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Zhai C, Wang Z, Cai J, Fang L, Li X, Jiang K, Shen Y, Wang Y, Xu X, Liu W, Wang T, Wu Q. Repeated trans-spinal magnetic stimulation promotes microglial phagocytosis of myelin debris after spinal cord injury through LRP-1. Exp Neurol 2024; 379:114844. [PMID: 38830500 DOI: 10.1016/j.expneurol.2024.114844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/07/2024] [Accepted: 05/28/2024] [Indexed: 06/05/2024]
Abstract
Spinal cord injury (SCI) is a serious trauma of the central nervous system. The clearance of myelin debris is a critical step in the functional recovery following spinal cord injury (SCI). Recent studies have begun to reveal critical roles for professional phagocytes in the central nervous system, microglia, and their receptors in the control of myelin debris in neurodegenerative disease. Repeated trans-spinal magnetic stimulation (rTSMS) has been demonstrated as a noninvasive SCI treatment that enhances tissue repair and functional recovery. In this study, we investigated the role and molecular mechanism of rTSMS on microglial phagocytosis of myelin debris in a rat SCI model. In our studies, we found that rTSMS significantly promoted the motor function recovery of SCI rats associated with the inhibition the neuroinflammation and glia scar formation. Immunofluorescence results further showed that the rTSMS promotes the clearance of myelin debris by microglia in vivo and in vitro. Additionally, receptor-associated protein (RAP), a Low-density lipoprotein receptor-related protein-1 (LRP-1) inhibitor, could cancel the accelerated microglial phagocytosis of myelin debris after rTSMS in vitro experiments. Simultaneously, Elisa's results and western blotting respectively showed that rTSMS significantly decreased the levels of soluble LRP-1(sLRP-1) and the LRP-1 splicing enzyme of ADAM17. In conclusion, rTSMS could promote the clearance of myelin debris by microglia through LRP-1 to improve the functional recovery of SCI rats.
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Affiliation(s)
- Chenyuan Zhai
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zun Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Rehabilitation medicine department, School of Acupuncture and Tuina, School of Health and Rehabilitation, Nanjing university of Chinese medicine, Nanjing 210023, China
| | - Jili Cai
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Lu Fang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiangzhe Li
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Rehabilitation Medicine Center, Suzhou Hospital, Affiliated Hospital of Medical School, Nanjing University, Suzhou, Jiangsu 215153, China
| | - Kunmao Jiang
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, Nanjing, Jiangsu 211166, China
| | - Ying Shen
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yu Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xingjun Xu
- Department of Rehabilitation, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, China
| | - Wentao Liu
- Jiangsu Key Laboratory of Neurodegeneration, Department of Pharmacology, Nanjing Medical University, Nanjing, Jiangsu 211166, China.
| | - Tong Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Qi Wu
- Department of Rehabilitation, Hengyang Medical School, The First Affiliated Hospital, University of South China, Hengyang 421000, China.
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Duan X, Huang D, Zhong H, Wu J, Xiao Z, Yang P, Han Y, Jiang H, Zhou P, Liu X. Efficacy of rTMS in treating functional impairment in post-stroke patients: a systematic review and meta-analysis. Neurol Sci 2024; 45:3887-3899. [PMID: 38512529 DOI: 10.1007/s10072-024-07455-2] [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: 01/15/2024] [Accepted: 03/08/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Most stroke patients suffer from an imbalance in blood supply, which causes severe brain damage leading to functional deficits in motor, sensory, swallowing, cognitive, emotional, and speech functions. Repetitive transcranial magnetic stimulation (rTMS) is thought to restore functions impaired during the stroke process and improve the quality of life of stroke patients. However, the efficacy of rTMS in treating post-stroke function impairment varies significantly. Therefore, we conducted a meta-analysis of the number of patients with effective rTMS in treating post-stroke dysfunction. METHODS The PubMed, Embase, and Cochrane Library databases were searched. Screening and full-text review were performed by three investigators. Single-group rate meta-analysis was performed on the extracted data using a random variable model. Then subgroup analyses were performed at the levels of stroke acuity (acute, chronic, or subacute); post-stroke symptoms (including upper and lower limb motor function, dysphagia, depression, aphasia); rTMS stimulation site (affected side, unaffected side); and whether or not it was a combination therapy. RESULTS We obtained 8955 search records, and finally 33 studies (2682 patients) were included in the meta-analysis. The overall analysis found that effective strength (ES) of rTMS was 0.53. In addition, we found that the ES of rTMS from acute/subacute/chronic post-stroke was 0.69, 0.45, and 0.52. We also found that the ES of rTMS using high-frequency stimulation was 0.56, while the ES of rTMS using low-frequency stimulation was 0.53. From post-stroke symptoms, we found that the ES of rTMS in sensory aspects, upper limb functional aspects, swallowing function, and aphasia was 0.50, 0.52, 0.51, and 0.54. And from the site of rTMS stimulation, we found that the ES of rTMS applied to the affected side was 0.51, while the ES applied to the unaffected side was 0.54. What's more, we found that the ES of rTMS applied alone was 0.53, while the ES of rTMS applied in conjunction with other therapeutic modalities was 0.53. CONCLUSIONS By comparing the results of the data, we recommend rTMS as a treatment option for rehabilitation of functional impairment in patients after stroke. We also recommend that rehabilitation physicians or clinicians use combination therapy as one of the options for patients.
