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Xu R, Zhu GY, Zhu J, Wang Y, Xing XX, Chen LY, Li J, Shen FQ, Chen JB, Hua XY, Xu DS. Using Hebbian-Type Stimulation to Rescue Arm Function After Stroke: Study Protocol for a Randomized Clinical Trial. Front Neural Circuits 2022; 15:789095. [PMID: 35221930 PMCID: PMC8867068 DOI: 10.3389/fncir.2021.789095] [Citation(s) in RCA: 1] [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: 10/04/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Upper-extremity hemiplegia after stroke remains a significant clinical problem. The supplementary motor area (SMA) is vital to the motor recovery outcomes of chronic stroke patients. Therefore, rebuilding the descending motor tract from the SMA to the paralyzed limb is a potential approach to restoring arm motor function after stroke. Paired associative stimulation (PAS), which is based on Hebbian theory, is a potential method for reconstructing the connections in the impaired motor neural circuits. The study described in this protocol aims to assess the effects of cortico–peripheral Hebbian-type stimulation (HTS), involving PAS, for neural circuit reconstruction to rescue the paralyzed arm after stroke. Methods The study is a 4-month double-blind randomized sham-controlled clinical trial. We will recruit 90 post-stroke individuals with mild to moderate upper limb paralysis. Based on a 1:1 ratio, the participants will be randomly assigned to the HTS and sham groups. Each participant will undergo 5-week HTS or sham stimulation. Assessments will be conducted at baseline, immediately after the 5-week treatment, and at a 3-month follow-up. The primary outcome will be the Wolf Motor Function Test (WMFT). The secondary outcomes will be Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Functional Independence Measure (FIM), and functional near-infrared spectroscopy (fNIRS) parameters. The adverse events will be recorded throughout the study. Discussion Upper-limb paralysis in stroke patients is due to neural circuit disruption, so the reconstruction of effective motor circuits is a promising treatment approach. Based on its anatomical structure and function, the SMA is thought to compensate for motor dysfunction after focal brain injury at the cortical level. Our well-designed randomized controlled trial will allow us to analyze the clinical efficacy of this novel Hebbian theory-based neuromodulation strategy regarding promoting the connection between the cortex and peripheral limb. The results may have significance for the development and implementation of effective neurorehabilitation treatments. Clinical Trial Registration [www.ClinicalTrials.gov], identifier [ChiCTR2000039949].
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Affiliation(s)
- Rong Xu
- Shanghai Zhaxin Traditional Chinese and Western Medicine Hospital, Shanghai, China
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Guang-Yue Zhu
- Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Jun Zhu
- Shanghai Zhaxin Traditional Chinese and Western Medicine Hospital, Shanghai, China
| | - Yong Wang
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Xiang-Xin Xing
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lin-Yu Chen
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Jie Li
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Fu-Qiang Shen
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Jian-Bing Chen
- Shanghai Yangzhi Rehabilitation Hospital, Shanghai, China
| | - Xu-Yun Hua
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xu-Yun Hua,
| | - Dong-Sheng Xu
- Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xu-Yun Hua,
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Chen S, Shu X, Wang H, Ding L, Fu J, Jia J. The Differences Between Motor Attempt and Motor Imagery in Brain-Computer Interface Accuracy and Event-Related Desynchronization of Patients With Hemiplegia. Front Neurorobot 2021; 15:706630. [PMID: 34803647 PMCID: PMC8602190 DOI: 10.3389/fnbot.2021.706630] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Motor attempt and motor imagery (MI) are two common motor tasks used in brain-computer interface (BCI). They are widely researched for motor rehabilitation in patients with hemiplegia. The differences between the motor attempt (MA) and MI tasks of patients with hemiplegia can be used to promote BCI application. This study aimed to explore the accuracy of BCI and event-related desynchronization (ERD) between the two tasks. Materials and Methods: We recruited 13 patients with stroke and 3 patients with traumatic brain injury, to perform MA and MI tasks in a self-control design. The BCI accuracies from the bilateral, ipsilesional, and contralesional hemispheres were analyzed and compared between different tasks. The cortical activation patterns were evaluated with ERD and laterality index (LI). Results: The study showed that the BCI accuracies of MA were significantly (p < 0.05) higher than MI in the bilateral, ipsilesional, and contralesional hemispheres in the alpha-beta (8–30 Hz) frequency bands. There was no significant difference in ERD and LI between the MA and MI tasks in the 8–30 Hz frequency bands. However, in the MA task, there was a negative correlation