1
|
Mizuta N, Hasui N, Kai T, Inui Y, Sato M, Ohnishi S, Taguchi J, Nakatani T. Characteristics of limb kinematics in the gait disorders of post-stroke patients. Sci Rep 2024; 14:3082. [PMID: 38321081 PMCID: PMC10847092 DOI: 10.1038/s41598-024-53616-w] [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: 05/22/2023] [Accepted: 02/02/2024] [Indexed: 02/08/2024] Open
Abstract
Post-stroke gait disorders involve altered lower limb kinematics. Recently, the endpoint of the lower limb has been used as a control variable to understand gait kinematics better. In a cross-sectional study of sixty-seven post-stroke patients, the limb extension angle and effective limb length during gait were used as input variables with a mixed Gaussian model-based probabilistic clustering approach to identify five distinct clusters. Each cluster had unique characteristics related to motor paralysis, spasticity, balance ability, and gait strategy. Cluster 1 exhibited high limb extension angle and length values, indicating increased spasticity. Cluster 2 had moderate extension angles and high limb lengths, indicating increased spasticity and reduced balance ability. Cluster 3 had low limb extension angles and high limb length, indicating reduced balance ability, more severe motor paralysis, and increased spasticity. Cluster 4 demonstrated high extension angles and short limb lengths, with a gait strategy that prioritized stride length in the component of gait speed. Cluster 5 had moderate extension angles and short limb lengths, with a gait strategy that prioritized cadence in the component of gait speed. These findings provide valuable insights into post-stroke gait impairment and can guide the development of personalized and effective rehabilitation strategies.
Collapse
Affiliation(s)
- Naomichi Mizuta
- Department of Rehabilitation, Faculty of Health Sciences, Nihon Fukushi University, 26-2 Higashihaemi-cho, Handa-shi, Aichi, 475-0012, Japan.
- Neurorehabilitation Research Center, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan.
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan.
| | - Naruhito Hasui
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Takumi Kai
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Rehabilitation Medicine, Hatsudai Rehabilitation Hospital, 3-53-3 Honmachi, Shibuya-ku, Tokyo, 151-0071, Japan
| | - Yasuhiro Inui
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
- Department of Rehabilitation, Nara Prefecture General Rehabilitation Center, 722 Oo, Tawaramoto, Shiki-gun, Nara, 636-0393, Japan
| | - Masahiro Sato
- Department of Rehabilitation, Nakazuyagi Hospital, 1-31, Nakazu, Tokushima-shi, Tokushima, 770-0856, Japan
| | - Sora Ohnishi
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
- Department of Neurorehabilitation, Graduate School of Health Sciences, Kio University, 4-2-2 Umaminaka, Koryo, Kitakatsuragi-gun, Nara, 635-0832, Japan
| | - Junji Taguchi
- Department of Medical, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| | - Tomoki Nakatani
- Department of Therapy, Takarazuka Rehabilitation Hospital, 22-2 Tsurunoso, Takarazuka-shi, Hyogo, 665-0833, Japan
| |
Collapse
|
2
|
Li LL, Wu JJ, Ma J, Li YL, Xue X, Li KP, Jin J, Hua XY, Zheng MX, Xu JG. White matter fiber integrity and structural brain network topology: implications for balance function in postischemic stroke patients. Cereb Cortex 2024; 34:bhad452. [PMID: 38037387 DOI: 10.1093/cercor/bhad452] [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: 09/14/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Previous studies have suggested that ischemic stroke can result in white matter fiber injury and modifications in the structural brain network. However, the relationship with balance function scores remains insufficiently explored. Therefore, this study aims to explore the alterations in the microstructural properties of brain white matter and the topological characteristics of the structural brain network in postischemic stroke patients and their potential correlations with balance function. We enrolled 21 postischemic stroke patients and 21 age, sex, and education-matched healthy controls (HC). All participants underwent balance function assessment and brain diffusion tensor imaging. Tract-based spatial statistics (TBSS) were used to compare the fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity of white matter fibers between the two groups. The white matter structural brain network was constructed based on the automated anatomical labeling atlas, and we conducted a graph theory-based analysis of its topological properties, including global network properties and local node properties. Additionally, the correlation between the significant structural differences and balance function score was analyzed. The TBSS results showed that in comparison to the HC, postischemic stroke patients exhibited extensive damage to their whole-brain white matter fiber tracts (P < 0.05). Graph theory analysis showed that in comparison to the HC, postischemic stroke patients exhibited statistically significant reductions in the values of global efficiency, local efficiency, and clustering coefficient, as well as an increase in characteristic path length (P < 0.05). In addition, the degree centrality and nodal efficiency of some nodes in postischemic stroke patients were significantly reduced (P < 0.05). The white matter fibers of the entire brain in postischemic stroke patients are extensively damaged, and the topological properties of the structural brain network are altered, which are closely related to balance function. This study is helpful in further understanding the neural mechanism of balance function after ischemic stroke from the white matter fiber and structural brain network topological properties.