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Affiliation(s)
- Xiaodong Duan
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China
- Department of Rehabilitation Medicine, Southwest Medical University, Luzhou, Sichuan, China
- Rehabilitation Medicine and Engineering Key Laboratory of Luzhou, Luzhou, Sichuan, China
| | - Delong Huang
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Haoshu Zhong
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai, China
| | - Junhao Wu
- Department of Nuclear Medicine & PET Center, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhihan Xiao
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Peng Yang
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Yuanhang Han
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Haodong Jiang
- Clinical Medical College, Southwest Medical University, Luzhou, Sichuan, China
| | - Ping Zhou
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.
| | - Xi Liu
- Department of Rehabilitation Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou, 646000, Sichuan, China.
- Department of Rehabilitation Medicine, Southwest Medical University, Luzhou, Sichuan, China.
- Rehabilitation Medicine and Engineering Key Laboratory of Luzhou, Luzhou, Sichuan, China.
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Markowska A, Tarnacka B. Molecular Changes in the Ischemic Brain as Non-Invasive Brain Stimulation Targets-TMS and tDCS Mechanisms, Therapeutic Challenges, and Combination Therapies. Biomedicines 2024; 12:1560. [PMID: 39062133 PMCID: PMC11274560 DOI: 10.3390/biomedicines12071560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/07/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Ischemic stroke is one of the leading causes of death and disability. As the currently used neurorehabilitation methods present several limitations, the ongoing research focuses on the use of non-invasive brain stimulation (NIBS) techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). NIBS methods were demonstrated to modulate neural excitability and improve motor and cognitive functioning in neurodegenerative diseases. However, their mechanisms of action are not fully elucidated, and the clinical outcomes are often unpredictable. This review explores the molecular processes underlying the effects of TMS and tDCS in stroke rehabilitation, including oxidative stress reduction, cell death, stimulation of neurogenesis, and neuroprotective phenotypes of glial cells. A highlight is put on the newly emerging therapeutic targets, such as ferroptotic and pyroptotic pathways. In addition, the issue of interindividual variability is discussed, and the role of neuroimaging techniques is investigated to get closer to personalized medicine. Furthermore, translational challenges of NIBS techniques are analyzed, and limitations of current clinical trials are investigated. The paper concludes with suggestions for further neurorehabilitation stroke treatment, putting the focus on combination and personalized therapies, as well as novel protocols of brain stimulation techniques.