between the ERD values in the channel CP1 and ipsilesional hemispheric BCI accuracies (r = −0.552, p = 0.041, n = 14) and a negative correlation between the ERD values in channel CP2 and bilateral hemispheric BCI accuracies (r = −0.543, p = 0.045, n = 14). While in the MI task, there were negative correlations between the ERD values in channel C4 and bilateral hemispheric BCI accuracies (r = −0.582, p = 0.029, n = 14) as well as the contralesional hemispheric BCI accuracies (r = −0.657, p = 0.011, n = 14). As for motor dysfunction, there was a significant positive correlation between the ipsilesional BCI accuracies and FMA scores of the hand part in 8–13 Hz (r = 0.565, p = 0.035, n = 14) in the MA task and a significant positive correlation between the ipsilesional BCI accuracies and FMA scores of the hand part in 13–30 Hz (r = 0.558, p = 0.038, n = 14) in the MI task. Conclusion: The MA task may achieve better BCI accuracy but have similar cortical activations with the MI task. Cortical activation (ERD) may influence the BCI accuracy, which should be carefully considered in the BCI motor rehabilitation of patients with hemiplegia.
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Affiliation(s)
- Shugeng Chen
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaokang Shu
- School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hewei Wang
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Li Ding
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianghong Fu
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.,National Center for Neurological Disorders, Shanghai, China
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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: 25] [Impact Index Per Article: 6.3] [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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Chen C, Fang Y, Wang X, Bao SC, Tang Z, Tong RKY. Excitation Comparison between Multi-site Stimulation using Network-based tDCS and Focal Stimulation using High-definition tDCS. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:6884-6887. [PMID: 31947422 DOI: 10.1109/embc.2019.8857287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transcranial direct current stimulation (tDCS) has been developed rapidly in recent years and derived various forms which serve as therapeutic tools for neurological disorders. However, differences of stimulation effect among these stimulation strategies have not been fully explored. In this pilot study, we compared the stimulation effect between High-definition tDCS (HD-tDCS) and Network-based tDCS (NB-tDCS) on a healthy subject. HD-tDCS mainly stimulated primary motor cortex with 2mA current and NB-tDCS was designed to stimulate main motor-related areas including primary motor cortex, premotor cortex and supplementary motor area with the same amount of current in total. Cortico-muscular coherence (CMC) derived from EEG/EMG, which measures the synchrony between cortical neural activity and muscles, was collected from isometric wrist extension tasks. The results demonstrated more motor-related regions excited and longer high-level lasting effect after NB-tDCS compared with HD-tDCS, which indicated the potential power of multi-site stimulation. This study might provide some guidance and hints for transcranial stimulation strategies in the future.
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Wang X, Seguin C, Zalesky A, Wong WW, Chu WCW, Tong RKY. Synchronization lag in post stroke: relation to motor function and structural connectivity. Netw Neurosci 2019; 3:1121-1140. [PMID: 31637341 PMCID: PMC6777982 DOI: 10.1162/netn_a_00105] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/25/2019] [Indexed: 12/20/2022] Open
Abstract
Stroke is characterized by delays in the resting-state hemodynamic response, resulting in synchronization lag in neural activity between brain regions. However, the structural basis of this lag remains unclear. In this study, we used resting-state functional MRI (rs-fMRI) to characterize synchronization lag profiles between homotopic regions in 15 individuals (14 males, 1 female) with brain lesions consequent to stroke as well as a group of healthy comparison individuals. We tested whether the network communication efficiency of each individual's structural brain network (connectome) could explain interindividual and interregional variation in synchronization lag profiles. To this end, connectomes were mapped using diffusion MRI data, and communication measures were evaluated under two schemes: shortest paths and navigation. We found that interindividual variation in synchronization lags was inversely associated with communication efficiency under both schemes. Interregional variation in lag was related to navigation efficiency and navigation distance, reflecting its dependence on both distance and structural constraints. Moreover, severity of motor deficits significantly correlated with average synchronization lag in stroke. Our results provide a structural basis for the delay of information transfer between homotopic regions inferred from rs-fMRI and provide insight into the clinical significance of structural-functional relationships in stroke individuals.
