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Beausejour JP, Guinto G, Artrip C, Corvalan A, Furtado Mesa M, Lebron MA, Stock MS. Successful Powerlifting in a Unilateral, Transtibial Amputee: A Descriptive Case Series. J Strength Cond Res 2024; 38:e243-e252. [PMID: 38373088 DOI: 10.1519/jsc.0000000000004733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
ABSTRACT Beausejour, JP, Guinto, G, Artrip, C, Corvalan, A, Mesa, MF, Lebron, MA, and Stock, MS. Successful powerlifting in a unilateral, transtibial amputee: A descriptive case series. J Strength Cond Res 38(5): e243-e252, 2024-There are no reports in the literature of powerlifting success after amputation. We had the unique opportunity to characterize functional outcomes, strength, muscle contractility and size, and corticospinal excitability in an accomplished, competitive powerlifter (best competition squat = 205.0 kg, deadlift = 262.7 kg) with a unilateral, transtibial amputation relative to amputee controls. Four men (age range = 23-49 years) with unilateral, lower-limb amputation (3 transtibial, 1 transfemoral) participated in 1 laboratory visit. We assessed 10-m gait speed, the timed up and go (TUG) test, 5-time sit-to-stand performance (5TSTS), contractile properties of the vastus lateralis (VL) and medial gastrocnemius by tensiomyography, and VL cross-sectional area (CSA) by ultrasonography. Unilateral assessments for the intact limb included isokinetic knee extension and flexion torque and power and transcranial magnetic stimulation derived corticospinal excitability. An interview with the powerlifter provided contextual perspective. Compared with the control subjects, the powerlifter performed the 5TSTS faster (6.8%), exhibited faster VL contraction times (intact limb = 12.2%; residual limb = 23.9%), and showed larger VL CSA for the intact limb (46.7%). The powerlifter exhibited greater knee extension and flexion peak torque and mean power, particularly at 180°·s -1 , as well as greater corticospinal excitability for the intact VL (65.6%) and tibialis anterior (79.6%). By contrast, the control subjects were faster in the TUG (18.3%) and comfortable (13.0%) and fast (21.4%) in the 10-m walk test. The major themes of our interview included needing to modify lifting mechanics, persistence, and remarkable pain tolerance. Our findings highlight the impressive neuromuscular adaptations that are attainable after lower-limb amputation.
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Affiliation(s)
- Jonathan P Beausejour
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Goldshawn Guinto
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Chloe Artrip
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Alejandra Corvalan
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Maxine Furtado Mesa
- Physiology of Work & Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Modesto A Lebron
- Physiology of Work & Exercise Response (POWER) Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
| | - Matt S Stock
- Neuromuscular Plasticity Laboratory, Institute of Exercise Physiology and Rehabilitation Science, University of Central Florida, Orlando, Florida
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Zhang H, Zhang W, Ohlerth A, Schwendner M, Schröder A, Meyer B, Krieg SM, Ille S. Motor mapping of the hand muscles using peripheral innervation-based navigated transcranial magnetic stimulation to identify functional reorganization of primary motor regions in malignant tumors. Hum Brain Mapp 2024; 45:e26642. [PMID: 38433701 PMCID: PMC10910269 DOI: 10.1002/hbm.26642] [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: 10/15/2023] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
Tumor-related motor reorganization remains unclear. Navigated transcranial magnetic stimulation (nTMS) can investigate plasticity non-invasively. nTMS-induced motor-evoked potentials (MEPs) of different muscles are commonly used to measure the center of gravity (CoG), the location with the highest density of corticospinal neurons in the precentral gyrus. We hypothesized that a peripheral innervation-based MEP analysis could outline the tumor-induced motor reorganization with a higher clinical and oncological relevance. Then, 21 patients harboring tumors inside the left corticospinal tract (CST) or precentral gyrus were enrolled in group one (G1), and 24 patients with tumors outside the left CST or precentral gyrus were enrolled in Group 2 (G2). Median- and ulnar-nerve-based MEP analysis combined with diffusion tensor imaging fiber tracking was used to explore motor function distribution. There was no significant difference in CoGs or size of motor regions and underlying tracts between G1 and G2. However, G1 involved a sparser distribution of motor regions and more motor-positive sites in the supramarginal gyrus-tumors inside motor areas induced motor reorganization. We propose an "anchor-and-ship theory" hypothesis for this process of motor reorganization: motor CoGs are stably located in the cortical projection area of the CST, like a seated anchor, as the core area for motor output. Primary motor regions can relocate to nearby gyri via synaptic plasticity and association fibers, like a ship moving around its anchor. This principle can anticipate functional reorganization and be used as a neuro-oncological tool for local therapy, such as radiotherapy or surgery.