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Affiliation(s)
- Aleksandra Markowska
- Department of Rehabilitation Medicine, Faculty of Medicine, Warsaw Medical University, Spartańska 1, 02-637 Warsaw, Poland;
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Wang X, Ding Q, Li Y, Li T, Li Y, Yin J, Zhuang W. Repetitive transcranial magnetic stimulation impacts the executive function of patients with vascular cognitive impairment: a systematic review and meta-analysis. Front Neurol 2024; 15:1374395. [PMID: 38962482 PMCID: PMC11220282 DOI: 10.3389/fneur.2024.1374395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024] Open
Abstract
Objective Executive dysfunction is a core symptom of vascular cognitive impairment (VCI), which seriously affects patients' prognosis. This paper aims to investigate the effectiveness of rTMS on executive function in VCI. Methods The databases selected for this study included Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, China Science and Technology Journal Database (VIP), and China Biology Medicine Disc (CBM). The screening times were conducted from the time of library construction until August 23, 2023. The inclusion criteria for this meta-analysis were randomized controlled trials (RCTs) on rTMS for VCI, which include executive function scores. The primary metrics were executive subscale scores of the Cognitive Comprehensive Scale and total scores of the Executive Specificity Scale. The secondary metrics were subscale scores of the Executive Specificity Scale. The quality of each eligible study was assessed using the Cochrane Risk of Bias tool. Meta-analysis and bias analysis were performed using Stata (version 16.0) and RevMan (version 5.3). Results A total of 20 high-quality clinical RCTs with 1,049 samples were included in this paper. The findings from the primary outcomes revealed that within the rTMS group, there were significantly higher scores observed for the executive sub-item on the cognitive composite scale (SMD = 0.93, 95% CI = 0.77-1.08, p < 0.00001, I 2 = 14%) and the total score on the executive specific scale (SMD = 0.69, 95% CI = 0.44-0.94, p < 0.00001, I 2 = 0%) compared to the control group. As for the secondary outcome measures, as shown by the Trail Making Test-A (time) (MD = -35.75, 95% CI = -68.37 to -3.12, p = 0.03, I 2 = 55%), the Stroop-C card (time) (SMD = -0.46, 95% CI = -0.86 to -0.06, p = 0.02, I 2 = 0%) and the Stroop-C card (correct number) (SMD = 0.49, 95% CI = 0.04-0.94, p = 0.03, I 2 = 0%), the experimental group shorts time and enhances accuracy of executive task in comparison to the control group. Subgroup analysis of the main outcome demonstrated that intermittent theta burst stimulation (iTBS), higher frequency, lower intensity, longer duration, and combined comprehensive therapy exhibited superior efficacy. Conclusion rTMS is effective in the treatment of the executive function of VCI. The present study has some limitations, so multi-center, large-sample, objective indicators and parameters are needed to further explore in the future.Systematic review registration:https://www.crd.york.ac.uk/prospero/, CRD42023459669.
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Affiliation(s)
- Xu Wang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Qixin Ding
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, China
| | - Yuefang Li
- School of Clinical Medicine, Henan University, Zhengzhou, China
| | - Tianshu Li
- Department of Rehabilitation Medicine, The First People’s Hospital of Zhengzhou, Zhengzhou, China
| | - Yakun Li
- Department of Rehabilitation, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jialin Yin
- Department of Rehabilitation, Henan Provincial People's Hospital, Zhengzhou, China
| | - Weisheng Zhuang
- Department of Rehabilitation, School of Rehabilitation Medicine, Henan Provincial People's Hospital, Henan University of Chinese Medicine, Zhengzhou, China
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Hong J, Chen J, Li C, Zhao F, Zhang J, Shan Y, Wen H. High-frequency rTMS alleviates cognitive impairment and regulates synaptic plasticity in the hippocampus of rats with cerebral ischemia. Behav Brain Res 2024; 467:115018. [PMID: 38678971 DOI: 10.1016/j.bbr.2024.115018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/15/2024] [Accepted: 04/24/2024] [Indexed: 05/01/2024]
Abstract
Poststroke cognitive impairment (PSCI) is a common complication of stroke, but effective treatments are currently lacking. Repetitive transcranial magnetic stimulation (rTMS) is gradually being applied to treat PSCI, but there is limited evidence of its efficacy. To determine rTMS effects on PSCI, we constructed a transient middle cerebral artery occlusion (tMCAO) rat model. Rats were then grouped by random digital table method: the sham group (n = 10), tMCAO group (n = 10) and rTMS group (n = 10). The shuttle box and Morris water maze (MWM) tests were conducted to detect the cognitive functions of the rats. In addition, synaptic density and synaptic ultrastructural parameters, including the active zone length, synaptic cleft width, and postsynaptic density (PSD) thickness, were quantified and analyzed using an electron microscope. What's more, synaptic associated proteins, including PSD95, SYN, and BDNF were detected by western blot. According to the shuttle box and MWM tests, rTMS improved tMCAO rats' cognitive functions, including spatial learning and memory and decision-making abilities. Electron microscopy revealed that rTMS significantly increased the synaptic density, synaptic active zone length and PSD thickness and decreased the synaptic cleft width. The western blot results showed that the expression of PSD95, SYN, and BDNF was markedly increased after rTMS stimulation. Based on these results, we propose that 20 Hz rTMS can significantly alleviate cognitive impairment after stroke. The underlying mechanism might be modulating the synaptic plasticity and up-regulating the expression PSD95, SYN, and BDNF in the hippocampus.
