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Zhao YN, Han PP, Zhang XY, Bi X. Applications of Functional Near-Infrared Spectroscopy (fNIRS) Neuroimaging During Rehabilitation Following Stroke: A Review. Med Sci Monit 2024; 30:e943785. [PMID: 38879751 PMCID: PMC11188690 DOI: 10.12659/msm.943785] [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: 01/12/2024] [Accepted: 04/17/2024] [Indexed: 06/22/2024] Open
Abstract
Stroke is a cerebrovascular disease that impairs blood supply to localized brain tissue regions due to various causes. This leads to ischemic and hypoxic lesions, necrosis of the brain tissue, and a variety of functional disorders. Abnormal cortical activation and functional connectivity occur in the brain after a stroke, but the activation patterns and functional reorganization are not well understood. Rehabilitation interventions can enhance functional recovery in stroke patients. However, clinicians require objective measures to support their practice, as outcome measures for functional recovery are based on scale scores. Furthermore, the most effective rehabilitation measures for treating patients are yet to be investigated. Functional near-infrared spectroscopy (fNIRS) is a non-invasive neuroimaging method that detects changes in cerebral hemodynamics during task performance. It is widely used in neurological research and clinical practice due to its safety, portability, high motion tolerance, and low cost. This paper briefly introduces the imaging principle and the advantages and disadvantages of fNIRS to summarize the application of fNIRS in post-stroke rehabilitation.
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Affiliation(s)
- Yi-Ning Zhao
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, PR China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, PR China
| | - Ping-Ping Han
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, PR China
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, PR China
| | - Xing-Yu Zhang
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, PR China
- Graduate School of Shanghai University of Traditional Chinese Medicine, Shanghai, PR China
| | - Xia Bi
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, PR China
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Boebinger S, Payne A, Martino G, Kerr K, Mirdamadi J, McKay JL, Borich M, Ting L. Precise cortical contributions to sensorimotor feedback control during reactive balance. PLoS Comput Biol 2024; 20:e1011562. [PMID: 38630803 PMCID: PMC11057980 DOI: 10.1371/journal.pcbi.1011562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 04/29/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
The role of the cortex in shaping automatic whole-body motor behaviors such as walking and balance is poorly understood. Gait and balance are typically mediated through subcortical circuits, with the cortex becoming engaged as needed on an individual basis by task difficulty and complexity. However, we lack a mechanistic understanding of how increased cortical contribution to whole-body movements shapes motor output. Here we use reactive balance recovery as a paradigm to identify relationships between hierarchical control mechanisms and their engagement across balance tasks of increasing difficulty in young adults. We hypothesize that parallel sensorimotor feedback loops engaging subcortical and cortical circuits contribute to balance-correcting muscle activity, and that the involvement of cortical circuits increases with balance challenge. We decomposed balance-correcting muscle activity based on hypothesized subcortically- and cortically-mediated feedback components driven by similar sensory information, but with different loop delays. The initial balance-correcting muscle activity was engaged at all levels of balance difficulty. Its onset latency was consistent with subcortical sensorimotor loops observed in the lower limb. An even later, presumed, cortically-mediated burst of muscle activity became additionally engaged as balance task difficulty increased, at latencies consistent with longer transcortical sensorimotor loops. We further demonstrate that evoked cortical activity in central midline areas measured using electroencephalography (EEG) can be explained by a similar sensory transformation as muscle activity but at a delay consistent with its role in a transcortical loop driving later cortical contributions to balance-correcting muscle activity. These results demonstrate that a neuromechanical model of muscle activity can be used to infer cortical contributions to muscle activity without recording brain activity. Our model may provide a useful framework for evaluating changes in cortical contributions to balance that are associated with falls in older adults and in neurological disorders such as Parkinson's disease.
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Affiliation(s)
- Scott Boebinger
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, United States of America
| | - Aiden Payne
- Department of Psychology, Florida State University, Tallahassee, Florida, United States of America
| | - Giovanni Martino
- Department of Biomedical Sciences, University of Padova, Padua, Italy
| | - Kennedy Kerr
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, United States of America
| | - Jasmine Mirdamadi
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, United States of America
| | - J. Lucas McKay
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, United States of America
- Departments of Biomedical Informatics and Neurology, Emory University, Atlanta, Georgia, United States of America
| | - Michael Borich
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, United States of America
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Lena Ting
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, Georgia, United States of America
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, Atlanta, Georgia, United States of America
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De Las Heras B, Rodrigues L, Cristini J, Moncion K, Ploughman M, Tang A, Fung J, Roig M. Measuring Neuroplasticity in Response to Cardiovascular Exercise in People With Stroke: A Critical Perspective. Neurorehabil Neural Repair 2024:15459683231223513. [PMID: 38291890 DOI: 10.1177/15459683231223513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Rehabilitative treatments that promote neuroplasticity are believed to improve recovery after stroke. Animal studies have shown that cardiovascular exercise (CE) promotes neuroplasticity but the effects of this intervention on the human brain and its implications for the functional recovery of patients remain unclear. The use of biomarkers has enabled the assessment of cellular and molecular events that occur in the central nervous system after brain injury. Some of these biomarkers have proven to be particularly valuable for the diagnosis of severity, prognosis of recovery, as well as for measuring the neuroplastic response to different treatments after stroke. OBJECTIVES To provide a critical analysis on the current evidence supporting the use of neurophysiological, neuroimaging, and blood biomarkers to assess the neuroplastic response to CE in individuals poststroke. RESULTS Most biomarkers used are responsive to the effects of acute and chronic CE interventions, but the response appears to be variable and is not consistently associated with functional improvements. Small sample sizes, methodological variability, incomplete information regarding patient's characteristics, inadequate standardization of training parameters, and lack of reporting of associations with functional outcomes preclude the quantification of the neuroplastic effects of CE poststroke using biomarkers. CONCLUSION Consensus on the optimal biomarkers to monitor the neuroplastic response to CE is currently lacking. By addressing critical methodological issues, future studies could advance our understanding of the use of biomarkers to measure the impact of CE on neuroplasticity and functional recovery in patients with stroke.
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Affiliation(s)
- Bernat De Las Heras
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Lynden Rodrigues
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Jacopo Cristini
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Kevin Moncion
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Ada Tang
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Joyce Fung
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
| | - Marc Roig
- Memory and Motor Rehabilitation Laboratory (MEMORY-LAB), Jewish Rehabilitation Hospital, Laval, QC, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital, Center for Interdisciplinary Research in Rehabilitation (CRIR), Laval, QC, Canada
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Palmer JA, Payne AM, Mirdamadi JL, Ting LH, Borich MR. Delayed cortical engagement associated with balance dysfunction after stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.28.23299035. [PMID: 38076827 PMCID: PMC10705625 DOI: 10.1101/2023.11.28.23299035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Cortical resources are typically engaged for balance and mobility in older adults, but these resources are impaired post-stroke. Although slowed balance and mobility after stroke have been well-characterized, the effects of unilateral cortical lesions due to stroke on neuromechanical control of balance is poorly understood. Our central hypothesis is that stroke impairs the ability to rapidly and effectively engage the cerebral cortex during balance and mobility behaviors, resulting in asymmetrical contributions of each limb to balance control. Using electroencephalography (EEG), we assessed cortical N1 responses evoked over fronto-midline regions (Cz) during balance recovery in response to backward support-surface perturbations loading both legs, as well as posterior-lateral directions that preferentially load the paretic or nonparetic leg. Cortical N1 responses were smaller and delayed in the stroke group. While older adults exhibited weak or absent relationships between cortical responses and clinical function, stroke survivors exhibited strong associations between slower N1 latencies and slower walking, lower clinical mobility, and lower balance function. We further assessed kinetics of balance recovery during perturbations using center of pressure rate of rise. During backward support-surface perturbations that loaded the legs bilaterally, balance recovery kinetics were not different between stroke and control groups and were not associated with cortical response latency. However, lateralized perturbations revealed slower kinetic reactions during paretic loading compared to controls, and to non-paretic loading within stroke participants. Individuals post stroke had similar nonparetic-loaded kinetic reactions to controls implicating that they effectively compensate for impaired paretic leg kinetics when relying on the non-paretic leg. In contrast, paretic-loaded balance recovery revealed time-synchronized associations between slower cortical responses and slower kinetic reactions only in the stroke group, potentially reflecting the limits of cortical engagement for balance recovery revealed within the behavioral context of paretic motor capacity. Overall, our results implicate individuals after stroke may be uniquely limited in their balance ability by the slowed speed of their cortical engagement, particularly under challenging balance conditions that rely on the paretic leg. We expect this neuromechanical insight will enable progress toward an individualized framework for the assessment and treatment of balance impairments based on the interaction between neuropathology and behavioral context.