Collapse
Affiliation(s)
- Ling-Ling Li
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jia-Jia Wu
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jie Ma
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Yu-Lin Li
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xin Xue
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Kun-Peng Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Jing Jin
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Mou-Xiong Zheng
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai 201203, China
| |
Collapse
|
3
|
Park H, Han S, Sung J, Hwang S, Youn I, Kim SJ. Classification of gait phases based on a machine learning approach using muscle synergy. Front Hum Neurosci 2023; 17:1201935. [PMID: 37266322 PMCID: PMC10230056 DOI: 10.3389/fnhum.2023.1201935] [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: 04/07/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023] Open
Abstract
The accurate detection of the gait phase is crucial for monitoring and diagnosing neurological and musculoskeletal disorders and for the precise control of lower limb assistive devices. In studying locomotion mode identification and rehabilitation of neurological disorders, the concept of modular organization, which involves the co-activation of muscle groups to generate various motor behaviors, has proven to be useful. This study aimed to investigate whether muscle synergy features could provide a more accurate and robust classification of gait events compared to traditional features such as time-domain and wavelet features. For this purpose, eight healthy individuals participated in this study, and wireless electromyography sensors were attached to four muscles in each lower extremity to measure electromyography (EMG) signals during walking. EMG signals were segmented and labeled as 2-class (stance and swing) and 3-class (weight acceptance, single limb support, and limb advancement) gait phases. Non-negative matrix factorization (NNMF) was used to identify specific muscle groups that contribute to gait and to provide an analysis of the functional organization of the movement system. Gait phases were classified using four different machine learning algorithms: decision tree (DT), k-nearest neighbors (KNN), support vector machine (SVM), and neural network (NN). The results showed that the muscle synergy features had a better classification accuracy than the other EMG features. This finding supported the hypothesis that muscle synergy enables accurate gait phase classification. Overall, the study presents a novel approach to gait analysis and highlights the potential of muscle synergy as a tool for gait phase detection.
Collapse
Affiliation(s)
- Heesu Park
- Biomedical Research Division, Korea Institute of Science and Technology, Seoul, Republic of Korea
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sungmin Han
- Biomedical Research Division, Korea Institute of Science and Technology, Seoul, Republic of Korea
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, Republic of Korea
| | - Joohwan Sung
- Biomedical Research Division, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Soree Hwang
- Biomedical Research Division, Korea Institute of Science and Technology, Seoul, Republic of Korea
- School of Biomedical Engineering, Korea University, Seoul, Republic of Korea
| | - Inchan Youn
- Biomedical Research Division, Korea Institute of Science and Technology, Seoul, Republic of Korea
- Division of Bio-Medical Science and Technology, KIST School, Korea University of Science and Technology, Seoul, Republic of Korea
| | - Seung-Jong Kim
- Department of Biomedical Engineering, Korea University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
4
|
Costanzo R, Balasubramanian K, Marrone S, Porzio M, Iacopino DG, Nicoletti GF, Scalia G. Letter to the Editor Regarding "Natural History of Intracranial Arachnoid Cysts". World Neurosurg 2023; 173:286-288. [PMID: 37189311 DOI: 10.1016/j.wneu.2023.01.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Roberta Costanzo
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy.