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Affiliation(s)
- Haosu Zhang
- Department of NeurosurgeryTechnical University of Munich, School of MedicineMunichGermany
- Department of NeurosurgeryHeidelberg University HospitalHeidelbergGermany
| | - Wei Zhang
- Department of NeurosurgeryTechnical University of Munich, School of MedicineMunichGermany
| | - Ann‐Katrin Ohlerth
- Department of NeurosurgeryTechnical University of Munich, School of MedicineMunichGermany
- Center for Language and Cognition GroningenUniversity of GroningenGroningenNetherlands
| | - Maximilian Schwendner
- Department of NeurosurgeryTechnical University of Munich, School of MedicineMunichGermany
- Department of NeurosurgeryHeidelberg University HospitalHeidelbergGermany
| | - Axel Schröder
- Department of NeurosurgeryTechnical University of Munich, School of MedicineMunichGermany
| | - Bernhard Meyer
- Department of NeurosurgeryTechnical University of Munich, School of MedicineMunichGermany
| | - Sandro M. Krieg
- Department of NeurosurgeryTechnical University of Munich, School of MedicineMunichGermany
- Department of NeurosurgeryHeidelberg University HospitalHeidelbergGermany
- TUM‐Neuroimaging CenterTechnical University of Munich, School of MedicineMunichGermany
| | - Sebastian Ille
- Department of NeurosurgeryTechnical University of Munich, School of MedicineMunichGermany
- Department of NeurosurgeryHeidelberg University HospitalHeidelbergGermany
- TUM‐Neuroimaging CenterTechnical University of Munich, School of MedicineMunichGermany
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Simis M, Marques LM, Barbosa SP, Sugawara AT, Sato JR, Pacheco-Barrios K, Battistella LR, Fregni F. Distinct patterns of metabolic motor cortex activity for phantom and residual limb pain in people with amputations: A functional near-infrared spectroscopy study. Neurophysiol Clin 2024; 54:102939. [PMID: 38382136 DOI: 10.1016/j.neucli.2023.102939] [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: 05/02/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Phantom pain limb (PLP) has gained more attention due to the large number of people with amputations around the world and growing knowledge of the pain process, although its mechanisms are not completely understood. OBJECTIVES The aim of this study was to understand, in patients with amputations, the association between PLP and residual limb pain (RLP), and the brain metabolic response in cortical motor circuits, using functional near-infrared spectroscopy (fNIRS). METHODS Sixty participants were recruited from the rehabilitation program in São Paulo, Brazil. Included patients were aged over 18 years, with traumatic unilateral lower-limb amputation, with PLP for at least 3 months after full recovery from amputation surgery. PLP and RLP levels were measured using visual analogue scales. fNIRS was performed during motor execution and motor mirror tasks for 20 s. In order to highlight possible variables related to variation in pain measures, univariate linear regression analyses were performed for both experimental conditions, resulting in four fNIRS variables (two hemispheres x two experimental conditions). Later, in order to test the topographic specificity of the models, eight multivariate regression analyses were performed (two pain scales x two experimental conditions x two hemispheres), including the primary motor cortex (PMC) related channel as an independent variable as well as five other channels related to the premotor area, supplementary area, and somatosensory cortex. All models were controlled for age, sex, ethnicity, and education. RESULTS We found that: i) there is an asymmetric metabolic activation during motor execution and mirror task between hemispheres (with a predominance that is ipsilateral to the amputated limb), ii) increased metabolic response in the PMC ipsilateral to the amputation is associated with increased PLP (during both experimental tasks), while increased metabolic response in the contralateral PMC is associated with increased RLP (during the mirror motor task only); ii) increased metabolic activity of the ipsilateral premotor region is associated with increased PLP during the motor mirror task; iii) RLP was only associated with higher metabolic activity in the contralateral PMC and lower metabolic activity in the ipsilateral inferior frontal region during motor mirror task, but PLP was associated with higher metabolic activity during both tasks. CONCLUSION These results suggest there is both task and region specificity for the association between the brain metabolic response and the two different types of post-amputation pain. The metabolic predominance that is ipsilateral to the amputated limb during both tasks was associated with higher levels of PLP, suggesting a cortical motor network activity imbalance due to potential interhemispheric compensatory mechanisms. The present work contributes to the understanding of the underlying topographical patterns in the motor-related circuits associated with pain after amputations.