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Affiliation(s)
- Jacqueline A Palmer
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
| | - Aiden M Payne
- Department of Psychology, College of Arts and Sciences, Florida State University, Tallahassee, FL, USA
| | - Jasmine L Mirdamadi
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
| | - Lena H Ting
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
- Department of Biomedical Engineering, Emory and Georgia Tech, 1760 Haygood Road, Atlanta, GA, 30322, USA
| | - Michael R Borich
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University, 1441 Clifton Road NE, Atlanta, GA 30322 USA
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Boyer KA, Hayes KL, Umberger BR, Adamczyk PG, Bean JF, Brach JS, Clark BC, Clark DJ, Ferrucci L, Finley J, Franz JR, Golightly YM, Hortobágyi T, Hunter S, Narici M, Nicklas B, Roberts T, Sawicki G, Simonsick E, Kent JA. Age-related changes in gait biomechanics and their impact on the metabolic cost of walking: Report from a National Institute on Aging workshop. Exp Gerontol 2023; 173:112102. [PMID: 36693530 PMCID: PMC10008437 DOI: 10.1016/j.exger.2023.112102] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/09/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
Changes in old age that contribute to the complex issue of an increased metabolic cost of walking (mass-specific energy cost per unit distance traveled) in older adults appear to center at least in part on changes in gait biomechanics. However, age-related changes in energy metabolism, neuromuscular function and connective tissue properties also likely contribute to this problem, of which the consequences are poor mobility and increased risk of inactivity-related disease and disability. The U.S. National Institute on Aging convened a workshop in September 2021 with an interdisciplinary group of scientists to address the gaps in research related to the mechanisms and consequences of changes in mobility in old age. The goal of the workshop was to identify promising ways to move the field forward toward improving gait performance, decreasing energy cost, and enhancing mobility for older adults. This report summarizes the workshop and brings multidisciplinary insight into the known and potential causes and consequences of age-related changes in gait biomechanics. We highlight how gait mechanics and energy cost change with aging, the potential neuromuscular mechanisms and role of connective tissue in these changes, and cutting-edge interventions and technologies that may be used to measure and improve gait and mobility in older adults. Key gaps in the literature that warrant targeted research in the future are identified and discussed.
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Affiliation(s)
- Katherine A Boyer
- Department of Kinesiology, University of Massachusetts Amherst, MA, USA; Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Kate L Hayes
- Department of Kinesiology, University of Massachusetts Amherst, MA, USA
| | | | | | - Jonathan F Bean
- New England GRECC, VA Boston Healthcare System, Boston, MA, USA; Department of PM&R, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Jennifer S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian C Clark
- Ohio Musculoskeletal and Neurological Institute and the Department of Biomedical Sciences, Ohio University, Athens, OH, USA
| | - David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA; Department of Physiology and Aging, University of Florida, Gainesville, FL, USA
| | - Luigi Ferrucci
- Intramural Research Program of the National Institute on Aging, NIH, Baltimore, MD, USA
| | - James Finley
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Yvonne M Golightly
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA; Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Tibor Hortobágyi
- Hungarian University of Sports Science, Department of Kinesiology, Budapest, Hungary; Institute of Sport Sciences and Physical Education, University of Pécs, Hungary; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Center for Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands
| | - Sandra Hunter
- Department of Physical Therapy, Marquette University, Milwaukee, WI, USA
| | - Marco Narici
- Neuromuscular Physiology Laboratory, Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Barbara Nicklas
- Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, USA
| | - Thomas Roberts
- Department of Ecology and Evolutionary Biology, Brown University, USA
| | - Gregory Sawicki
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, USA
| | - Eleanor Simonsick
- Intramural Research Program of the National Institute on Aging, NIH, Baltimore, MD, USA
| | - Jane A Kent
- Department of Kinesiology, University of Massachusetts Amherst, MA, USA
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Liu Y, Luo J, Fang J, Yin M, Cao J, Zhang S, Huang L, Cheng Q, Ai Y, Zheng H, Hu X. Screening diagnosis of executive dysfunction after ischemic stroke and the effects of transcranial magnetic stimulation: A prospective functional near-infrared spectroscopy study. CNS Neurosci Ther 2023; 29:1561-1570. [PMID: 36786133 PMCID: PMC10173709 DOI: 10.1111/cns.14118] [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: 08/12/2022] [Revised: 01/21/2023] [Accepted: 01/29/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Post-ischemic stroke executive impairment (PISEI) is a serious obstacle for patients to returning to their society and is currently difficult to screen early and clinically ineffective. AIM The aim of the study was to clarify whether functional near-infrared spectroscopy (fNIRS) can be used as a rapid screening tool for PISEI and to explore the efficacy of transcranial magnetic stimulation (TMS) in PISEI patients and the changes in brain function. METHODS A single-blind, randomized controlled study design was used to detect hemodynamic differences by fNIIRS in 16 PISEI patients and 16 healthy subjects during the resting state and Stroop task, respectively. After 3 days, all subjects received a single TMS intervention and underwent simultaneous fNIRS testing for the Stroop task before and 3 days after the TMS intervention. RESULTS PISEI patients had significantly higher HbO2 content in the left dorsolateral prefrontal cortex (DLPFC), the right pre-motor cortex (PMC) and the right primary sensorimotor cortex (SM1) during the Stroop task compared to the resting state (F = 141.966, p < 0.001), but significantly lower than healthy subjects (T = -3.413, p = 0.002). After TMS intervention, PISEI patients' time and error number scores on the Stroop test were significantly enhanced, and the functional activity of the above-mentioned brain regions was significantly more active than at baseline, while the strength of their functional connections with each other was markedly increased. CONCLUSIONS fNIRS helped screen and diagnose PISEI. A single TMS session benefited PISEI patients with effects lasting 3 days, which may be attributed to activation of the left DLPFC, right PMC and right SM1 brain regions.