| | | | - Salvatore Marrone
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Massimiliano Porzio
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone," Post Graduate Residency Program in Neurologic Surgery, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy
| | | | - Gianluca Scalia
- Department of Head and Neck Surgery, Neurosurgery Unit, Garibaldi Hospital, Catania, Italy
| |
Collapse
|
5
|
Joubran K, Bar-Haim S, Shmuelof L. The functional and structural neural correlates of dynamic balance impairment and recovery in persons with acquired brain injury. Sci Rep 2022; 12:7990. [PMID: 35568728 PMCID: PMC9107482 DOI: 10.1038/s41598-022-12123-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 05/03/2022] [Indexed: 12/29/2022] Open
Abstract
Dynamic balance control is associated with the function of multiple brain networks and is impaired following Acquired Brain Injury (ABI). This study aims to characterize the functional and structural correlates of ABI-induced dynamic balance impairments and recovery following a rehabilitation treatment. Thirty-one chronic participants with ABI participated in a novel rehabilitation treatment composed of 22 sessions of a perturbation-based rehabilitation training. Dynamic balance was assessed using the Community Balance and Mobility scale (CB&M) and the 10-Meter Walking Test (10MWT). Brain function was estimated using resting-state fMRI imaging that was analysed using independent component analysis (ICA), and regions-of-interest analyses. Brain morphology was also assessed using structural MRI. ICA revealed a reduction in component-related activation within the sensorimotor and cerebellar networks post-intervention. Improvement in CB&M scale was associated with a reduction in FC within the cerebellar network and with baseline FC within the cerebellar-putamen and cerebellar-thalamic networks. Improvement in 10MWT was associated with baseline FC within the cerebellar-putamen and cerebellar-cortical networks. Brain volume analysis did not reveal structural correlates of dynamic balance, but dynamic balance was correlated with time since injury. Our results show that dynamic balance recovery is associated with FC reduction within and between the cerebellar and sensorimotor networks. The lack of global structural correlates of dynamic balance may point to the involvement of specific networks in balance control.
Collapse
Affiliation(s)
- Katherin Joubran
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel. .,Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel. .,Department of Physical Therapy, Zefat College, Zefat, Israel.
| | - Simona Bar-Haim
- Department of Physical Therapy, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Lior Shmuelof
- Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel. .,Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, 84105, Beer-Sheva, Israel.
| |
Collapse
|
6
|
Nam SM, Lee DY. Effects of Visual Cue Deprivation Balance Training with Head Control on Balance and Gait Function in Stroke Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:629. [PMID: 35630046 PMCID: PMC9148052 DOI: 10.3390/medicina58050629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Visual cue deprivation is the instability of head control is increased. The purpose of this study is to investigate the effects of visual cue deprivation balance training by applying head control feedback to the balance and gait ability of stroke patients. Materials and Methods: The study was conducted on 41 patients diagnosed with hemiplegia due to stroke. Subjects were randomly assigned to any of the following groups: the experimental group I, the experimental group II or the control group. The randomization method used a simple randomization method. To evaluate changes in balance function, a LOS (Limit of Stability) and a BBS (Berg Balance Scale) were performed. In addition, to evaluate changes in ST (stride time), SL (stride length), and cadence, a LEGSys were performed. Results: A two-way repeated ANOVA was conducted to analyze the differences between groups. There were significant differences between groups in all variables for the balance function. There were significant differences between groups in all variables for the balance function. There were significant differences between groups in SL and cadence for the gait function. Conclusions: Visual cue deprivation balance training applying head control feedback is effective in improving dynamic balance ability and cadence. It is necessary to constantly maintain the head orientation by feedback and to properly control the head movement.
