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Li W, Li C, Liu A, Lin PJ, Mo L, Zhao H, Xu Q, Meng X, Ji L. Lesion-specific cortical activation following sensory stimulation in patients with subacute stroke. J Neuroeng Rehabil 2023; 20:155. [PMID: 37957755 PMCID: PMC10644526 DOI: 10.1186/s12984-023-01276-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Sensory stimulation can play a fundamental role in the activation of the primary sensorimotor cortex (S1-M1), which can promote motor learning and M1 plasticity in stroke patients. However, studies have focused mainly on investigating the influence of brain lesion profiles on the activation patterns of S1-M1 during motor tasks instead of sensory tasks. Therefore, the objective of this study is to explore the lesion-specific activation patterns due to different brain lesion profiles and types during focal vibration (FV). METHODS In total 52 subacute stroke patients were recruited in this clinical experiment, including patients with basal ganglia hemorrhage/ischemia, brainstem ischemia, other subcortical ischemia, cortical ischemia, and mixed cortical-subcortical ischemia. Electroencephalograms (EEG) were recorded following a resting state lasting for 4 min and three sessions of FV. FV was applied over the muscle belly of the affected limb's biceps for 3 min each session. Beta motor-related EEG power desynchronization overlying S1-M1 was used to indicate the activation of S1-M1, while the laterality coefficient (LC) of the activation of S1-M1 was used to assess the interhemispheric asymmetry of brain activation. RESULTS (1) Regarding brain lesion profiles, FV could lead to the significant activation of bilateral S1-M1 in patients with basal ganglia ischemia and other subcortical ischemia. The activation of ipsilesional S1-M1 in patients with brainstem ischemia was higher than that in patients with cortical ischemia. No activation of S1-M1 was observed in patients with lesions involving cortical regions. (2) Regarding brain lesion types, FV could induce the activation of bilateral S1-M1 in patients with basal ganglia hemorrhage, which was significantly higher than that in patients with basal ganglia ischemia. Additionally, LC showed no significant correlation with the modified Barthel index (MBI) in all patients, but a positive correlation with MBI in patients with basal ganglia lesions. CONCLUSIONS These results reveal that sensory stimulation can induce lesion-specific activation patterns of S1-M1. This indicates FV could be applied in a personalized manner based on the lesion-specific activation of S1-M1 in stroke patients with different lesion profiles and types. Our study may contribute to a better understanding of the underlying mechanisms of cortical reorganization.
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Affiliation(s)
- Wei Li
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Chong Li
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
- School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
- Medical Research Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Aixian Liu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ping-Ju Lin
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
| | - Linhong Mo
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hongliang Zhao
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Quan Xu
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Xiangzun Meng
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
| | - Linhong Ji
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
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Mackay MT, Chen J, Shapiro J, Pastore-Wapp M, Slavova N, Grunt S, Stojanovski B, Steinlin M, Beare RJ, Yang JYM. Association of Acute Infarct Topography With Development of Cerebral Palsy and Neurologic Impairment in Neonates With Stroke. Neurology 2023; 101:e1509-e1520. [PMID: 37591776 PMCID: PMC10585702 DOI: 10.1212/wnl.0000000000207705] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 06/09/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Research investigating neonatal arterial ischemic stroke (NAIS) outcomes have shown that combined cortical and basal ganglia infarction or involvement of the corticospinal tract predict cerebral palsy (CP). The research question was whether voxel-based lesion-symptom mapping (VLSM) on acute MRI can identify brain regions associated with CP and neurodevelopmental impairments in NAIS. METHODS Newborns were recruited from prospective Australian and Swiss pediatric stroke registries. CP diagnosis was based on clinical examination. Language and cognitive-behavioral impairments were assessed using the Pediatric Stroke Outcome Measure, dichotomized to good (0-0.5) or poor (≥1), at ≥18 months of age. Infarcts were manually segmented using diffusion-weighted imaging, registered to a neonatal-specific brain template. VLSM was conducted using MATLAB SPM12 toolbox. A general linear model was used to correlate lesion masks with motor, language, and cognitive-behavioral outcomes. Voxel-wise t-statistics were calculated, correcting for multiple comparisons using family-wise error (FWE) rate. RESULTS Eighty-five newborns met the inclusion criteria. Infarct lateralization was left hemisphere (62%), right (8%), and bilateral (30%). At a median age of 2.1 years (interquartile range 1.9-2.6), 33% developed CP and 42% had neurologic impairments. Fifty-four grey and white matter regions correlated with CP (t > 4.33; FWE < 0.05), including primary motor pathway regions, such as the precentral gyrus, and cerebral peduncle, and regions functionally connected to the primary motor pathway, such as the pallidum, and corpus callosum motor segment. No significant correlations were found for language or cognitive-behavioral outcomes. DISCUSSION CP after NAIS correlates with infarct regions directly involved in motor control and in functionally connected regions. Areas associated with language or cognitive-behavioral impairment are less clear.