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Affiliation(s)
- Yuanwen Liu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing Luo
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Fang
- Department of Rehabilitation Medicine, Xiamen Humanity Rehabilitation Hospital, Xiamen, China
| | - Mingyu Yin
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jie Cao
- Department of Education, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Shuxian Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Li Huang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qilin Cheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, China
| | - Yinan Ai
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiqing Zheng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiquan Hu
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Wang Q, Dai W, Xu S, Zhu S, Sui Y, Kan C, Shen Y, Zhu Y, Guo C, Wang T. Brain activation of the PFC during dual-task walking in stroke patients: A systematic review and meta-analysis of functional near-infrared spectroscopy studies. Front Neurosci 2023; 17:1111274. [PMID: 36875661 PMCID: PMC9980909 DOI: 10.3389/fnins.2023.1111274] [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: 11/29/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Background Dual-task walking is a good paradigm to measure the walking ability of stroke patients in daily life. It allows for a better observation of brain activation under dual-task walking to assess the impact of the different tasks on the patient when combining with functional near-infrared spectroscopy (fNIRS). This review aims to summarize the cortical change of the prefrontal cortex (PFC) detected in single-task and dual-task walking in stroke patients. Methods Six databases (Medline, Embase, PubMed, Web of Science, CINAHL, and Cochrane Library) were systematically searched for relevant studies, from inception to August 2022. Studies that measured the brain activation of single-task and dual-task walking in stroke patients were included. The main outcome of the study was PFC activity measured using fNIRS. In addition, a subgroup analysis was also performed for study characteristics based on HbO to analyze the different effects of disease duration and the type of dual task. Results Ten articles were included in the final review, and nine articles were included in the quantitative meta-analysis. The primary analysis showed more significant PFC activation in stroke patients performing dual-task walking than single-task walking (SMD = 0.340, P = 0.02, I 2 = 7.853%, 95% CI = 0.054-0.626). The secondary analysis showed a significant difference in PFC activation when performing dual-task walking and single-task walking in chronic patients (SMD = 0.369, P = 0.038, I 2 = 13.692%, 95% CI = 0.020-0.717), but not in subacute patients (SMD = 0.203, P = 0.419, I 2 = 0%, 95% CI = -0.289-0.696). In addition, performing walking combining serial subtraction (SMD = 0.516, P < 0.001, I 2 = 0%, 95% CI = 0.239-0.794), obstacle crossing (SMD = 0.564, P = 0.002, I 2 = 0%, 95% CI = 0.205-0.903), or a verbal task (SMD = 0.654, P = 0.009, I 2 = 0%, 95% CI = 0.164-1.137) had more PFC activation than single-task walking, while performing the n-back task did not show significant differentiation (SMD = 0.203, P = 0.419, I 2 = 0%, 95% CI = -0.289-0.696). Conclusions Different dual-task paradigms produce different levels of dual-task interference in stroke patients with different disease durations, and it is important to choose the matching dual-task type in relation to the walking ability and cognitive ability of the patient, in order to better improve the assessment and training effects. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022356699.
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Affiliation(s)
- Qinglei Wang
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Wenjun Dai
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sheng Xu
- Department of Rehabilitation, Changzhou Dean Hospital, Changzhou, China
| | - Shizhe Zhu
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Youxin Sui
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China
| | - Chaojie Kan
- School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China.,Department of Rehabilitation, Changzhou Dean Hospital, Changzhou, China
| | - Ying Shen
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Zhu
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chuan Guo
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Tong Wang
- Department of Rehabilitation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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8
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Kaźmierczak K, Wareńczak-Pawlicka A, Miedzyblocki M, Lisiński P. Effect of Treadmill Training with Visual Biofeedback on Selected Gait Parameters in Subacute Hemiparetic Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16925. [PMID: 36554805 PMCID: PMC9779267 DOI: 10.3390/ijerph192416925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Functional limitations after a stroke are unique to each person and often include impaired independent mobility. A reduction in existing gait deficits after a stroke is often one of the main goals of rehabilitation. Gait re-education after stroke is a complex process, which consists of the effects of many therapeutic interventions. OBJECTIVE The study aimed to analyze the effects of using a treadmill with visual feedback in gait re-education in the sub-acute stroke period and assess the impact of biofeedback treadmill training on selected gait parameters, improving static balance and reducing the need for orthopedic aids. METHODS The study included 92 patients (F: 45, M: 47) aged 63 ± 12 years, with post-ischemic sub-acute (within six months onset) stroke hemiparesis, treated at a neurological rehabilitation ward. All patients participated in a specific rehabilitation program, and in addition, patients in the study group (n = 62) have a further 10 min of treadmill training with visual feedback. Patients in the control group (n = 30) participated in additional conventional gait training under the direct supervision of a physiotherapist. The evaluation of static balance was assessed with the Romberg Test. A Biodex Gait Trainer 3 treadmill with biofeedback function was used to evaluate selected gait parameters (walking speed, step length, % limb loading, and traveled distance). The use of an orthopedic aid (walker or a crutch) was noted. RESULTS After four weeks of rehabilitation, step length, walking speed, traveled distance, and static balance were significantly improved for the study and control group (p < 0.05). Treadmill gait training yielded significantly better results than a conventional rehabilitation program. Only the study group observed a corrected walking base (p < 0.001). All participants showed a reduction in the use of walking aids (p = 0.006). There was no asymmetry in the % of limb loading for either group prior to or following rehabilitation. CONCLUSIONS The treadmill with visual biofeedback as conventional gait training has resulted in a significant improvement in parameters such as step length, walking speed, static balance, and a reduction in the use of locomotion aids. However, the achieved improvement in gait parameters is still not in line with the physiological norm.
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9
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McCabe JP, Pundik S, Daly JJ. Targeting CNS Neural Mechanisms of Gait in Stroke Neurorehabilitation. Brain Sci 2022; 12:brainsci12081055. [PMID: 36009118 PMCID: PMC9405607 DOI: 10.3390/brainsci12081055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/17/2023] Open
Abstract
The central nervous system (CNS) control of human gait is complex, including descending cortical control, affective ascending neural pathways, interhemispheric communication, whole brain networks of functional connectivity, and neural interactions between the brain and spinal cord. Many important studies were conducted in the past, which administered gait training using externally targeted methods such as treadmill, weight support, over-ground gait coordination training, functional electrical stimulation, bracing, and walking aids. Though the phenomenon of CNS activity-dependent plasticity has served as a basis for more recently developed gait training methods, neurorehabilitation gait training has yet to be precisely focused and quantified according to the CNS source of gait control. Therefore, we offer the following hypotheses to the field: Hypothesis 1. Gait neurorehabilitation after stroke will move forward in important ways if research studies include brain structural and functional characteristics as measures of response to treatment. Hypothesis 2. Individuals with persistent gait dyscoordination after stroke will achieve greater recovery in response to interventions that incorporate the current and emerging knowledge of CNS function by directly engaging CNS plasticity and pairing it with peripherally directed, plasticity-based motor learning interventions. These hypotheses are justified by the increase in the study of neural control of motor function, with emerging research beginning to elucidate neural factors that drive recovery. Some are developing new measures of brain function. A number of groups have developed and are sharing sophisticated, curated databases containing brain images and brain signal data, as well as other types of measures and signal processing methods for data analysis. It will be to the great advantage of stroke survivors if the results of the current state-of-the-art and emerging neural function research can be applied to the development of new gait training interventions.