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Affiliation(s)
- Marcel Simis
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil; Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Lucas Murrins Marques
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - Sara Pinto Barbosa
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - André Tadeu Sugawara
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil
| | - João Ricardo Sato
- Interdisciplinary Unit for Applied Neuroscience (NINA), Universidade Federal do ABC (UFABC), São Bernardo do Campo, Brazil; Center for Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), São Bernardo do Campo, Brazil
| | - Kevin Pacheco-Barrios
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru; Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Linamara Rizzo Battistella
- Instituto de Medicina Fisica e Reabilitacao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brasil; Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brasil
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, USA.
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Musumeci G, D'Alonzo M, Ranieri F, Falato E, Capone F, Motolese F, Di Pino G, Di Lazzaro V, Pilato F. Intracortical and interhemispheric excitability changes in arm amputees: A TMS study. Clin Neurophysiol 2023; 156:98-105. [PMID: 37918223 DOI: 10.1016/j.clinph.2023.09.017] [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: 03/12/2023] [Revised: 09/05/2023] [Accepted: 09/21/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE To evaluate cortical circuits and excitability of the motor cortex in the hemisphere contralateral to the affected (AH) and to the unaffected arm (UH), in upper limb amputees. METHODS Motor evoked potentials (MEP) were recorded in 17 subjects who had upper limb amputation: 11 trans-radial (TR) and 6 trans-humeral (TH). Motor thresholds (MT), short interval intracortical inhibition (SICI), and interhemispheric inhibition (IHI) in the available arm muscles of the stump were evaluated. RESULTS There was no significant difference in MT between hemispheres. SICI was preserved in TR but not in TH group. Additionally, in the TR group, the MEP amplitudes in AH were higher than in UH. A significant IHI was observed in the whole sample but not in each hemisphere or patient group. CONCLUSIONS In our population of TR amputees, we found increased corticospinal excitability in the AH with preserved intracortical inhibition. This finding was not observed in the TH population. SIGNIFICANCE Understanding the changes in intracortical excitability in amputees may enhance knowledge of the functional reorganization of the brain in the post-amputation phase, bringing useful information for prosthetic rehabilitation.
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Affiliation(s)
- Gabriella Musumeci
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University of Rome, via Alvaro del Portillo, 5, Rome 00128, Italy
| | - Marco D'Alonzo
- NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University of Rome, via Alvaro del Portillo, 5, Rome 00128, Italy
| | - Federico Ranieri
- Unit of Neurology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro, 10, 37134 Verona, Italy
| | - Emma Falato
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Fioravante Capone
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Francesco Motolese
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Giovanni Di Pino
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; NeXT: Neurophysiology and Neuroengineering of Human-Technology Interaction Research Unit, Campus Bio-Medico University of Rome, via Alvaro del Portillo, 5, Rome 00128, Italy
| | - Vincenzo Di Lazzaro
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Fabio Pilato
- Research Unit of Neurology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy.