Collapse
Affiliation(s)
- Seung-Min Nam
- Department of Sports Rehabilitation & Exercise Management, Yeungnam University College, Daegu-si 42415, Korea;
| | - Do-Youn Lee
- Department of Physical Therapy, Daegu University, Gyeongsan-si 38541, Korea
| |
Collapse
|
7
|
Effects of Transcranial Direct Current Electrical Stimulation over the Supplementary Motor Area Combined with Walking on the Intramuscular Coherence of the Tibialis Anterior in a Subacute Post-Stroke Patient: A Single-Case Study. Brain Sci 2022; 12:brainsci12050540. [PMID: 35624929 PMCID: PMC9139188 DOI: 10.3390/brainsci12050540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 02/04/2023] Open
Abstract
Motor recovery is related to the corticospinal tract (CST) lesion in post-stroke patients. The CST originating from the supplementary motor area (SMA) affects the recovery of impaired motor function. We confirmed the effects of transcranial direct current stimulation (tDCS) over the SMA combined with walk training on CST excitability. This study involved a stroke patient with severe sensorimotor deficits and a retrospective AB design. Walk training was conducted only in phase A. Phase B consisted of anodal tDCS (1.5 mA) combined with walk training. Walking speed, stride time variability (STV; reflecting gait stability), and beta-band intramuscular coherence—derived from the paired tibialis anterior on the paretic side (reflecting CST excitability)—were measured. STV quantified the coefficient of variation in stride time using accelerometers. Intramuscular coherence during the early stance phase noticeably increased in phase B compared with phase A. Intramuscular coherence in both the stance and swing phases was reduced at follow-up. Walking speed showed no change, while STV was noticeably decreased in phase B compared with phase A. These results suggest that tDCS over the SMA during walking improves gait stability by enhancing CST excitability in the early stance phase.
Collapse
|
8
|
Mutoh T, Kunitoki K, Tatewaki Y, Yamamoto S, Thyreau B, Matsudaira I, Kawashima R, Taki Y. Impact of medium-chain triglycerides on gait performance and brain metabolic network in healthy older adults: a double-blind, randomized controlled study. GeroScience 2022; 44:1325-1338. [PMID: 35380356 DOI: 10.1007/s11357-022-00553-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/21/2022] [Indexed: 12/22/2022] Open
Abstract
Nutritional supplementation with medium-chain triglycerides (MCTs) has the potential to increase memory function in elderly patients with frailty and dementia. Our aim was to investigate the effects of MCT on cognitive and gait functions and their relationships with focal brain metabolism and functional connectivity even in healthy older adults. Participants were blindly randomized and allocated to two groups: 18 g/day of MCT oil and matching placebo formula (control) administered as a jelly stick (6 g/pack, ingested three times a day). Gait analysis during the 6-m walk test, cognition, brain focal glucose metabolism quantified by 18F-fluorodeocyglucose positron emission tomography, and magnetic resonance imaging-based functional connectivity were assessed before and after a 3-month intervention. Sixty-three healthy, normal adults (females and males) were included. Compared with the control group, the MCT group showed better balance ability, as represented by the lower Lissajous index (23.1 ± 14.4 vs. 31.3 ± 18.9; P < 0.01), although no time × group interaction was observed in cognitive and other gait parameters. Moreover, MCT led to suppressed glucose metabolism in the right sensorimotor cortex compared with the control (P < 0.001), which was related to improved balance (r = 0.37; P = 0.04) along with increased functional connectivity from the ipsilateral cerebellar hemisphere. In conclusion, a 3-month MCT supplementation improves walking balance by suppressing glucose metabolism, which suggests the involvement of the cerebro-cerebellar network. This may reflect, at least in part, the inverse reaction of the ketogenic switch as a beneficial effect of long-term MCT dietary treatment.
Collapse
Affiliation(s)
- Tatsushi Mutoh
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan. .,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Aoba-ku, Sendai, 980-8575, Japan. .,Department of Neurosurgery, Research Institute for Brain and Blood Vessels-AKITA, Senshu-Kubota-machi, Akita, 010-0874, Japan.
| | - Keiko Kunitoki
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Yasuko Tatewaki
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Aoba-ku, Sendai, 980-8575, Japan
| | - Shuzo Yamamoto
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan.,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Aoba-ku, Sendai, 980-8575, Japan
| | - Benjamin Thyreau
- Smart-Aging Research Center, Tohoku University, Aoba-ku, Sendai, 980-8575, Japan
| | - Izumi Matsudaira
- Smart-Aging Research Center, Tohoku University, Aoba-ku, Sendai, 980-8575, Japan
| | - Ryuta Kawashima
- Department of Functional Brain Imaging, Institute of Development, Aging and Cancer, Tohoku University, Aoba-ku, Sendai, 980-8575, Japan
| | - Yasuyuki Taki
- Department of Aging Research and Geriatric Medicine, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan. .,Department of Geriatric Medicine and Neuroimaging, Tohoku University Hospital, Aoba-ku, Sendai, 980-8575, Japan. .,Smart-Aging Research Center, Tohoku University, Aoba-ku, Sendai, 980-8575, Japan.