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Affiliation(s)
- Jessica P. McCabe
- Brain Plasticity and NeuroRecovery Laboratory, Cleveland VA Medical Center, Cleveland, OH 44106, USA
| | - Svetlana Pundik
- Brain Plasticity and NeuroRecovery Laboratory, Cleveland VA Medical Center, Cleveland, OH 44106, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH 44016, USA
| | - Janis J. Daly
- Brain Plasticity and NeuroRecovery Laboratory, Cleveland VA Medical Center, Cleveland, OH 44106, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH 44016, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32608, USA
- Correspondence: or
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10
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Lim SB, Peters S, Yang CL, Boyd LA, Liu-Ambrose T, Eng JJ. Frontal, Sensorimotor, and Posterior Parietal Regions Are Involved in Dual-Task Walking After Stroke. Front Neurol 2022; 13:904145. [PMID: 35812105 PMCID: PMC9256933 DOI: 10.3389/fneur.2022.904145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022] Open
Abstract
Background Walking within the community requires the ability to walk while simultaneously completing other tasks. After a stroke, completing an additional task while walking is significantly impaired, and it is unclear how the functional activity of the brain may impact this. Methods Twenty individual in the chronic stage post-stroke participated in this study. Functional near-infrared spectroscopy (fNIRS) was used to measure prefrontal, pre-motor, sensorimotor, and posterior parietal cortices during walking and walking while completing secondary verbal tasks of varying difficulty. Changes in brain activity during these tasks were measured and relationships were accessed between brain activation changes and cognitive or motor abilities. Results Significantly larger activations were found for prefrontal, pre-motor, and posterior parietal cortices during dual-task walking. Increasing dual-task walking challenge did not result in an increase in brain activation in these regions. Higher general cognition related to lower increases in activation during the easier dual-task. With the harder dual-task, a trend was also found for higher activation and less motor impairment. Conclusions This is the first study to show that executive function, motor preparation/planning, and sensorimotor integration areas are all important for dual-task walking post-stroke. A lack of further brain activation increase with increasing challenge suggests a point at which a trade-off between brain activation and performance occurs. Further research is needed to determine if training would result in further increases in brain activity or improved performance.
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Affiliation(s)
- Shannon B. Lim
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Sue Peters
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada
- School of Physical Therapy, Western University, London, ON, Canada
| | - Chieh-ling Yang
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Lara A. Boyd
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- The David Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- The David Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Janice J. Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- *Correspondence: Janice J. Eng
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11
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Deblock-Bellamy A, Lamontagne A, McFadyen BJ, Ouellet MC, Blanchette AK. Dual-Task Abilities During Activities Representative of Daily Life in Community-Dwelling Stroke Survivors: A Pilot Study. Front Neurol 2022; 13:855226. [PMID: 35592466 PMCID: PMC9110886 DOI: 10.3389/fneur.2022.855226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background In addition to several physical skills, being able to walk in the community, walking independently and safely in the community requires the ability to divide attention between walking and other tasks performed simultaneously. The aims of the present pilot study were to measure cognitive-locomotor dual-task (DT) abilities during activities representative of daily living in stroke survivors and to compare them with age- and gender-matched healthy individuals. Methods To assess DT abilities, all participants walked along a virtual shopping mall corridor and memorized a 5-item shopping list. Two levels of task complexity were used for the walking task (with or without virtual agents to avoid) and the cognitive task to recall a list of items (with or without a modification at mid-course). The assessment was conducted using an omnidirectional platform and a virtual reality (VR) headset. Locomotor and cognitive DT costs (DTC) were calculated as the percent change from single-task (ST) performance. Walking speed and minimal distance between the participant and the virtual agents were used to characterize locomotor performance. Cognitive performance was assessed by the number of correctly recalled items. One-sample Wilcoxon tests were used to determine the presence of DTCs and Mann-Whitney tests were performed to compare DTCs between the 2 groups. Results Twelve community-dwelling stroke survivors [60.50 years old (25-75th percentiles: 53.50–65.75); 5 women; 13.41 months post-stroke (5.34–48.90)] and 12 age- and gender- matched healthy individuals were recruited. Significant cognitive or mutual (cognitive and locomotor) interferences were observed in participants with stroke in all DT conditions, except the simplest (no virtual agents, no modifications to the list). For the control group, significant mutual interferences were only observed during the most complex DT condition. A group difference was detected in cognitive DTCs during the most complex DT condition (virtual agents and list modifications; p = 0.02). Stroke survivors had greater cognitive DTCs than the control group. Conclusions Using an ecological perspective contributes to understanding behavior of stroke survivors in daily activities. Virtual scenarios appear to be an interesting avenue for a more comprehensive understanding of DT abilities during activities representative of daily living in stroke survivors. The usability and feasibility of such an approach will have to be studied before considering implementation in rehabilitation settings.
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Affiliation(s)
- Anne Deblock-Bellamy
- Faculty of Medicine, Universite Laval, Quebec City, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris)–CIUSSS de la Capitale-Nationale, Quebec City, QC, Canada
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- Jewish Rehabilitation Hospital-CISSS de Laval, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, QC, Canada
| | - Bradford J. McFadyen
- Faculty of Medicine, Universite Laval, Quebec City, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris)–CIUSSS de la Capitale-Nationale, Quebec City, QC, Canada
- Department of Rehabilitation, Universite Laval, Quebec City, QC, Canada
| | - Marie-Christine Ouellet
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris)–CIUSSS de la Capitale-Nationale, Quebec City, QC, Canada
- Faculty of Social Sciences, School of Psychology, Universite Laval, Quebec City, QC, Canada
| | - Andréanne K. Blanchette
- Faculty of Medicine, Universite Laval, Quebec City, QC, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris)–CIUSSS de la Capitale-Nationale, Quebec City, QC, Canada
- Department of Rehabilitation, Universite Laval, Quebec City, QC, Canada
- *Correspondence: Andréanne K. Blanchette
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12
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Jor’dan AJ, Bernad-Elazari H, Mirelman A, Gouskova NA, Lo OY, Hausdorff JM, Manor B. Transcranial Direct Current Stimulation May Reduce Prefrontal Recruitment During Dual Task Walking in Functionally Limited Older Adults – A Pilot Study. Front Aging Neurosci 2022; 14:843122. [PMID: 35360209 PMCID: PMC8963782 DOI: 10.3389/fnagi.2022.843122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Transcranial direct current stimulation (tDCS) targeting the left dorsolateral prefrontal cortex (dlPFC) improves dual task walking in older adults, when tested just after stimulation. The acute effects of tDCS on the cortical physiology of walking, however, remains unknown. Methods In a previous study, older adults with slow gait and executive dysfunction completed a dual task walking assessment before and after 20 min of tDCS targeting the left dlPFC or sham stimulation. In a subset of seven participants per group, functional near-infrared spectroscopy (fNIRS) was used to quantify left and right prefrontal recruitment defined as the oxygenated hemoglobin response to usual and dual task walking (ΔHbO2), as well as the absolute change in this metric from usual to dual task conditions (i.e., ΔHbO2cost). Paired t-tests examined pre- to post-stimulation differences in each fNIRS metric within each group. Results The tDCS group exhibited pre- to post-stimulation reduction in left prefrontal ΔHbO2cost (p = 0.03). This mitigation of dual task “cost” to prefrontal recruitment was induced primarily by a reduction in left prefrontal ΔHbO2 specifically within the dual task condition (p = 0.001), an effect that was observed in all seven participants within this group. Sham stimulation did not influence ΔHbO2cost or ΔHbO2 in either walking condition (p > 0.35), and neither tDCS nor sham substantially influenced right prefrontal recruitment (p > 0.16). Discussion This preliminary fNIRS data suggests that tDCS over the left dlPFC may modulate prefrontal recruitment, as reflected by a relative reduction in the oxygen consumption of this brain region in response to dual task walking.