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Abstract
Neurological insults, such as congenital blindness, deafness, amputation, and stroke, often result in surprising and impressive behavioural changes. Cortical reorganisation, which refers to preserved brain tissue taking on a new functional role, is often invoked to account for these behavioural changes. Here, we revisit many of the classical animal and patient cortical remapping studies that spawned this notion of reorganisation. We highlight empirical, methodological, and conceptual problems that call this notion into doubt. We argue that appeal to the idea of reorganisation is attributable in part to the way that cortical maps are empirically derived. Specifically, cortical maps are often defined based on oversimplified assumptions of 'winner-takes-all', which in turn leads to an erroneous interpretation of what it means when these maps appear to change. Conceptually, remapping is interpreted as a circuit receiving novel input and processing it in a way unrelated to its original function. This implies that neurons are either pluripotent enough to change what they are tuned to or that a circuit can change what it computes. Instead of reorganisation, we argue that remapping is more likely to occur due to potentiation of pre-existing architecture that already has the requisite representational and computational capacity pre-injury. This architecture can be facilitated via Hebbian and homeostatic plasticity mechanisms. Crucially, our revised framework proposes that opportunities for functional change are constrained throughout the lifespan by the underlying structural 'blueprint'. At no period, including early in development, does the cortex offer structural opportunities for functional pluripotency. We conclude that reorganisation as a distinct form of cortical plasticity, ubiquitously evoked with words such as 'take-over'' and 'rewiring', does not exist.
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Affiliation(s)
- Tamar R Makin
- MRC Cognition and Brain Sciences Unit, University of CambridgeCambridgeUnited Kingdom
| | - John W Krakauer
- Department of Neuroscience, Johns Hopkins University School of MedicineBaltimoreUnited States
- Department of Neurology, Johns Hopkins University School of MedicineBaltimoreUnited States
- The Santa Fe InstituteSanta FeUnited States
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Mereu F, Morosato F, Cordella F, Zollo L, Gruppioni E. Exploring the EMG transient: the muscular activation sequences used as novel time-domain features for hand gestures classification. Front Neurorobot 2023; 17:1264802. [PMID: 38023447 PMCID: PMC10667427 DOI: 10.3389/fnbot.2023.1264802] [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: 07/24/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Muscular activation sequences have been shown to be suitable time-domain features for classification of motion gestures. However, their clinical application in myoelectric prosthesis control was never investigated so far. The aim of the paper is to evaluate the robustness of these features extracted from the EMG signal in transient state, on the forearm, for classifying common hand tasks. Methods The signal associated to four hand gestures and the rest condition were acquired from ten healthy people and two persons with trans-radial amputation. A feature extraction algorithm allowed for encoding the EMG signals into muscular activation sequences, which were used to train four commonly used classifiers, namely Linear Discriminant Analysis (LDA), Support Vector Machine (SVM), Non-linear Logistic Regression (NLR) and Artificial Neural Network (ANN). The offline performances were assessed with the entire sample of recruited people. The online performances were assessed with the amputee subjects. Moreover, a comparison of the proposed method with approaches based on the signal envelope in the transient state and in the steady state was conducted. Results The highest performance were obtained with the NLR classifier. Using the sequences, the offline classification accuracy was higher than 93% for healthy and amputee subjects and always higher than the approach with the signal envelope in transient state. As regards the comparison with the steady state, the performances obtained with the proposed method are slightly lower (<4%), but the classification occurred at least 200 ms earlier. In the online application, the motion completion rate reached up to 85% of the total classification attempts, with a motion selection time that never exceeded 218 ms. Discussion Muscular activation sequences are suitable alternatives to the time-domain features commonly used in classification problems belonging to the sole EMG transient state and could be potentially exploited in control strategies of myoelectric prosthesis hands.