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Affiliation(s)
- Xin Wang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Caio Seguin
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Andrew Zalesky
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Wan-wa Wong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie Chiu-wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Raymond Kai-yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
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Mehler DMA, Williams AN, Krause F, Lührs M, Wise RG, Turner DL, Linden DEJ, Whittaker JR. The BOLD response in primary motor cortex and supplementary motor area during kinesthetic motor imagery based graded fMRI neurofeedback. Neuroimage 2019; 184:36-44. [PMID: 30205210 PMCID: PMC6264383 DOI: 10.1016/j.neuroimage.2018.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 08/02/2018] [Accepted: 09/04/2018] [Indexed: 01/28/2023] Open
Abstract
There is increasing interest in exploring the use of functional MRI neurofeedback (fMRI-NF) as a therapeutic technique for a range of neurological conditions such as stroke and Parkinson's disease (PD). One main therapeutic potential of fMRI-NF is to enhance volitional control of damaged or dysfunctional neural nodes and networks via a closed-loop feedback model using mental imagery as the catalyst of self-regulation. The choice of target node/network and direction of regulation (increase or decrease activity) are central design considerations in fMRI-NF studies. Whilst it remains unclear whether the primary motor cortex (M1) can be activated during motor imagery, the supplementary motor area (SMA) has been robustly activated during motor imagery. Such differences in the regulation potential between primary and supplementary motor cortex are important because these areas can be differentially affected by a stroke or PD, and the choice of fMRI-NF target and grade of self-regulation of activity likely have substantial influence on the clinical effects and cost effectiveness of NF-based interventions. In this study we therefore investigated firstly whether healthy subjects would be able to achieve self-regulation of the hand-representation areas of M1 and the SMA using fMRI-NF training. There was a significant decrease in M1 neural activity during fMRI-NF, whereas SMA neural activity was increased, albeit not with the predicated graded effect. This study has important implications for fMRI-NF protocols that employ motor imagery to modulate activity in specific target regions of the brain and to determine how they may be tailored for neurorehabilitation.
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Affiliation(s)
- David M A Mehler
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, United Kingdom; Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, United Kingdom
| | - Angharad N Williams
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, United Kingdom
| | - Florian Krause
- Donders Institute for Brain, Cognition and Behaviour Radboud University Medical Center, 6500 HB, Nijmegen, The Netherlands
| | - Michael Lührs
- Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands; Brain Innovation B.V, Oxfordlaan 55, 6229 EV, Maastricht, The Netherlands
| | - Richard G Wise
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, United Kingdom
| | - Duncan L Turner
- Neurorehabilitation Unit, School of Health, Sport and Bioscience, University of East London, London, E15 4LZ, United Kingdom
| | - David E J Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, United Kingdom; Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, United Kingdom; School of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
| | - Joseph R Whittaker
- Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, CF24 4HQ, United Kingdom; School of Physics and Astronomy, Cardiff University, Cardiff, CF24 3AA, United Kingdom.
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1H MR spectroscopy of the motor cortex immediately following transcranial direct current stimulation at 7 Tesla. PLoS One 2018; 13:e0198053. [PMID: 30157179 PMCID: PMC6114283 DOI: 10.1371/journal.pone.0198053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that may modulate cortical excitability, metabolite concentration, and human behaviour. The supplementary motor area (SMA) has been largely ignored as a potential target for tDCS neurorehabilitation but is an important region in motor compensation after brain injury with strong efferent connections to the primary motor cortex (M1). The objective of this work was to measure tissue metabolite changes in the human motor cortex immediately following tDCS. We hypothesized that bihemispheric tDCS would change levels of metabolites involved in neuromodulation including N-acetylaspartate (NAA), glutamate (Glu), and creatine (tCr). In this single-blind, randomized, cross-over study, fifteen healthy adults aged 21–60 participated in two 7T MRI sessions, to identify changes in metabolite concentrations by magnetic resonance spectroscopy. Immediately after 20 minutes of tDCS, there were no significant changes in metabolite levels or metabolite ratios comparing tDCS to sham. However there was a trend toward increased NAA/tCr concentration (p = 0.08) in M1 under the stimulating cathode. There was a strong, positive correlation between the change in the absolute concentration of NAA and the change in the absolute concentration of tCr (p<0.001) suggesting an effect of tDCS. Both NAA and creatine are important markers of neurometabolism. Our findings provide novel insight into the modulation of neural metabolites in the motor cortex immediately following application of bihemispheric tDCS.