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Affiliation(s)
- Mark T Mackay
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland.
| | - Jian Chen
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
| | - Jesse Shapiro
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
| | - Manuela Pastore-Wapp
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
| | - Nedelina Slavova
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
| | - Sebastian Grunt
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
| | - Belinda Stojanovski
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
| | - Maja Steinlin
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
| | - Richard J Beare
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
| | - Joseph Yuan-Mou Yang
- From the Department of Neurology (M.T.M., B.S.), Royal Children's Hospital; Neuroscience Research (M.T.M., J.S., B.S., J.Y.-M.Y.), Murdoch Children's Research Institute; Florey Institute of Neurosciences and Mental Health (M.T.M.); Department of Paediatrics (M.T.M., J.Y.-M.Y.), University of Melbourne; Developmental Imaging (J.C., R.J.B., J.Y.-M.Y.); Brain and Mind (J.S.), Murdoch Children's Research Institute, Melbourne, Australia; Support Center for Advanced Neuroimaging (SCAN) (M.P.-W., N.S.), Institute of Diagnostic and Interventional Neuroradiology, University Hospital, Inselspital; Division of Neuropaediatrics, Development and Rehabilitation (S.G., M.S.), Department of Pediatrics, Inselspital Bern University Hospital, University of Bern, Switzerland; Peninsula Clinical School and National Centre for Healthy Ageing (R.J.B.), Monash University; Neuroscience Advanced Clinical Imaging Service (NACIS) (J.Y.-M.Y.), Department of Neurosurgery, Royal Children's Hospital, Melbourne, Australia; and ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation (M.P.-W.), University of Bern, Switzerland
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Frenkel-Toledo S, Ofir-Geva S, Mansano L, Granot O, Soroker N. Stroke Lesion Impact on Lower Limb Function. Front Hum Neurosci 2021; 15:592975. [PMID: 33597852 PMCID: PMC7882502 DOI: 10.3389/fnhum.2021.592975] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
The impact of stroke on motor functioning is analyzed at different levels. ‘Impairment’ denotes the loss of basic characteristics of voluntary movement. ‘Activity limitation’ denotes the loss of normal capacity for independent execution of daily activities. Recovery from impairment is accomplished by ‘restitution’ and recovery from activity limitation is accomplished by the combined effect of ‘restitution’ and ‘compensation.’ We aimed to unravel the long-term effects of variation in lesion topography on motor impairment of the hemiparetic lower limb (HLL), and gait capacity as a measure of related activity limitation. Gait was assessed by the 3 m walk test (3MWT) in 67 first-event chronic stroke patients, at their homes. Enduring impairment of the HLL was assessed by the Fugl–Meyer Lower Extremity (FMA-LE) test. The impact of variation in lesion topography on HLL impairment and on walking was analyzed separately for left and right hemispheric damage (LHD, RHD) by voxel-based lesion-symptom mapping (VLSM). In the LHD group, HLL impairment tended to be affected by damage to the posterior limb of the internal capsule (PLIC). Walking capacity tended to be affected by a larger array of structures: PLIC and corona radiata, external capsule and caudate nucleus. In the RHD group, both HLL impairment and walking capacity were sensitive to damage in a much larger number of brain voxels. HLL impairment was affected by damage to the corona radiata, superior longitudinal fasciculus and insula. Walking was affected by damage to the same areas, plus the internal and external capsules, putamen, thalamus and parts of the perisylvian cortex. In both groups, voxel clusters have been found where damage affected FMA-LE and also 3MWT, along with voxels where damage affected only one of the measures (mainly 3MWT). In stroke, enduring ‘activity limitation’ is affected by damage to a much larger array of brain structures and voxels within specific structures, compared to enduring ‘impairment.’ Differences between the effects of left and right hemisphere damage are likely to reflect variation in motor-network organization and post-stroke re-organization related to hemispheric dominance. Further studies with larger sample size are required for the validation of these results.
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Affiliation(s)
- Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Shay Ofir-Geva
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lihi Mansano
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Granot
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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