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Affiliation(s)
- Jiena Hong
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
| | - Jiemei Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
| | - Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
| | - Fei Zhao
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
| | - Jiantao Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
| | - Yilong Shan
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China.
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Chauhan P, Das SK, Shahanawaz SD. The Simultaneous Application of Transcranial Magnetic Stimulation and Virtual Reality to Treat Cognitive Deficits Among Stroke Patients: A Randomized Controlled Trial. Cureus 2024; 16:e62434. [PMID: 39011230 PMCID: PMC11249079 DOI: 10.7759/cureus.62434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/14/2024] [Indexed: 07/17/2024] Open
Abstract
Background and objective Integrating virtual reality (VR) and transcranial magnetic stimulation (TMS) offers a promising strategy for stroke rehabilitation, as it specifically focuses on reorganizing neural connections and activating brain activity in the cortex. The main goal is to create equitable connections between the brain's two hemispheres to enhance the execution of voluntary movements by stimulating the central executive network (CEN) to strengthen both motor and cognitive abilities. This study aims to propose a therapeutic approach that can improve cognitive recovery and overall quality of life in patients after a stroke. Methods A total of 69 participants were enrolled in the study based on certain inclusion and exclusion criteria. The patients underwent pre-assessment and were randomly allocated into three groups: Group 1 received simultaneous repetitive TMS (rTMS) and virtual reality treatment (VRT), Group 2 received rTMS combined with sham VRT, and Group 3 received sham stimulation with VRT, in a 1:1:1 ratio using opaque, sealed, and stapled envelopes (SNOSE). Post-assessment was carried out using the same measures: the National Institutes of Health Stroke Scale (NIHSS), Addenbrooke's Cognitive Test (ACE III), and Montreal Cognitive Assessment (MOCA). Statistical analysis was conducted to determine the specific outcomes. Data analysis was carried out using IBM SPSS Statistics version 29 (IBM Corp., Armonk, NY), employing student's t-test for within-group comparisons and repeated measures ANOVA for between-group comparisons. The significance level was set at 5%. Results The results demonstrated statistical significance in NIHSS scores across all treatment groups (p<0.001). Regarding cognitive outcomes, improvements were observed in memory, language, and overall cognitive performance (ACE III) within all groups (p<0.05), with significant between-group outcomes (p = 0.009, p = 0.01, p = 0.004, respectively), suggesting variations in treatment effects across cognitive domains. However, no significant differences between groups were found in terms of fluency and visuospatial skills (p = 0.49, p = 0.13), indicating no treatment effects in these domains. Conclusions Based on our findings, the combined intervention involving rTMS and VRT, compared to sham treatments, demonstrates promising outcomes in alleviating stroke severity and improving specific cognitive functions such as memory, language, and overall cognitive performance. Additionally, the combined administration offers a more effective therapy than when they are administered separately.