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Affiliation(s)
- Federico Mereu
- Centro Protesi Inail, Vigorso di Budrio, Bologna, Italy
- Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Francesca Cordella
- Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Loredana Zollo
- Unit of Advanced Robotics and Human-Centred Technologies, Università Campus Bio-Medico di Roma, Rome, Italy
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Chong DST, Pople M, Hardy TJ, Cowan A, Birchley D, Guy A, McCarthy R, Welchman SA. Mirror Therapy for the Management of Phantom Limb Pain: A Single- Center Experience. Ann Vasc Surg 2023; 95:184-187. [PMID: 37075833 DOI: 10.1016/j.avsg.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Phantom limb pain (PLP) can have devastating consequences, affecting up to 90% of amputees. PLP is associated with analgesia dependence and impaired quality of life. Mirror therapy (MT) is a novel treatment that has been applied in other pain syndromes. We prospectively evaluated MT in the management of PLP. METHODS A prospective study of patients recruited between 2008 and 2020 who underwent unilateral major limb amputation, with a healthy contralateral limb. Participants were invited to attend weekly MT sessions. Pain in the 7 days prior to each MT session was scored on a Visual Analog Scale (VAS: 0-10 mm) and the short form McGill pain questionnaire. RESULTS Ninety eight patients (68 males and 30 females) aged 17-89 years were recruited over 12 years. Forty four percent of patients had amputations due to peripheral vascular disease. Over an average of 2.5 sessions, the final treatment score on the VAS scale was 2.6 (standard deviation ± 3.0) with a reduction of 4.5 points on VAS score. As a comparison using the short form McGill pain questionnaire scoring system, the average final treatment score was 3.2 (± 5.0) with 91% overall improvement. CONCLUSIONS MT is a very powerful and effective intervention for PLP. It is an exciting addition to the armory of vascular surgeons in the management of this condition.
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Affiliation(s)
| | - Maryanne Pople
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Andrew Cowan
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - David Birchley
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Alison Guy
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Robert McCarthy
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
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Jadidi AF, Jensen W, Zarei AA, Lontis ER, Atashzar SF. From pulse width modulated TENS to cortical modulation: based on EEG functional connectivity analysis. Front Neurosci 2023; 17:1239068. [PMID: 37600002 PMCID: PMC10433172 DOI: 10.3389/fnins.2023.1239068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Modulation in the temporal pattern of transcutaneous electrical nerve stimulation (TENS), such as Pulse width modulated (PWM), has been considered a new dimension in pain and neurorehabilitation therapy. Recently, the potentials of PWM TENS have been studied on sensory profiles and corticospinal activity. However, the underlying mechanism of PWM TENS on cortical network which might lead to pain alleviation is not yet investigated. Therefore, we recorded cortical activity using electroencephalography (EEG) from 12 healthy subjects and assessed the alternation of the functional connectivity at the cortex level up to an hour following the PWM TENS and compared that with the effect of conventional TENS. The connectivity between eight brain regions involved in sensory and pain processing was calculated based on phase lag index and spearman correlation. The alteration in segregation and integration of information in the network were investigated using graph theory. The proposed analysis discovered several statistically significant network changes between PWM TENS and conventional TENS, such as increased local strength and efficiency of the network in high gamma-band in primary and secondary somatosensory sources one hour following stimulation. Our findings regarding the long-lasting desired effects of PWM TENS support its potential as a therapeutic intervention in clinical research.