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Affiliation(s)
- Azizah J. Jor’dan
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA, United States
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Azizah J. Jor’dan,
| | - Hagar Bernad-Elazari
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anat Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalia A. Gouskova
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
| | - On-Yee Lo
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Brad Manor
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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13
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Kim H, Fraser S. Neural correlates of dual-task walking in people with central neurological disorders: a systematic review. J Neurol 2022; 269:2378-2402. [PMID: 34989867 DOI: 10.1007/s00415-021-10944-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND People with central neurological disorders experience difficulties with dual-task walking due to disease-related impairments. The objective of this review was to provide a comprehensive examination of the neural correlates (structural/functional brain changes) of dual-task walking in people with Parkinson's disease (PD), multiple sclerosis (MS), stroke, and Alzheimer's disease (AD). METHODS A systematic review of the literature was conducted, following PRISMA guidelines, on Medline, Embase, and Scopus. Included studies examined the relationship between structural and functional brain imaging and dual-task walking performance in people with PD, MS, stroke, and AD. Articles that met the inclusion criteria had baseline characteristics, study design, and behavioral and brain outcomes extracted. Twenty-three studies were included in this review. RESULTS Most structural imaging studies (75%) found an association between decreased brain integrity and poor dual-task performance. Specific brain regions that showed this association include the striatum regions and hippocampus in PD and supplementary motor area in MS. Functional imaging studies reported an association between increased prefrontal activity and maintained (compensatory recruitment) or decreased dual-task walking performance in PD and stroke. A subset (n = 2) of the stroke papers found no significant correlations. Increased supplementary motor area activity was associated with decreased performance in MS and stroke. No studies on AD were identified. CONCLUSION In people with PD, MS, and stroke, several neural correlates of dual-task walking have been identified, however, the direction of the association between neural and performance outcomes varied across the studies. The type of cognitive task used and presentation modality (e.g., visual) may have contributed to these mixed findings.
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Affiliation(s)
- Hyejun Kim
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 125 University Private, Ottawa, ON, K1N 6N5, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25 University Private, Ottawa, ON, K1N 7K4, Canada.
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14
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Maidan I, Hacham R, Galperin I, Giladi N, Holtzer R, Hausdorff JM, Mirelman A. Neural Variability in the Prefrontal Cortex as a Reflection of Neural Flexibility and Stability in Patients With Parkinson Disease. Neurology 2021; 98:e839-e847. [PMID: 34906983 DOI: 10.1212/wnl.0000000000013217] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/24/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Functional Near-Infrared Spectroscopy (fNIRS) studies provide direct evidence to the important role of the prefrontal cortex (PFC) during walking in aging and Parkinson's disease (PD). Most studies mainly explored mean HbO2 levels, while moment-to-moment variability measures have been rarely investigated. Variability measures can inform on flexibility that is imperative for adaptive function. We hypothesized that patients with PD will show less variability in HbO2 signals during walking compared to healthy controls. METHODS 206 participants, 57 healthy controls (age: 68.9±1.0 years; 27 women) and 149 idiopathic PD patients (age: 69.8±0.6 years, 50 women, disease duration: 8.27±5.51 years) performed usual walking and dual-task walking (serial 3 subtractions) with an fNIRS system placed on the forehead. HbO2 variability was calculated using the standard deviation (SD), range, and mean detrended time series of fNIRS-derived HbO2 signal evaluated during each walking task. HbO2 variability was compared between groups and between walking tasks using mixed model analyses. RESULTS Higher variability (SD, range, mean detrended time series) was observed during dual-task walking, compared to usual walking (p<0.025), but this was derived from the differences within the healthy control group (group X task interaction: p<0.007). On the other hand, task repetition demonstrated reduced variability in healthy controls but increased variability in patients with PD (interaction group*walk-repetition: p<0.048). The MDS-UPDRS motor score correlated with HbO2 range (r=0.142, p=0.050) and HbO2 SD (r=0.173, p=0.018) during usual walking in all participants. DISCUSSION In this study, we suggest a new way to interpret changes in HbO2 variability. We relate increased HbO2 variability to flexible adaptation to environmental challenges and decreased HbO2 variability to the stability of performance. Our results show that both are limited in PD however, further investigation of these concepts is required. Moreover, HbO2 variability measures are an important aspect of brain function that adds new insights into the role of PFC during walking with aging and PD. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that patients with PD have more variability within Hb02 signals during usual-walking, compared to healthy controls, but not during dual-task walking.
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Affiliation(s)
- Inbal Maidan
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel .,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Roni Hacham
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ira Galperin
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Giladi
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Roee Holtzer
- Yeshiva University and Albert Einstein College of Medicine, New York, USA
| | - Jeffrey M Hausdorff
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel.,Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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15
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Control of low flow regions in the cortical vasculature determines optimal arterio-venous ratios. Proc Natl Acad Sci U S A 2021; 118:2021840118. [PMID: 34413186 DOI: 10.1073/pnas.2021840118] [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] [Indexed: 11/18/2022] Open
Abstract
The energy demands of neurons are met by a constant supply of glucose and oxygen via the cerebral vasculature. The cerebral cortex is perfused by dense, parallel arterioles and venules, consistently in imbalanced ratios. Whether and how arteriole-venule arrangement and ratio affect the efficiency of energy delivery to the cortex has remained an unanswered question. Here, we show by mathematical modeling and analysis of the mapped mouse sensory cortex that the perfusive efficiency of the network is predicted to be limited by low-flow regions produced between pairs of arterioles or pairs of venules. Increasing either arteriole or venule density decreases the size of these low-flow regions, but increases their number, setting an optimal ratio between arterioles and venules that matches closely that observed across mammalian cortical vasculature. Low-flow regions are reshaped in complex ways by changes in vascular conductance, creating geometric challenges for matching cortical perfusion with neuronal activity.
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16
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Bishnoi A, Holtzer R, Hernandez ME. Brain Activation Changes While Walking in Adults with and without Neurological Disease: Systematic Review and Meta-Analysis of Functional Near-Infrared Spectroscopy Studies. Brain Sci 2021; 11:291. [PMID: 33652706 PMCID: PMC7996848 DOI: 10.3390/brainsci11030291] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
(1) Functional near-infrared spectroscopy (fNIRS) provides a useful tool for monitoring brain activation changes while walking in adults with neurological disorders. When combined with dual task walking paradigms, fNIRS allows for changes in brain activation to be monitored when individuals concurrently attend to multiple tasks. However, differences in dual task paradigms, baseline, and coverage of cortical areas, presents uncertainty in the interpretation of the overarching findings. (2) Methods: By conducting a systematic review of 35 studies and meta-analysis of 75 effect sizes from 17 studies on adults with or without neurological disorders, we show that the performance of obstacle walking, serial subtraction and letter generation tasks while walking result in significant increases in brain activation in the prefrontal cortex relative to standing or walking baselines. (3) Results: Overall, we find that letter generation tasks have the largest brain activation effect sizes relative to walking, and that significant differences between dual task and single task gait are seen in persons with multiple sclerosis and stroke. (4) Conclusions: Older adults with neurological disease generally showed increased brain activation suggesting use of more attentional resources during dual task walking, which could lead to increased fall risk and mobility impairments. PROSPERO ID: 235228.