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Affiliation(s)
- Priya Chauhan
- Department of Physiotherapy, Amity Institute of Health Allied Sciences, Noida, IND
| | - Sanjib K Das
- Department of Physiotherapy, Amity Institute of Health Allied Sciences, Noida, IND
| | - S D Shahanawaz
- Department of Physiotherapy, College of Applied Medical Sciences, University of Hail, Hail, SAU
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Wang L, Wang L, Wang Z, Gao F, Wu J, Tang H. Clinical Effect Analysis of Wearable Sensor Technology-Based Gait Function Analysis in Post-Transcranial Magnetic Stimulation Stroke Patients. SENSORS (BASEL, SWITZERLAND) 2024; 24:3051. [PMID: 38793907 PMCID: PMC11125090 DOI: 10.3390/s24103051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
(1) Background: This study evaluates the effectiveness of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in improving gait in post-stroke hemiplegic patients, using wearable sensor technology for objective gait analysis. (2) Methods: A total of 72 stroke patients were randomized into control, sham stimulation, and LF-rTMS groups, with all receiving standard medical treatment. The LF-rTMS group underwent stimulation on the unaffected hemisphere for 6 weeks. Key metrics including the Fugl-Meyer Assessment Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and gait parameters were measured before and after treatment. (3) Results: The LF-rTMS group showed significant improvements in the FMA-LE, BBS, MBI, and various gait parameters compared to the control and sham groups (p < 0.05). Specifically, the FMA-LE scores improved by an average of 5 points (from 15 ± 3 to 20 ± 2), the BBS scores increased by 8 points (from 35 ± 5 to 43 ± 4), the MBI scores rose by 10 points (from 50 ± 8 to 60 ± 7), and notable enhancements in gait parameters were observed: the gait cycle time was reduced from 2.05 ± 0.51 s to 1.02 ± 0.11 s, the stride length increased from 0.56 ± 0.04 m to 0.97 ± 0.08 m, and the walking speed improved from 35.95 ± 7.14 cm/s to 75.03 ± 11.36 cm/s (all p < 0.001). No adverse events were reported. The control and sham groups exhibited improvements but were not as significant. (4) Conclusions: LF-rTMS on the unaffected hemisphere significantly enhances lower-limb function, balance, and daily living activities in subacute stroke patients, with the gait parameters showing a notable improvement. Wearable sensor technology proves effective in providing detailed, objective gait analysis, offering valuable insights for clinical applications in stroke rehabilitation.
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Affiliation(s)
- Litong Wang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, China;
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Likai Wang
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Zhan Wang
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Fei Gao
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Jingyi Wu
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Hong Tang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, China;
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Raghavan P. Top-Down and Bottom-Up Mechanisms of Motor Recovery Poststroke. Phys Med Rehabil Clin N Am 2024; 35:235-257. [PMID: 38514216 DOI: 10.1016/j.pmr.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Stroke remains a leading cause of disability. Motor recovery requires the interaction of top-down and bottom-up mechanisms, which reinforce each other. Injury to the brain initiates a biphasic neuroimmune process, which opens a window for spontaneous recovery during which the brain is particularly sensitive to activity. Physical activity during this sensitive period can lead to rapid recovery by potentiating anti-inflammatory and neuroplastic processes. On the other hand, lack of physical activity can lead to early closure of the sensitive period and downstream changes in muscles, such as sarcopenia, muscle stiffness, and reduced cardiovascular capacity, and blood flow that impede recovery.
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Affiliation(s)
- Preeti Raghavan
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA; Department of Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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Cai M, Zhang JL, Wang XJ, Cai KR, Li SY, Du XL, Wang LY, Yang RY, Han J, Hu JY, Lyu J. Clinical application of repetitive transcranial magnetic stimulation in improving functional impairments post-stroke: review of the current evidence and potential challenges. Neurol Sci 2024; 45:1419-1428. [PMID: 38102519 DOI: 10.1007/s10072-023-07217-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
In recent years, the stroke incidence has been increasing year by year, and the related sequelae after stroke, such as cognitive impairment, motor dysfunction, and post-stroke depression, seriously affect the patient's rehabilitation and daily activities. Repetitive transcranial magnetic stimulation (rTMS), as a safe, non-invasive, and effective new rehabilitation method, has been widely recognized in clinical practice. This article reviews the application and research progress of rTMS in treating different functional impairments (cognitive impairment, motor dysfunction, unilateral spatial neglect, depression) after stroke in recent years, and preliminary summarized the possible mechanisms. It has been found that the key parameters that determine the effectiveness of rTMS in improving post-stroke functional impairments include pulse number, stimulated brain areas, stimulation intensity and frequency, as well as duration. Generally, high-frequency stimulation is used to excite the ipsilateral cerebral cortex, while low-frequency stimulation is used to inhibit the contralateral cerebral cortex, thus achieving a balance of excitability between the two hemispheres. However, the specific mechanisms and the optimal stimulation mode for different functional impairments have not yet reached a consistent conclusion, and more research is needed to explore and clarify the best way to use rTMS. Furthermore, we will identify the issues and challenges in the current research, explore possible mechanisms to deepen understanding of rTMS, propose future research directions, and offer insightful insights for better clinical applications.