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Kemlin C, Moulton E, Samson Y, Rosso C. Do Motor Imagery Performances Depend on the Side of the Lesion at the Acute Stage of Stroke? Front Hum Neurosci 2016; 10:321. [PMID: 27445761 PMCID: PMC4921466 DOI: 10.3389/fnhum.2016.00321] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/13/2016] [Indexed: 11/14/2022] Open
Abstract
Motor imagery has been considered a substitute for overt motor execution to study post-stroke motor recovery. However, motor imagery abilities at the acute stage (<3 weeks) are poorly known. The aim of this study was to compare explicit and implicit motor imagery abilities in stroke patients and healthy subjects, correlate them with motor function, and investigate the role of right or left hemisphere lesions on performance. Twenty-four stroke patients at the acute stage and 24 age- and gender-matched healthy volunteers performed implicit (Hand Laterality Judgment Task) and explicit (number of imagined/executed hand movements) motor imagery tasks and a clinical motor assessment. Differences between healthy subjects and patients as well as the impact of lesion side on motor imagery were studied using ANOVA. We analyzed the relationship between motor executed and imagined movements (temporal congruence) using Pearson correlations. Our study shows that for implicit imagery, stroke patients had slower reaction times [RTs, t(46) = 1.7, p = 0.02] and higher error rates for the affected hand [t(46) = 3.7, p < 0.01] yet shared similar characteristics [angle effect: F(1,46) = 30.8, p ≤ 0.0001] with respect to healthy subjects. For the unaffected hand, right-sided stroke patients had a higher error rate and similar RTs whereas left sided stroke had higher RTs but similar error rate than healthy subjects. For explicit imagery, patients exhibited bilateral deficits compared to healthy subjects in the executed and imagined condition (p < 0.0001). Patients and healthy subjects exhibited a temporal congruence between executed and imagined movements (p ≤ 0.04) except for right-sided strokes who had no correlation for both hands. When using motor imagery as a tool for upper limb rehabilitation early after stroke, caution must be taken related to the side of the lesion.
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Affiliation(s)
- Claire Kemlin
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-SalpêtrièreParis, France; APHP, Service de Médecine Physique et Réadaptation, Hôpital Pitié-SalpêtrièreParis, France; Centre de Recherche de l'Institut du Cerveau et de la Moelle épinièreParis, France; UPMC Paris 6, INSERM, U1127; CNRS, UMR 7225Paris, France; CONAM, UPMC Paris 6, INSERM, U1127, CNRS, UMR 7225Paris, France
| | - Eric Moulton
- Centre de Recherche de l'Institut du Cerveau et de la Moelle épinièreParis, France; UPMC Paris 6, INSERM, U1127; CNRS, UMR 7225Paris, France; CONAM, UPMC Paris 6, INSERM, U1127, CNRS, UMR 7225Paris, France
| | - Yves Samson
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-SalpêtrièreParis, France; Centre de Recherche de l'Institut du Cerveau et de la Moelle épinièreParis, France; UPMC Paris 6, INSERM, U1127; CNRS, UMR 7225Paris, France; COGIMAGE, UPMC Paris 6, INSERM, U1127, CNRS, UMR 7225Paris, France
| | - Charlotte Rosso
- APHP, Urgences Cérébro-Vasculaires, Hôpital Pitié-SalpêtrièreParis, France; Centre de Recherche de l'Institut du Cerveau et de la Moelle épinièreParis, France; UPMC Paris 6, INSERM, U1127; CNRS, UMR 7225Paris, France; CONAM, UPMC Paris 6, INSERM, U1127, CNRS, UMR 7225Paris, France
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