| |
Collapse
|
9
|
Cordani C, Preziosa P, Gatti R, Castellani C, Filippi M, Rocca MA. Mapping brain structure and function in professional fencers: A model to study training effects on central nervous system plasticity. Hum Brain Mapp 2022; 43:3375-3385. [PMID: 35362649 PMCID: PMC9248301 DOI: 10.1002/hbm.25854] [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: 09/22/2021] [Revised: 01/10/2022] [Accepted: 03/16/2022] [Indexed: 11/12/2022] Open
Abstract
Brain magnetic resonance imaging (MRI) studies have shown different patterns of structural and functional reorganization in high‐level athletes compared with controls, but little is known about their relationship with interlimb coordination mechanisms. To this aim, we investigated brain structural and functional differences in high‐level fencers compared with nonathlete controls and the MRI substrates of interlimb coordination in elite athletes. Fourteen right‐handed male fencers (median age = 22.3 years) and 15 right‐handed age‐ and sex‐matched healthy subjects (median age = 22.4 years) underwent structural and functional MRI acquisition during the execution of cyclic bimanual‐movements as well as during in‐phase and antiphase hand/foot‐movements of the dominant‐right limbs. No between‐group differences were found in gray matter volumes and white matter architecture. Active‐fMRI showed that controls versus fencers had higher activations in parietal and temporal areas during bimanual‐task; whereas fencers versus controls had higher activations in the basal ganglia. During in‐phase task, controls versus fencers showed higher activation of right cerebellum, whereas fencers had higher activity mainly in frontal areas. The functional‐connectivity (FC) analysis showed that fencers versus controls had an increased FC between left motor cortex and fronto‐temporal areas as well as bilateral thalami during the different tasks. Intensive and prolonged fencing activity is associated with brain functional changes mainly involving frontal regions related to high‐level motor control and planning of complex tasks. These modifications are likely to reflect an optimization of brain networks involved in motor activities, including interlimb coordination tasks, occurring after intensive training.
Collapse
Affiliation(s)
- Claudio Cordani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Gatti
- Humanitas Clinical and Research Center, IRCCS and Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
10
|
Perry MK, Peters DM. Neural correlates of walking post-stroke: neuroimaging insights from the past decade. Exp Brain Res 2021; 239:3439-3446. [PMID: 34585257 DOI: 10.1007/s00221-021-06217-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 09/02/2021] [Indexed: 11/25/2022]
Abstract
Walking dysfunction such as slow walking speed and reduced independent mobility are common impairments following stroke. Neural mechanisms of upper limb impairment and motor recovery have been highly studied, while less is known about the neural correlates of walking dysfunction and rehabilitation after stroke. Our objective was to review the literature on neuroimaging correlates of walking and walking recovery post-stroke to provide a more comprehensive picture of neurological regions of interest. We searched the databases PubMed, CINAHL, Web of Science, and Cochrane Trials for articles published in English between January 1, 2010 and November 30, 2020 that assessed walking after stroke through neuroimaging and various clinical measures. The following key words were used: stroke, gait, walking, rehabilitation, brain mapping, neuroimaging, neural control of walking, motor recovery and motor function, and resulted in eighteen articles included in this review. These articles revealed regions of interest associated with lower extremity impairment and walking post-stroke to include the putamen, caudate, insula, pallidum, superior temporal gyrus, internal capsule, superior longitudinal fasciculus, corticospinal tract, corona radiata, and white matter associated with the pedunculopontine nucleus. This information strengthens our understanding of supraspinal control of walking post-stroke. However, future research on lesion location, functional and structural connectivity, and walking deficits is needed to confidently associate specific brain regions and white matter tracts/connectivity with specific impairments. Greater insight into neuromechanisms associated with response to neurorehabilitation post-stroke could improve treatment selection and prediction of motor recovery.