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Affiliation(s)
- Ming Cai
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Jia-Ling Zhang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Xiao-Jun Wang
- Medical Research and Education Department, Shanghai Health Rehabilitation Hospital, Shanghai, 201615, China
| | - Ke-Ren Cai
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Shu-Yao Li
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Xin-Lin Du
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Li-Yan Wang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Ruo-Yu Yang
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Jia Han
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China
| | - Jing-Yun Hu
- Central Lab, Shanghai Key Laboratory of Pathogenic Fungi Medical Testing, Shanghai Pudong New Area People's Hospital, Shanghai, 201299, China.
| | - Jie Lyu
- College of Rehabilitation Sciences, Shanghai University of Medicine and Health Sciences, Shanghai, 201318, China.
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Han C, Tang J, Tang B, Han T, Pan J, Wang N. The effectiveness and safety of noninvasive brain stimulation technology combined with speech training on aphasia after stroke: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e36880. [PMID: 38215135 PMCID: PMC10783273 DOI: 10.1097/md.0000000000036880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Although the effectiveness of noninvasive brain stimulation (NIBS) technology in assisting rehabilitation is widely recognized, its therapeutic efficacy in patients with poststroke aphasia (PSA) requires further validation. Here, we aimed to explore the efficacy and safety of the NIBS technique combined with speech training in PSA by traditional Meta-analysis and to compare the intervention effects of the 2 NIBS techniques by Network meta-analysis. METHODS Randomized controlled trials of the NIBS technique combined with speech training for treating PSA in 9 databases, including Web of Science, PubMed, and CNKI, and 2 clinical trial registries were searched by computer. Literature screening was performed using EndNote X9 software, and data analysis and presentation of results were performed using RevMan 5.4.1 and Stata 17.0 software. RESULTS Screening yielded 17 studies with 1013 patients with PSA. Meta-analysis showed that aphasia quotient scores were higher in the intervention group than in the control group [standardized mean difference (SMD) = 1.06, 95% confidence interval (CI) (0.63, 1.49), Z = 4.80, P < .00001]; Western aphasia battery scores on all 4 subscales were higher than those of the control group, the spontaneous language score is [SMD = 0.62, 95% CI (0.46, 0.78), Z = 7.52, P < .00001], the listening comprehension score is [SMD = 0.46, 95% CI (0.30, 0.62), Z = 5.62, P < .00001], the repetition score is [SMD = 1.14, 95% CI (0.59, 1.70), Z = 4.04, P < .0001], the naming score is [SMD = 1.06, 95% CI (0.79, 1.32), Z = 7.85, P < .00001]; The effective rate of the intervention group was higher than that of the control group [odd ratio = 4.19, 95% CI (2.39, 7.37), Z = 4.99, P < .00001]. The results of the Network meta-analysis showed that the best probability ranking of the 2 NIBS techniques combined with speech training in improving aphasia quotient scores was repetitive transcranial magnetic stimulation group (92.2%) > transcranial direct current stimulation group (55.7%). Regarding safety, it was not found that the NIBS technique combined with speech training to treat PSA increases the risk of adverse reactions. CONCLUSION The NIBS technique combined with speech training can effectively improve the recovery of language function in PSA patients with minimal adverse effects, and the clinic can give priority to r TMS combined with speech training in treating PSA.
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Affiliation(s)
- Congli Han
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jiqin Tang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
- The First Clinical Medical College of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Bingshun Tang
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Tao Han
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Jienuo Pan
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Nan Wang
- College of Rehabilitation Medicine, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Chai L, Huang Y, Guo X, Xiong A, Lin B, Huang J. Does SLT combined with NIBS enhance naming recovery in post-stroke aphasia? A meta-analysis and systematic review. NeuroRehabilitation 2024; 54:543-561. [PMID: 38875053 DOI: 10.3233/nre-240065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024]
Abstract
BACKGROUND Non-invasive brain stimulation has been widely used as an adjunctive treatment for aphasia following stroke. OBJECTIVE The aim of this study was to investigate the effect of non-invasive brain stimulation as an adjunctive treatment on naming function in aphasia following stroke. METHODS This review included randomized controlled trials (RCTs) involving 5 databases (Web of Science, Embase, Cochrane Library, OVID and PubMed) that investigated the effects of electrical stimulation on stroke patients. The search included literature published up to November 2023. RESULTS We identified 18 studies, and the standardized mean differences (SMDs) showed that the effect sizes of TMS and tDCS were small to medium. Moreover, the treatment effects persisted over time, indicating long-term efficacy. CONCLUSION This study suggested that NIBS combined with speech and language therapy can effectively promote the recovery of naming function in patients with post-stroke aphasia (PSA) and that the effects are long lasting.