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Affiliation(s)
- Armita Faghani Jadidi
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Winnie Jensen
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Ali Asghar Zarei
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Eugen Romulus Lontis
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - S. Farokh Atashzar
- Department of Electrical and Computer Engineering, New York University, New York, NY, United States
- Department of Mechanical and Aerospace Engineering, New York University, New York, NY, United States
- Department of Biomedical Engineering, New York University, New York, NY, United States
- NYU WIRELESS, New York University (NYU), New York, NY, United States
- NYU Center for Urban Science and Progress (CUSP), New York University (NYU), New York, NY, United States
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Hunter SW, Motala A, Cronin AE, Bartha R, Viana R, Payne MW. Cortical activation during imagined walking for people with lower limb loss: a pilot study. Front Hum Neurosci 2023; 17:1163526. [PMID: 37476004 PMCID: PMC10354232 DOI: 10.3389/fnhum.2023.1163526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
Each year in Canada, a substantial number of adults undergo limb amputation, with lower limb amputation (LLA) the most prevalent. Enhancing walking ability is crucial for optimizing rehabilitation outcomes, promoting participation, and facilitating community reintegration. Overcoming challenges during the acute post-amputation phase and sub-acute rehabilitation necessitates alternative approaches, such as motor imagery and mental practice, to maximize rehabilitation success. However, the current evidence on activation patterns using motor imagery in individuals with LLA is limited. The primary objective was to assess the feasibility of observing brain activation during imagined walking in individuals with LLA utilizing 3T functional magnetic resonance imaging (fMRI). Eight individuals with LLA and 11 control subjects participated. Consistent with representations of the lower limbs, both control and amputee groups demonstrated bilateral activation in the medial surface of the primary motor and somatosensory cortices. However, individuals with lower limb amputations exhibited significantly greater activation during imagined walking, particularly in frontal regions and the medial surface of the primary motor and supplementary motor cortices. Furthermore, the volume of activation in the bilateral primary motor cortices was higher for participants with amputations compared to controls. The protocol developed in this study establishes a foundation for evaluating the effects of a gait training program that incorporates mental imagery alongside conventional rehabilitation practices, in contrast to standard care alone. This pilot investigation holds potential to enhance our understanding of brain plasticity in individuals with LLA and pave the way for more effective rehabilitation strategies to optimize functional recovery and community reintegration.
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Affiliation(s)
- Susan W. Hunter
- School of Physical Therapy, The University of Western Ontario, London, ON, Canada
| | - Aysha Motala
- School of Psychology, The University of Stirling, Stirling, Scotland
| | - Alicia E. Cronin
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, ON, Canada
| | - Robert Bartha
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Centre for Functional and Metabolic Mapping, Robarts Research Institute, The University of Western Ontario, London, ON, Canada
| | - Ricardo Viana
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
| | - Michael W. Payne
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
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Vucic S, Stanley Chen KH, Kiernan MC, Hallett M, Benninger DH, Di Lazzaro V, Rossini PM, Benussi A, Berardelli A, Currà A, Krieg SM, Lefaucheur JP, Long Lo Y, Macdonell RA, Massimini M, Rosanova M, Picht T, Stinear CM, Paulus W, Ugawa Y, Ziemann U, Chen R. Clinical diagnostic utility of transcranial magnetic stimulation in neurological disorders. Updated report of an IFCN committee. Clin Neurophysiol 2023; 150:131-175. [PMID: 37068329 PMCID: PMC10192339 DOI: 10.1016/j.clinph.2023.03.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/09/2023] [Indexed: 03/31/2023]
Abstract
The review provides a comprehensive update (previous report: Chen R, Cros D, Curra A, Di Lazzaro V, Lefaucheur JP, Magistris MR, et al. The clinical diagnostic utility of transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2008;119(3):504-32) on clinical diagnostic utility of transcranial magnetic stimulation (TMS) in neurological diseases. Most TMS measures rely on stimulation of motor cortex and recording of motor evoked potentials. Paired-pulse TMS techniques, incorporating conventional amplitude-based and threshold tracking, have established clinical utility in neurodegenerative, movement, episodic (epilepsy, migraines), chronic pain and functional diseases. Cortical hyperexcitability has emerged as a diagnostic aid in amyotrophic lateral sclerosis. Single-pulse TMS measures are of utility in stroke, and myelopathy even in the absence of radiological changes. Short-latency afferent inhibition, related to central cholinergic transmission, is reduced in Alzheimer's disease. The triple stimulation technique (TST) may enhance diagnostic utility of conventional TMS measures to detect upper motor neuron involvement. The recording of motor evoked potentials can be used to perform functional mapping of the motor cortex or in preoperative assessment of eloquent brain regions before surgical resection of brain tumors. TMS exhibits utility in assessing lumbosacral/cervical nerve root function, especially in demyelinating neuropathies, and may be of utility in localizing the site of facial nerve palsies. TMS measures also have high sensitivity in detecting subclinical corticospinal lesions in multiple sclerosis. Abnormalities in central motor conduction time or TST correlate with motor impairment and disability in MS. Cerebellar stimulation may detect lesions in the cerebellum or cerebello-dentato-thalamo-motor cortical pathways. Combining TMS with electroencephalography, provides a novel method to measure parameters altered in neurological disorders, including cortical excitability, effective connectivity, and response complexity.