Collapse
Affiliation(s)
- McKenna K Perry
- Neuroscience Graduate Program, University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, USA.
| | - Denise M Peters
- Department of Rehabilitation and Movement Science, University of Vermont, 106 Carrigan Drive, Burlington, VT, 05405, USA
| |
Collapse
|
11
|
Formstone L, Huo W, Wilson S, McGregor A, Bentley P, Vaidyanathan R. Quantification of Motor Function Post-Stroke Using Novel Combination of Wearable Inertial and Mechanomyographic Sensors. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1158-1167. [PMID: 34129501 DOI: 10.1109/tnsre.2021.3089613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Subjective clinical rating scales represent the gold-standard for diagnosis of motor function following stroke. In practice however, they suffer from well-recognized limitations including assessor variance, low inter-rater reliability and low resolution. Automated systems have been proposed for empirical quantification but have not significantly impacted clinical practice. We address translational challenges in this arena through: (1) implementation of a novel sensor suite combining inertial measurement and mechanomyography (MMG) to quantify hand and wrist motor function; and (2) introduction of a new range of signal features extracted from the suite to supplement predicted clinical scores. The wearable sensors, signal features, and machine learning algorithms have been combined to produce classified ratings from the Fugl-Meyer clinical assessment rating scale. Furthermore, we have designed the system to augment clinical rating with several sensor-derived supplementary features encompassing critical aspects of motor dysfunction (e.g. joint angle, muscle activity, etc.). Performance is validated through a large-scale study on a post-stroke cohort of 64 patients. Fugl-Meyer Assessment tasks were classified with 75% accuracy for gross motor tasks and 62% for hand/wrist motor tasks. Of greater import, supplementary features demonstrated concurrent validity with Fugl-Meyer ratings, evidencing their utility as new measures of motor function suited to automated assessment. Finally, the supplementary features also provide continuous measures of sub-components of motor function, offering the potential to complement low accuracy but well-validated clinical rating scales when high-quality motor outcome measures are required. We believe this work provides a basis for widespread clinical adoption of inertial-MMG sensor use for post-stroke clinical motor assessment.
Collapse
|
12
|
Aerobic Exercise After Left-Sided Stroke Improves Gait Speed and Endurance: A Prospective Cohort Study. Am J Phys Med Rehabil 2021; 100:576-583. [PMID: 32932358 DOI: 10.1097/phm.0000000000001596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the effects of aerobic exercise on individuals who have had a stroke and showed baseline scores lower than the standard scores for the 6-min and 10-meter walk tests. DESIGN Individuals were assigned to groups according to gait performance, defined by the standard values in the 6-min and 10-meter walk tests (standard baseline score and lower baseline score), and brain injury side. Aerobic exercise, 30 mins per day, 2 times a week, for a total of 12 wks. The 6-min and 10-meter walk tests in five assessments: initial, after 4, 8, 12 wks, and 4 wks of follow-up, analyzed by multivariate analysis, with P value of less than 0.05. RESULTS The 6-min walk test data showed an increase in endurance for lower baseline score and left-brain injury, during assessments 4, and follow-up, compared with standard baseline score (F4,84 = 14.64). Lower baseline score showed endurance increase for assessments 2, 3, 4, and follow-up compared with assessment 1 (F4,84 = 7.70). The 10-meter walk test data showed an increase in speed for lower baseline score and left-brain injury, during assessments 3, 4, and follow-up, compared with assessment 1, 4, and follow-up, compared with assessment 2 (F4,84 = 5.33). CONCLUSIONS Aerobic exercise increases gait endurance and speed in individuals who have had a stroke, with left-brain injury, and lower baseline score in the 6-min and 10-meter walk tests.