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Affiliation(s)
- Linsong Chai
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Yunshi Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Xinqi Guo
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Ailing Xiong
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Bingbing Lin
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jia Huang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
- Fujian Key Laboratory of Rehabilitation Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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12
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Li X, Jin M, Zhang N, Hongman W, Fu L, Qi Q. Neural correlates of fine motor grasping skills: Longitudinal insights into motor cortex activation using fNIRS. Brain Behav 2024; 14:e3383. [PMID: 38376039 PMCID: PMC10784192 DOI: 10.1002/brb3.3383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/01/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Motor learning is essential for performing specific tasks and progresses through distinct stages, including the rapid learning phase (initial skill acquisition), the consolidation phase (skill refinement), and the stable performance phase (skill mastery and maintenance). Understanding the cortical activation dynamics during these stages can guide targeted rehabilitation interventions. METHODS In this longitudinal randomized controlled trial, functional near-infrared spectroscopy was used to explore the temporal dynamics of cortical activation in hand-related motor learning. Thirty-one healthy right-handed individuals were randomly assigned to perform either easy or intricate motor tasks with their non-dominant hand over 10 days. We conducted 10 monitoring sessions to track cortical activation in the right hemisphere (according to lateralization principles, the primary hemisphere for motor control) and evaluated motor proficiency concurrently. RESULTS The study delineated three stages of nondominant hand motor learning: rapid learning (days 1 and 2), consolidation (days 3-7), and stable performance (days 8-10). There was a power-law enhancement of motor skills correlated with learning progression. Sustained activation was observed in the supplementary motor area (SMA) and parietal lobe (PL), whereas activation in the right primary motor cortex (M1R) and dorsolateral prefrontal cortex (PFCR) decreased. These cortical activation patterns exhibited a high correlation with the augmentation of motor proficiency. CONCLUSIONS The findings suggest that early rehabilitation interventions, such as transcranial magnetic stimulation and transcranial direct current stimulation (tDCS), could be optimally directed at M1 and PFC in the initial stages. In contrast, SMA and PL can be targeted throughout the motor learning process. This research illuminates the path for developing tailored motor rehabilitation interventions based on specific stages of motor learning. NEW AND NOTEWORTHY In an innovative approach, our study uniquely combines a longitudinal design with the robustness of generalized estimating equations (GEEs). With the synergy of functional near-infrared spectroscopy (fNIRS) and the Minnesota Manual Dexterity Test (MMDT) paradigm, we precisely trace the evolution of neural resources during complex, real-world fine-motor task learning. Centering on right-handed participants using their nondominant hand magnifies the intricacies of right hemisphere spatial motor processing. We unravel the brain's dynamic response throughout motor learning stages and its potent link to motor skill enhancement. Significantly, our data point toward the early-phase rehabilitation potential of TMS and transcranial direct current stimulation on the M1 and PFC regions. Concurrently, SMA and PL appear poised to benefit from ongoing interventions during the entire learning curve. Our findings carve a path for refined motor rehabilitation strategies, underscoring the importance of timely noninvasive brain stimulation treatments.