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Affiliation(s)
- Alka Bishnoi
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA;
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY 10461, USA;
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Manuel E. Hernandez
- Department of Kinesiology & Community Health, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA;
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17
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Lim SB, Louie DR, Peters S, Liu-Ambrose T, Boyd LA, Eng JJ. Brain activity during real-time walking and with walking interventions after stroke: a systematic review. J Neuroeng Rehabil 2021; 18:8. [PMID: 33451346 PMCID: PMC7811232 DOI: 10.1186/s12984-020-00797-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/09/2020] [Indexed: 12/27/2022] Open
Abstract
Investigations of real-time brain activations during walking have become increasingly important to aid in recovery of walking after a stroke. Individual brain activation patterns can be a valuable biomarker of neuroplasticity during the rehabilitation process and can result in improved personalized medicine for rehabilitation. The purpose of this systematic review is to explore the brain activation characteristics during walking post-stroke by determining: (1) if different components of gait (i.e., initiation/acceleration, steady-state, complex) result in different brain activations, (2) whether brain activations differ from healthy individuals. Six databases were searched resulting in 22 studies. Initiation/acceleration showed bilateral activation in frontal areas; steady-state and complex walking showed broad activations with the majority exploring and finding increases in frontal regions and some studies also showing increases in parietal activation. Asymmetrical activations were often related to performance asymmetry and were more common in studies with slower gait speed. Hyperactivations and asymmetrical activations commonly decreased with walking interventions and as walking performance improved. Hyperactivations often persisted in individuals who had experienced severe strokes. Only a third of the studies included comparisons to a healthy group: individuals post-stroke employed greater brain activation compared to young adults, while comparisons to older adults were less clear and limited. Current literature suggests some indicators of walking recovery however future studies investigating more brain regions and comparisons with healthy age-matched adults are needed to further understand the effect of stroke on walking-related brain activation.
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Affiliation(s)
- Shannon B Lim
- Graduate Studies in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada.,Rehabiliation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC, V5Z 2G9, Canada
| | - Dennis R Louie
- Graduate Studies in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada.,Rehabiliation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC, V5Z 2G9, Canada
| | - Sue Peters
- Rehabiliation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC, V5Z 2G9, Canada.,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,The Djavad Mowafaghian Centre for Brain Health, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Centre for Hip Health and Mobility, Vancouver, Canada
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,The Djavad Mowafaghian Centre for Brain Health, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Janice J Eng
- Rehabiliation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel St, Vancouver, BC, V5Z 2G9, Canada. .,Department of Physical Therapy, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
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18
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Hermand E, Compagnat M, Dupuy O, Salle JY, Daviet JC, Perrochon A. Functional Status Is Associated With Prefrontal Cortex Activation in Gait in Subacute Stroke Patients: A Functional Near-Infrared Spectroscopy Study. Front Neurol 2020; 11:559227. [PMID: 33224085 PMCID: PMC7674599 DOI: 10.3389/fneur.2020.559227] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/22/2020] [Indexed: 11/13/2022] Open
Abstract
Increasing cerebral oxygenation, more precisely the overactivation of the prefrontal cortex (PFC), reflects cortical control of gait in stroke disease. Studies about the relationship between brain activation and the functional status in stroke patients remain scarce. The aim of this study was to compare brain activation, gait parameters, and cognitive performances in single and dual tasks according to the functional status in subacute stroke patients. Twenty-one subacute stroke patients were divided in two groups according to Barthel Index ("low Barthel" and "high Barthel") and randomly performed ordered walking, cognitive task (n-back task), and dual tasks (walking + n-back task). We assessed gait performances (speed, variability) using an electronic walkway system and cerebral oxygenation (ΔO2Hb) by functional near-infrared spectroscopy. Patients with better functional status (high Barthel) showed a lower PFC activation (ΔO2Hb) and better gait parameters in single and dual tasks compared to low-Barthel patients, who exhibited decreased gait performances despite a higher PFC activation, especially in the unaffected side (P < 0.001). PFC overactivation in less functional subacute stroke patients may be due to the loss of stepping automaticity. Our results underline the interest of proposing rehabilitation programs focused on walking, especially for patients with low functional capacity.
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Affiliation(s)
- Eric Hermand
- Laboratoire EA6310 HAVAE "Handicap, Activité, Vieillissement, Autonomie, Environnement," Université de Limoges, Limoges, France.,Laboratoire EA 7369 URePSSS "Unité de Recherche Pluridisciplinaire Sport, Santé, Société", Université du Littoral Côte d'Opale, Dunkerque, France
| | - Maxence Compagnat
- Laboratoire EA6310 HAVAE "Handicap, Activité, Vieillissement, Autonomie, Environnement," Université de Limoges, Limoges, France.,Médecine Physique et de Réadaptation, CHU de Limoges, Limoges, France
| | - Olivier Dupuy
- Laboratoire EA6314 MOVE "Mobilité Vieillissement et Exercice, " Université de Poitiers, Poitiers, France
| | - Jean-Yves Salle
- Médecine Physique et de Réadaptation, CHU de Limoges, Limoges, France
| | - Jean-Christophe Daviet
- Laboratoire EA6310 HAVAE "Handicap, Activité, Vieillissement, Autonomie, Environnement," Université de Limoges, Limoges, France.,Médecine Physique et de Réadaptation, CHU de Limoges, Limoges, France
| | - Anaick Perrochon
- Laboratoire EA6310 HAVAE "Handicap, Activité, Vieillissement, Autonomie, Environnement," Université de Limoges, Limoges, France
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19
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Menant JC, Maidan I, Alcock L, Al-Yahya E, Cerasa A, Clark DJ, de Bruin ED, Fraser S, Gramigna V, Hamacher D, Herold F, Holtzer R, Izzetoglu M, Lim S, Pantall A, Pelicioni P, Peters S, Rosso AL, St George R, Stuart S, Vasta R, Vitorio R, Mirelman A. A consensus guide to using functional near-infrared spectroscopy in posture and gait research. Gait Posture 2020; 82:254-265. [PMID: 32987345 DOI: 10.1016/j.gaitpost.2020.09.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/06/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Functional near-infrared spectroscopy (fNIRS) is increasingly used in the field of posture and gait to investigate patterns of cortical brain activation while people move freely. fNIRS methods, analysis and reporting of data vary greatly across studies which in turn can limit the replication of research, interpretation of findings and comparison across works. RESEARCH QUESTION AND METHODS Considering these issues, we propose a set of practical recommendations for the conduct and reporting of fNIRS studies in posture and gait, acknowledging specific challenges related to clinical groups with posture and gait disorders. RESULTS Our paper is organized around three main sections: 1) hardware set up and study protocols, 2) artefact removal and data processing and, 3) outcome measures, validity and reliability; it is supplemented with a detailed checklist. SIGNIFICANCE This paper was written by a core group of members of the International Society for Posture and Gait Research and posture and gait researchers, all experienced in fNIRS research, with the intent of assisting the research community to lead innovative and impactful fNIRS studies in the field of posture and gait, whilst ensuring standardization of research.