Collapse
|
13
|
Lee BJ, Joo NY, Kim SH, Kim CR, Yang D, Park D. Evaluation of balance functions using temporo-spatial gait analysis parameters in patients with brain lesions. Sci Rep 2021; 11:2745. [PMID: 33531533 PMCID: PMC7854662 DOI: 10.1038/s41598-021-82358-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/18/2021] [Indexed: 11/09/2022] Open
Abstract
This study aimed to compare gait analysis and balance function measurements, such as the Berg balance scale (BBS) score to seek specific measurements that can represent the balance functions of patients with brain lesions. Additionally, we also compared other different gait function scale scores with gait analysis measurements. This study included 77 patients with brain lesions admitted to our institution between January 2017 and August 2020. Their gait analysis parameters and clinical data, including personal data; clinical diagnosis; duration of the disease; cognition, ambulation, and stair-climbing sub-scores of the modified Barthel index (MBI); manual muscle test (MMT) findings of both lower extremities; functional ambulation category (FAC); and BBS score, were retrospectively analyzed. A multiple linear regression analysis was performed to identify the gait analysis parameters that would significantly correlate with the balance function and other physical performances. In the results, the BBS scores were significantly correlated with the gait speed and step width/height2. However, the other gait function measurements, such as the FAC and ambulation and stair-climbing sub-scores of the MBI, were correlated only with the gait speed. Additionally, both the summations of the lower extremity MMT findings and anti-gravity lower extremity MMT findings were correlated with the average swing phase time. Therefore, in the gait analysis, the gait speed may be an important factor in determining the balance and gait functions of the patients with brain lesions. Moreover, the step width/height2 may be a significant factor in determining their balance function. However, further studies with larger sample sizes should be performed to confirm this relationship.
Collapse
Affiliation(s)
- Byung Joo Lee
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Daegu, Republic of Korea
| | - Na-Young Joo
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin sunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Sung Hyun Kim
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin sunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Chung Reen Kim
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin sunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Dongseok Yang
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin sunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Donghwi Park
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojin sunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea.
| |
Collapse
|
14
|
Frenkel-Toledo S, Ofir-Geva S, Mansano L, Granot O, Soroker N. Stroke Lesion Impact on Lower Limb Function. Front Hum Neurosci 2021; 15:592975. [PMID: 33597852 PMCID: PMC7882502 DOI: 10.3389/fnhum.2021.592975] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
The impact of stroke on motor functioning is analyzed at different levels. ‘Impairment’ denotes the loss of basic characteristics of voluntary movement. ‘Activity limitation’ denotes the loss of normal capacity for independent execution of daily activities. Recovery from impairment is accomplished by ‘restitution’ and recovery from activity limitation is accomplished by the combined effect of ‘restitution’ and ‘compensation.’ We aimed to unravel the long-term effects of variation in lesion topography on motor impairment of the hemiparetic lower limb (HLL), and gait capacity as a measure of related activity limitation. Gait was assessed by the 3 m walk test (3MWT) in 67 first-event chronic stroke patients, at their homes. Enduring impairment of the HLL was assessed by the Fugl–Meyer Lower Extremity (FMA-LE) test. The impact of variation in lesion topography on HLL impairment and on walking was analyzed separately for left and right hemispheric damage (LHD, RHD) by voxel-based lesion-symptom mapping (VLSM). In the LHD group, HLL impairment tended to be affected by damage to the posterior limb of the internal capsule (PLIC). Walking capacity tended to be affected by a larger array of structures: PLIC and corona radiata, external capsule and caudate nucleus. In the RHD group, both HLL impairment and walking capacity were sensitive to damage in a much larger number of brain voxels. HLL impairment was affected by damage to the corona radiata, superior longitudinal fasciculus and insula. Walking was affected by damage to the same areas, plus the internal and external capsules, putamen, thalamus and parts of the perisylvian cortex. In both groups, voxel clusters have been found where damage affected FMA-LE and also 3MWT, along with voxels where damage affected only one of the measures (mainly 3MWT). In stroke, enduring ‘activity limitation’ is affected by damage to a much larger array of brain structures and voxels within specific structures, compared to enduring ‘impairment.’ Differences between the effects of left and right hemisphere damage are likely to reflect variation in motor-network organization and post-stroke re-organization related to hemispheric dominance. Further studies with larger sample size are required for the validation of these results.
