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Carson RG, Hayward KS. Using mechanistic knowledge to appraise contemporary approaches to the rehabilitation of upper limb function following stroke. J Physiol 2024. [PMID: 39129269 DOI: 10.1113/jp285559] [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: 10/04/2023] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
It is a paradox of neurological rehabilitation that, in an era in which preclinical models have produced significant advances in our mechanistic understanding of neural plasticity, there is inadequate support for many therapies recommended for use in clinical practice. When the goal is to estimate the probability that a specific form of therapy will have a positive clinical effect, the integration of mechanistic knowledge (concerning 'the structure or way of working of the parts in a natural system') may improve the quality of inference. This is illustrated by analysis of three contemporary approaches to the rehabilitation of lateralized dysfunction affecting people living with stroke: constraint-induced movement therapy; mental practice; and mirror therapy. Damage to 'cross-road' regions of the structural (white matter) brain connectome generates deficits that span multiple domains (motor, language, attention and verbal/spatial memory). The structural integrity of these regions determines not only the initial functional status, but also the response to therapy. As structural disconnection constrains the recovery of functional capability, 'disconnectome' modelling provides a basis for personalized prognosis and precision rehabilitation. It is now feasible to refer a lesion delineated using a standard clinical scan to a (dis)connectivity atlas derived from the brains of other stroke survivors. As the individual disconnection pattern thus obtained suggests the functional domains most likely be compromised, a therapeutic regimen can be tailored accordingly. Stroke is a complex disorder that burdens individuals with distinct constellations of brain damage. Mechanistic knowledge is indispensable when seeking to ameliorate the behavioural impairments to which such damage gives rise.
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Affiliation(s)
- Richard G Carson
- Trinity College Institute of Neuroscience and School of Psychology, Trinity College Dublin, Dublin 2, Ireland
- School of Psychology, Queen's University Belfast, Belfast, UK
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Kathryn S Hayward
- Departments of Physiotherapy, University of Melbourne, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- The Florey, University of Melbourne, Melbourne, Australia
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Suzuki Y, Jovanovic LI, Fadli RA, Yamanouchi Y, Marquez-Chin C, Popovic MR, Nomura T, Milosevic M. Evidence That Brain-Controlled Functional Electrical Stimulation Could Elicit Targeted Corticospinal Facilitation of Hand Muscles in Healthy Young Adults. Neuromodulation 2023; 26:1612-1621. [PMID: 35088740 DOI: 10.1016/j.neurom.2021.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Brain-computer interface (BCI)-controlled functional electrical stimulation (FES) has been used in rehabilitation for improving hand motor function. However, mechanisms of improvements are still not well understood. The objective of this study was to investigate how BCI-controlled FES affects hand muscle corticospinal excitability. MATERIALS AND METHODS A total of 12 healthy young adults were recruited in the study. During BCI calibration, a single electroencephalography channel from the motor cortex and a frequency band were chosen to detect event-related desynchronization (ERD) of cortical oscillatory activity during kinesthetic wrist motor imagery (MI). The MI-based BCI system was used to detect active states on the basis of ERD activity in real time and produce contralateral wrist extension movements through FES of the extensor carpi radialis (ECR) muscle. As a control condition, FES was used to generate wrist extension at random intervals. The two interventions were performed on separate days and lasted 25 minutes. Motor evoked potentials (MEPs) in ECR (intervention target) and flexor carpi radialis (FCR) muscles were elicited through single-pulse transcranial magnetic stimulation of the motor cortex to compare corticospinal excitability before (pre), immediately after (post0), and 30 minutes after (post30) the interventions. RESULTS After the BCI-FES intervention, ECR muscle MEPs were significantly facilitated at post0 and post30 time points compared with before the intervention (pre), whereas there were no changes in the FCR muscle corticospinal excitability. Conversely, after the random FES intervention, both ECR and FCR muscle MEPs were unaffected compared with before the intervention (pre). CONCLUSIONS Our results demonstrated evidence that BCI-FES intervention could elicit muscle-specific short-term corticospinal excitability facilitation of the intervention targeted (ECR) muscle only, whereas randomly applied FES was ineffective in eliciting any changes. Notably, these findings suggest that associative cortical and peripheral activations during BCI-FES can effectively elicit targeted muscle corticospinal excitability facilitation, implying possible rehabilitation mechanisms.
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Affiliation(s)
- Yoshiyuki Suzuki
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan
| | - Lazar I Jovanovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Rizaldi A Fadli
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan
| | - Yuki Yamanouchi
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan
| | - Cesar Marquez-Chin
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; CRANIA, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Milos R Popovic
- Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada; KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; CRANIA, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Taishin Nomura
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan
| | - Matija Milosevic
- Graduate School of Engineering Science, Department of Mechanical Science and Bioengineering, Osaka University, Toyonaka, Osaka, Japan.
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Arendsen LJ, Guggenberger R, Zimmer M, Weigl T, Gharabaghi A. Peripheral Electrical Stimulation Modulates Cortical Beta-Band Activity. Front Neurosci 2021; 15:632234. [PMID: 33867919 PMCID: PMC8044771 DOI: 10.3389/fnins.2021.632234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/08/2021] [Indexed: 11/24/2022] Open
Abstract
Low-frequency peripheral electrical stimulation using a matrix electrode (PEMS) modulates spinal nociceptive pathways. However, the effects of this intervention on cortical oscillatory activity have not been assessed yet. The aim of this study was to investigate the effects of low-frequency PEMS (4 Hz) on cortical oscillatory activity in different brain states in healthy pain-free participants. In experiment 1, PEMS was compared to sham stimulation. In experiment 2, motor imagery (MI) was used to modulate the sensorimotor brain state. PEMS was applied either during MI-induced oscillatory desynchronization (concurrent PEMS) or after MI (delayed PEMS) in a cross-over design. For both experiments, PEMS was applied on the left forearm and resting-state electroencephalography (EEG) was recording before and after each stimulation condition. Experiment 1 showed a significant decrease of global resting-state beta power after PEMS compared to sham (p = 0.016), with a median change from baseline of −16% for PEMS and −0.54% for sham. A cluster-based permutation test showed a significant difference in resting-state beta power comparing pre- and post-PEMS (p = 0.018) that was most pronounced over bilateral central and left frontal sensors. Experiment 2 did not identify a significant difference in the change from baseline of global EEG power for concurrent PEMS compared to delayed PEMS. Two cluster-based permutation tests suggested that frontal beta power may be increased following both concurrent and delayed PEMS. This study provides novel evidence for supraspinal effects of low-frequency PEMS and an initial indication that the presence of a cognitive task such as MI may influence the effects of PEMS on beta activity. Chronic pain has been associated with changes in beta activity, in particular an increase of beta power in frontal regions. Thus, brain state-dependent PEMS may offer a novel approach to the treatment of chronic pain. However, further studies are warranted to investigate optimal stimulation conditions to achieve a reduction of pain.
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Affiliation(s)
- Laura J Arendsen
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Robert Guggenberger
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Manuela Zimmer
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Tobias Weigl
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University of Tübingen, Tübingen, Germany
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