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Affiliation(s)
- Jasmine C Menant
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia; School of Population Health, University of New South Wales, New South Wales, Australia.
| | - Inbal Maidan
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Department of Neurology, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Alcock
- Translational and Clinical Research Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Emad Al-Yahya
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan; Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Antonio Cerasa
- IRIB, National Research Council, Mangone, CS, Italy; S. Anna Institute and Research in Advanced Neurorehabilitation (RAN), Crotone, Italy
| | - David J Clark
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA; Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Eling D de Bruin
- Institute of Human Movement Sciences and Sport, Department of Health Sciences and Technology, ETH Zürich, Zurich, Switzerland; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Sarah Fraser
- École interdisciplinaire des sciences de la santé (Interdisciplinary School of Health sciences), University of Ottawa, Ottawa, Ontario, Canada
| | - Vera Gramigna
- Neuroscience Research Center, "Magna Graecia" University, Catanzaro, Italy
| | - Dennis Hamacher
- German University for Health and Sports, (DHGS), Berlin, Germany
| | - Fabian Herold
- Research Group Neuroprotection, German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany; Department of Neurology, Medical Faculty, Otto Von Guericke University, Magdeburg, Germany
| | - Roee Holtzer
- Yeshiva University, Ferkauf Graduate School of Psychology, The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Meltem Izzetoglu
- Villanova University, Electrical and Computer Engineering Department, Villanova, PA, USA
| | - Shannon Lim
- Graduate Program in Rehabilitation Sciences, University of British Columbia, Vancouver, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Annette Pantall
- Translational and Clinical Research Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paulo Pelicioni
- Neuroscience Research Australia, University of New South Wales, New South Wales, Australia; School of Population Health, University of New South Wales, New South Wales, Australia
| | - Sue Peters
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andrea L Rosso
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | - Rebecca St George
- Sensorimotor Neuroscience and Ageing Research Group, School of Psychological Sciences, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Roberta Vasta
- Neuroscience Research Center, "Magna Graecia" University, Catanzaro, Italy
| | - Rodrigo Vitorio
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Neurological Institute, Tel Aviv Sourasky Medical Center, Israel; Department of Neurology, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
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20
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Clark DJ, Chatterjee SA, Skinner JW, Lysne PE, Sumonthee C, Wu SS, Cohen RA, Rose DK, Woods AJ. Combining Frontal Transcranial Direct Current Stimulation With Walking Rehabilitation to Enhance Mobility and Executive Function: A Pilot Clinical Trial. Neuromodulation 2020; 24:950-959. [PMID: 32808403 DOI: 10.1111/ner.13250] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This pilot study assessed whether frontal lobe transcranial direct current stimulation (tDCS) combined with complex walking rehabilitation is feasible, safe, and shows preliminary efficacy for improving walking and executive function. MATERIALS AND METHODS Participants were randomized to one of the following 18-session interventions: active tDCS and rehabilitation with complex walking tasks (Active/Complex); sham tDCS and rehabilitation with complex walking tasks (Sham/Complex); or sham tDCS and rehabilitation with typical walking (Sham/Typical). Active tDCS was delivered over F3 (cathode) and F4 (anode) scalp locations for 20 min at 2 mA intensity. Outcome measures included tests of walking function, executive function, and prefrontal activity measured by functional near infrared spectroscopy. RESULTS Ninety percent of participants completed the intervention protocol successfully. tDCS side effects of tingling or burning sensations were low (average rating less than two out of 10). All groups demonstrated gains in walking performance based on within-group effect sizes (d ≥ 0.50) for one or more assessments. The Sham/Typical group showed the greatest gains for walking based on between-group effect sizes. For executive function, the Active/Complex group showed the greatest gains based on moderate to large between-group effect sizes (d = 0.52-1.11). Functional near-infrared spectroscopy (fNIRS) findings suggest improved prefrontal cortical activity during walking. CONCLUSIONS Eighteen sessions of walking rehabilitation combined with tDCS is a feasible and safe intervention for older adults. Preliminary effects size data indicate a potential improvement in executive function by adding frontal tDCS to walking rehabilitation. This study justifies future larger clinical trials to better understand the benefits of combining tDCS with walking rehabilitation.
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Affiliation(s)
- David J Clark
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Sudeshna A Chatterjee
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA.,Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Jared W Skinner
- Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, Gainesville, FL, USA
| | - Paige E Lysne
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Chanoan Sumonthee
- College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
| | - Dorian K Rose
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, USA.,Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville, FL, USA
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21
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Chatterjee SA, Seidler RD, Skinner JW, Lysne PE, Sumonthee C, Wu SS, Cohen RA, Rose DK, Woods AJ, Clark DJ. Obstacle Negotiation in Older Adults: Prefrontal Activation Interpreted Through Conceptual Models of Brain Aging. Innov Aging 2020; 4:igaa034. [PMID: 32995566 DOI: 10.1093/geroni/igaa034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Indexed: 11/14/2022] Open
Abstract
Background and Objectives The influence of interindividual differences on brain activation during obstacle negotiation and the implications for walking performance are poorly understood in older adults. This study investigated the extent to which prefrontal recruitment during obstacle negotiation is explained by differences in age, executive function, and sex. These data were interpreted according to the Compensation-Related Utilization of Neural Circuits Hypothesis (CRUNCH) framework of brain aging. We also tested the association between prefrontal recruitment and walking performance. Research Design and Methods Prefrontal oxygenated hemoglobin concentration (O2Hb) was measured during typical walking (Typical) and obstacle negotiation (Obstacles) tasks in 50 adults aged 65 years and older using functional near-infrared spectroscopy. The primary outcome was the change in prefrontal recruitment (∆PFR), measured as Obstacles ∆O2Hb minus Typical ∆O2Hb. Multiple regression was used to test the relationship between ∆PFR and age, executive function measured by the Trail Making Test, and sex. Pearson's correlation coefficient was used to investigate the association between ∆PFR and the cost of Obstacles walking speed relative to Typical walking. Results Age, executive function, and their interaction significantly predicted greater ∆PFR (R 2 = 0.34, p = .01). Participants were subgrouped according to age and executive function to examine the interaction effects. Adults of lower age and with lower executive function exhibited greater ∆PFR during Obstacles compared to their peers with higher executive function (p = .03). Adults of advanced age exhibited a ceiling of prefrontal recruitment during obstacle negotiation, regardless of executive function level (p = .87). Greater ∆PFR was significantly associated with a smaller cost of Obstacles (r = 0.3, p = .03). Discussion and Implications These findings are consistent with the CRUNCH framework: neural inefficiency where a greater amount of brain activation is needed for task performance at a similar level, compensatory overactivation to prevent a steeper decline in task performance, and capacity limitation with a recruitment ceiling effect.