Collapse
Affiliation(s)
- Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Shay Ofir-Geva
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lihi Mansano
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Granot
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
15
|
Kim WS, Choi H, Jung JW, Yoon JS, Jeoung JH. Asymmetry and Variability Should Be Included in the Assessment of Gait Function in Poststroke Hemiplegia With Independent Ambulation During Early Rehabilitation. Arch Phys Med Rehabil 2020; 102:611-618. [PMID: 33161006 DOI: 10.1016/j.apmr.2020.10.115] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To extract independent features from spatiotemporal data of poststroke gait. DESIGN Retrospective observational study. SETTING Motion analysis laboratory in the rehabilitation department of a university hospital. PARTICIPANTS Convenience sample from inpatients in subacute recovery stage post stroke. Of 98 patients post stroke who underwent gait assessment, 69 patients post stroke were included in the data analysis (N=69). They could walk more than 10 m without personal assist or assistive devices. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Spatiotemporal parameters during level walking and their asymmetry and variability were obtained by insole foot pressure measurement system. RESULTS Of independent components extracted by principal component analysis, 3 independent components explained 81.9% of total variance of spatiotemporal poststroke gait data. The first component has associations with walking speed and proportion of double support phase, and it explains 46.6% of total variance. The second component has association with temporal asymmetry, and it explains 21.1% of total variance. The third component has association with temporal variability, and it explains 14.2% of total variance. Principal component scores did not show significant differences between stroke types and among stroke lesions. CONCLUSIONS Temporal asymmetry and variability should be included in the assessment of poststroke gait during early rehabilitation. They are independent of each other and provide characteristics of poststroke gait that are independent to the walking speed. They are helpful for rehabilitation planning and developing treatment strategy in poststroke gait rehabilitation.
Collapse
Affiliation(s)
- Woo-Sub Kim
- Department of Physical Medicine & Rehabilitation, Korea University Guro Hospital, Seoul, South Korea.
| | - Hanboram Choi
- Department of Physical Medicine & Rehabilitation, Korea University Guro Hospital, Seoul, South Korea
| | - Jung-Woo Jung
- Department of Physical Medicine & Rehabilitation, Korea University Guro Hospital, Seoul, South Korea
| | - Joon Sik Yoon
- Department of Physical Medicine & Rehabilitation, Korea University Guro Hospital, Seoul, South Korea
| | - Ju Hyong Jeoung
- Department of Physical Medicine & Rehabilitation, Korea University Guro Hospital, Seoul, South Korea
| |
Collapse
|
16
|
Frenkel-Toledo S, Ofir-Geva S, Soroker N. Lesion Topography Impact on Shoulder Abduction and Finger Extension Following Left and Right Hemispheric Stroke. Front Hum Neurosci 2020; 14:282. [PMID: 32765245 PMCID: PMC7379861 DOI: 10.3389/fnhum.2020.00282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
The existence of shoulder abduction and finger extension movement capacity shortly after stroke onset is an important prognostic factor, indicating favorable functional outcomes for the hemiparetic upper limb (HUL). Here, we asked whether variation in lesion topography affects these two movements similarly or distinctly and whether lesion impact is similar or distinct for left and right hemisphere damage. Shoulder abduction and finger extension movements were examined in 77 chronic post-stroke patients using relevant items of the Fugl-Meyer test. Lesion effects were analyzed separately for left and right hemispheric damage patient groups, using voxel-based lesion-symptom mapping. In the left hemispheric damage group, shoulder abduction and finger extension were affected only by damage to the corticospinal tract in its passage through the corona radiata. In contrast, following the right hemispheric damage, these two movements were affected not only by corticospinal tract damage but also by damage to white matter association tracts, the putamen, and the insular cortex. In both groups, voxel clusters have been found where damage affected shoulder abduction and also finger extension, along with voxels where damage affected only one of the two movements. The capacity to execute shoulder abduction and finger extension movements following stroke is affected significantly by damage to shared and distinct voxels in the corticospinal tract in left-hemispheric damage patients and by damage to shared and distinct voxels in a larger array of cortical and subcortical regions in right hemispheric damage patients.
Collapse
Affiliation(s)
- Silvi Frenkel-Toledo
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Shay Ofir-Geva
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
17
|
Fifteen Years of Wireless Sensors for Balance Assessment in Neurological Disorders. SENSORS 2020; 20:s20113247. [PMID: 32517315 PMCID: PMC7308812 DOI: 10.3390/s20113247] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.
Collapse
|