ana.24390] [Citation(s) in RCA: 295] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Motor imagery (MI) is assumed to enhance poststroke motor recovery, yet its benefits are debatable. Brain-computer interfaces (BCIs) can provide instantaneous and quantitative measure of cerebral functions modulated by MI. The efficacy of BCI-monitored MI practice as add-on intervention to usual rehabilitation care was evaluated in a randomized controlled pilot study in subacute stroke patients. METHODS Twenty-eight hospitalized subacute stroke patients with severe motor deficits were randomized into 2 intervention groups: 1-month BCI-supported MI training (BCI group, n = 14) and 1-month MI training without BCI support (control group; n = 14). Functional and neurophysiological assessments were performed before and after the interventions, including evaluation of the upper limbs by Fugl-Meyer Assessment (FMA; primary outcome measure) and analysis of oscillatory activity and connectivity at rest, based on high-density electroencephalographic (EEG) recordings. RESULTS Better functional outcome was observed in the BCI group, including a significantly higher probability of achieving a clinically relevant increase in the FMA score (p < 0.03). Post-BCI training changes in EEG sensorimotor power spectra (ie, stronger desynchronization in the alpha and beta bands) occurred with greater involvement of the ipsilesional hemisphere in response to MI of the paralyzed trained hand. Also, FMA improvements (effectiveness of FMA) correlated with the changes (ie, post-training increase) at rest in ipsilesional intrahemispheric connectivity in the same bands (p < 0.05). INTERPRETATION The introduction of BCI technology in assisting MI practice demonstrates the rehabilitative potential of MI, contributing to significantly better motor functional outcomes in subacute stroke patients with severe motor impairments.
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Affiliation(s)
- Floriana Pichiorri
- Santa Lucia Foundation Institute of Hospitalization and Scientific Care; Department of Neurology and Psychiatry, Sapienza University of Rome
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