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Affiliation(s)
- Sudeshna A Chatterjee
- Department of Physical Therapy, University of Florida, Gainesville.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida
| | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville
| | - Jared W Skinner
- Geriatric Research, Education, and Clinical Center, Malcom Randall VA Medical Center, Gainesville, Florida
| | - Paige E Lysne
- Department of Aging and Geriatric Research, University of Florida, Gainesville
| | - Chanoan Sumonthee
- College of Public Health and Health Professions, University of Florida, Gainesville
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville
| | - Ronald A Cohen
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville
| | - Dorian K Rose
- Department of Physical Therapy, University of Florida, Gainesville.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida
| | - Adam J Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory, McKnight Brain Institute, University of Florida, Gainesville
| | - David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, Florida.,Department of Aging and Geriatric Research, University of Florida, Gainesville
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22
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Muci B, Keser I, Meric A, Karatas GK. What are the factors affecting dual-task gait performance in people after stroke? Physiother Theory Pract 2020; 38:621-628. [DOI: 10.1080/09593985.2020.1777603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Birsen Muci
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara, Turkey
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Ilke Keser
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
| | - Aydin Meric
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, European Unıversity of Lefke, Lefke, Northern Cyprus
| | - Gulcin Kaymak Karatas
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Gazi University, Ankara, Turkey
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23
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Awosika OO, Matthews S, Staggs EJ, Boyne P, Song X, Rizik BA, Sucharew HJ, Zhang C, Mungcal G, Moudgal R, Bhattacharya A, Dunning K, Woo D, Kissela BM. Backward locomotor treadmill training combined with transcutaneous spinal direct current stimulation in stroke: a randomized pilot feasibility and safety study. Brain Commun 2020; 2:fcaa045. [PMID: 32954299 PMCID: PMC7425394 DOI: 10.1093/braincomms/fcaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 11/17/2022] Open
Abstract
Walking impairment impacts nearly 66% of stroke survivors and is a rising cause of morbidity worldwide. Despite conventional post-stroke rehabilitative care, the majority of stroke survivors experience continued limitations in their walking speed, temporospatial dynamics and walking capacity. Hence, novel and comprehensive approaches are needed to improve the trajectory of walking recovery in stroke survivors. Herein, we test the safety, feasibility and preliminary efficacy of two approaches for post-stroke walking recovery: backward locomotor treadmill training and transcutaneous spinal direct current stimulation. In this double-blinded study, 30 chronic stroke survivors (>6 months post-stroke) with mild-severe residual walking impairment underwent six 30-min sessions (three sessions/week) of backward locomotor treadmill training, with concurrent anodal (N = 19) or sham transcutaneous spinal direct current stimulation (N = 11) over the thoracolumbar spine, in a 2:1 stratified randomized fashion. The primary outcomes were: per cent participant completion, safety and tolerability of these two approaches. In addition, we collected data on training-related changes in overground walking speed, cadence, stride length (baseline, daily, 24-h post-intervention, 2 weeks post-intervention) and walking capacity (baseline, 24-h post-intervention, 2 weeks post-intervention), as secondary exploratory aims testing the preliminary efficacy of these interventions. Eighty-seven per cent (N = 26) of randomized participants completed the study protocol. The majority of the study attrition involved participants with severe baseline walking impairment. There were no serious adverse events in either the backward locomotor treadmill training or transcutaneous spinal direct current stimulation approaches. Also, both groups experienced a clinically meaningful improvement in walking speed immediately post-intervention that persisted at the 2-week follow-up. However, in contrast to our working hypothesis, anodal-transcutaneous spinal direct current stimulation did not enhance the degree of improvement in walking speed and capacity, relative to backward locomotor treadmill training + sham, in our sample. Backward locomotor treadmill training and transcutaneous spinal direct current stimulation are safe and feasible approaches for walking recovery in chronic stroke survivors. Definitive efficacy studies are needed to validate our findings on backward locomotor treadmill training-related changes in walking performance. The results raise interesting questions about mechanisms of locomotor learning in stroke, and well-powered transcutaneous spinal direct current stimulation dosing studies are needed to understand better its potential role as a neuromodulatory adjunct for walking rehabilitation.
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Affiliation(s)
- Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Saira Matthews
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Emily J Staggs
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Pierce Boyne
- College of Allied Health and Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Xiao Song
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Bridget A Rizik
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Heidi J Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christina Zhang
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Gabrielle Mungcal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Rohitha Moudgal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Amit Bhattacharya
- Biomechanics-Ergonomics Research Laboratories, Department of Environmental Health, University of Cincinnati Medical College, USA
| | - Kari Dunning
- College of Allied Health and Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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24
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Hoppes CW, Huppert TJ, Whitney SL, Dunlap PM, DiSalvio NL, Alshebber KM, Furman JM, Kwon YH, Rosso AL. Changes in Cortical Activation During Dual-Task Walking in Individuals With and Without Visual Vertigo. J Neurol Phys Ther 2020; 44:156-163. [PMID: 32168158 PMCID: PMC7112165 DOI: 10.1097/npt.0000000000000310] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Persons with vestibular disorders are known to have slower gait speed with greater imbalance and veering during dual-task walking than healthy individuals, but the cerebral mechanisms are unknown. The purpose of this study was to determine whether individuals with visual vertigo (VV) have different cerebral activation during dual-task walking compared with control subjects. METHODS Fourteen individuals with VV and 14 healthy controls (CON) were included (mean 39 years old, 85% women). A cross-sectional experimental study consisting of 4 combinations of 2 surfaces (even and uneven) and 2 task conditions (single- and dual-task) was performed. Participants walked over an even (level flooring) or uneven (wood prisms underneath carpeting) surface, either quietly or while reciting every other letter of the alphabet. Changes in cerebral activation over the bilateral prefrontal cortices were recorded using functional near-infrared spectroscopy during 4 task conditions relative to quiet standing. Gait speed and cognitive performance were recorded. RESULTS There were no between-group differences in cognitive performance. Both groups slowed when walking on an uneven surface or performing a dual-task; participants in the VV group walked more slowly than those in the CON group in all conditions. Participants with VV had decreased cerebral activation in the bilateral prefrontal regions in comparison to CON participants in all conditions. DISCUSSION AND CONCLUSIONS Participants with VV had lower prefrontal cortex activation than CON participants during dual-task walking. Lower cortical activity in those with VV may be due to shifted attention away from the cognitive task to prioritize maintenance of dynamic balance.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A303).
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Affiliation(s)
- Carrie W. Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA
| | | | | | | | - Nikki L. DiSalvio
- University of Southern California/Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA, USA
| | | | | | - Yong H. Kwon
- Yeungnam University College, Nam-gu, Daegu, South Korea
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25
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Clark DJ, Manini TM, Ferris DP, Hass CJ, Brumback BA, Cruz-Almeida Y, Pahor M, Reuter-Lorenz PA, Seidler RD. Multimodal Imaging of Brain Activity to Investigate Walking and Mobility Decline in Older Adults (Mind in Motion Study): Hypothesis, Theory, and Methods. Front Aging Neurosci 2020; 11:358. [PMID: 31969814 PMCID: PMC6960208 DOI: 10.3389/fnagi.2019.00358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022] Open
Abstract
Age-related brain changes likely contribute to mobility impairments, but the specific mechanisms are poorly understood. Current brain measurement approaches (e.g., functional magnetic resonance imaging (fMRI), functional near infrared spectroscopy (fNIRS), PET) are limited by inability to measure activity from the whole brain during walking. The Mind in Motion Study will use cutting edge, mobile, high-density electroencephalography (EEG). This approach relies upon innovative hardware and software to deliver three-dimensional localization of active cortical and subcortical regions with good spatial and temporal resolution during walking. Our overarching objective is to determine age-related changes in the central neural control of walking and correlate these findings with a comprehensive set of mobility outcomes (clinic-based, complex walking, and community mobility measures). Our hypothesis is that age-related walking deficits are explained in part by the Compensation Related Utilization of Neural Circuits Hypothesis (CRUNCH). CRUNCH is a well-supported model that describes the over-recruitment of brain regions exhibited by older adults in comparison to young adults, even at low levels of task complexity. CRUNCH also describes the limited brain reserve resources available with aging. These factors cause older adults to quickly reach a ceiling in brain resources when performing tasks of increasing complexity, leading to poor performance. Two hundred older adults and twenty young adults will undergo extensive baseline neuroimaging and walking assessments. Older adults will subsequently be followed for up to 3 years. Aim 1 will evaluate whether brain activity during actual walking explains mobility decline. Cross sectional and longitudinal designs will be used to study whether poorer walking performance and steeper trajectories of decline are associated with CRUNCH indices. Aim 2 is to harmonize high-density EEG during walking with fNIRS (during actual and imagined walking) and fMRI (during imagined walking). This will allow integration of CRUNCH-related hallmarks of brain activity across neuroimaging modalities, which is expected to lead to more widespread application of study findings. Aim 3 will study central and peripheral mechanisms (e.g., cerebral blood flow, brain regional volumes, and connectivity, sensory function) to explain differences in CRUNCH indices during walking. Research performed in the Mind in Motion Study will comprehensively characterize the aging brain during walking for developing new intervention targets.
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Affiliation(s)
- David J Clark
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Daniel P Ferris
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Chris J Hass
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Babette A Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | | | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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