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Affiliation(s)
- Xiaoli Li
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - Minxia Jin
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - Nan Zhang
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - Wei Hongman
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - LianHui Fu
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
| | - Qi Qi
- Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center)ShanghaiChina
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He Y, Tan X, Kang H, Wang H, Xie Y, Zheng D, Li C. Research trends and hotspots of post-stroke dysphagia rehabilitation: a bibliometric study and visualization analysis. Front Neurol 2023; 14:1279452. [PMID: 38156085 PMCID: PMC10754621 DOI: 10.3389/fneur.2023.1279452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 12/30/2023] Open
Abstract
Background Post-stroke dysphagia (PSD) is one of the most prevalent stroke sequelae, affecting stroke patients' prognosis, rehabilitation results, and quality of life while posing a significant cost burden. Although studies have been undertaken to characterize the pathophysiology, epidemiology, and risk factors of post-stroke dysphagia, there is still a paucity of research trends and hotspots on this subject. The purpose of this study was to create a visual knowledge map based on bibliometric analysis that identifies research hotspots and predicts future research trends. Methods We searched the Web of Science Core Collection for material on PSD rehabilitation research from its inception until July 27, 2023. We used CiteSpace, VOSviewer, and Bibliometrix R software packages to evaluate the annual number of publications, nations, institutions, journals, authors, references, and keywords to describe present research hotspots and prospective research orientations. Results This analysis comprised 1,097 articles from 3,706 institutions, 374 journals, and 239 countries or regions. The United States had the most publications (215 articles), and it is the most influential country on the subject. "Dysphagia" was the most published journal (100 articles) and the most referenced journal (4,606 citations). Highly cited references focused on the pathophysiology and neuroplasticity mechanisms of PSD, therapeutic modalities, rehabilitation tactics, and complications prevention. There was a strong correlation between the terms "validity" and "noninvasive," which were the strongest terms in PSD rehabilitation research. The most significant words in PSD rehabilitation research were "validity" and "noninvasive brain stimulation," which are considered two of the most relevant hotspots in the field. Conclusion We reviewed the research in the field of PSD rehabilitation using bibliometrics to identify research hotspots and cutting-edge trends in the field, primarily including the pathogenesis and neurological plasticity mechanisms of PSD, complications, swallowing screening and assessment methods, and swallowing rehabilitation modalities, and this paper can provide in the follow-up research in the field of PSD rehabilitation. The results of this study can provide insightful data for subsequent studies in the field of PSD rehabilitation.
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Affiliation(s)
- Yuanyuan He
- College of Nursing, Jinan University, Guangzhou, China
| | - Xuezeng Tan
- Department of Critical Care Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Huiqi Kang
- College of Nursing, Jinan University, Guangzhou, China
| | - Huan Wang
- College of Nursing, Jinan University, Guangzhou, China
| | - Yuyao Xie
- College of Nursing, Jinan University, Guangzhou, China
| | - Dongxiang Zheng
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Chen Li
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, China
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Cash JJ, Bowden MG, Boan AD, McTeague LM, Kindred JH. Systematic Evaluation of the Effects of Voluntary Activation on Lower Extremity Motor Thresholds. J Clin Med 2023; 12:5993. [PMID: 37762933 PMCID: PMC10531833 DOI: 10.3390/jcm12185993] [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: 08/19/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
The purpose of this investigation was to elucidate the relationship between the resting motor threshold (rMT) and active motor threshold (aMT). A cross-sectional comparison of MTs measured at four states of lower extremity muscle activation was conducted: resting, 5% maximal voluntary contraction (MVC), 10%MVC, and standing. MTs were measured at the tibialis anterior in the ipsilesional and contralesional limbs in participants in the chronic phase (>6 months) of stroke (n = 11) and in the dominant limb of healthy controls (n = 11). To compare across activation levels, the responses were standardized using averaged peak-to-peak background electromyography (EMG) activity measured at 10%MVC + 2SD for each participant, in addition to the traditional 0.05 mV criterion for rMT (rMT50). In all participants, as muscle activation increased, the least square mean estimates of MTs decreased (contralesional: p = 0.008; ipsilesional: p = 0.0015, healthy dominant: p < 0.0001). In healthy controls, rMT50 was significantly different from all other MTs (p < 0.0344), while in stroke, there were no differences in either limb (p > 0.10). This investigation highlights the relationship between rMT and aMTs, which is important as many stroke survivors do not present with an rMT, necessitating the use of an aMT. Future works may consider the use of the standardized criterion that accounted for background EMG activity across activation levels.
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Affiliation(s)
- Jasmine J. Cash
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Mark G. Bowden
- Department of Clinical Integration and Research, Brooks Rehabilitation, Jacksonville, FL 32216, USA;
| | - Andrea D. Boan
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Lisa M. McTeague
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA;
- Ralph H Johnson VA Health Care System, Charleston, SC 29401, USA
| | - John H. Kindred
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC 29425, USA;
- Ralph H Johnson VA Health Care System, Charleston, SC 29401, USA
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