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Affiliation(s)
- Steve Vucic
- Brain, Nerve Research Center, The University of Sydney, Sydney, Australia.
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney; and Department of Neurology, Royal Prince Alfred Hospital, Australia
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health, Bethesda, Maryland, United States
| | - David H Benninger
- Department of Neurology, University Hospital of Lausanne (CHUV), Switzerland
| | - Vincenzo Di Lazzaro
- Unit of Neurology, Neurophysiology, Neurobiology, Department of Medicine, University Campus Bio-Medico of Rome, Rome, Italy
| | - Paolo M Rossini
- Department of Neurosci & Neurorehab IRCCS San Raffaele-Rome, Italy
| | - Alberto Benussi
- Centre for Neurodegenerative Disorders, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alfredo Berardelli
- IRCCS Neuromed, Pozzilli; Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Currà
- Department of Medico-Surgical Sciences and Biotechnologies, Alfredo Fiorini Hospital, Sapienza University of Rome, Terracina, LT, Italy
| | - Sandro M Krieg
- Department of Neurosurgery, Technical University Munich, School of Medicine, Klinikum rechts der Isar, Munich, Germany
| | - Jean-Pascal Lefaucheur
- Univ Paris Est Creteil, EA4391, ENT, Créteil, France; Clinical Neurophysiology Unit, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Yew Long Lo
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital, Singapore, and Duke-NUS Medical School, Singapore
| | | | - Marcello Massimini
- Dipartimento di Scienze Biomediche e Cliniche, Università degli Studi di Milano, Milan, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico, Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Mario Rosanova
- Department of Biomedical and Clinical Sciences University of Milan, Milan, Italy
| | - Thomas Picht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Cluster of Excellence: "Matters of Activity. Image Space Material," Humboldt University, Berlin Simulation and Training Center (BeST), Charité-Universitätsmedizin Berlin, Germany
| | - Cathy M Stinear
- Department of Medicine Waipapa Taumata Rau, University of Auckland, Auckland, Aotearoa, New Zealand
| | - Walter Paulus
- Department of Neurology, Ludwig-Maximilians-Universität München, München, Germany
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Japan
| | - Ulf Ziemann
- Department of Neurology and Stroke, Eberhard Karls University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany; Hertie Institute for Clinical Brain Research, Eberhard Karls University of Tübingen, Otfried-Müller-Straße 27, 72076 Tübingen, Germany
| | - Robert Chen
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital-UHN, Division of Neurology-University of Toronto, Toronto Canada
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Pinto CB, Pacheco-Barrios K, Saleh Velez FG, Gunduz ME, Münger M, Fregni F. Detangling the Structural Neural Correlates Associated with Resting versus Dynamic Phantom Limb Pain Intensity Using a Voxel-based Morphometry Analysis. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:528-537. [PMID: 36583548 PMCID: PMC10406160 DOI: 10.1093/pm/pnac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 09/23/2022] [Accepted: 10/20/2022] [Indexed: 12/31/2022]
Abstract
The management of phantom limb pain (PLP) is still challenging due to a partial understanding of its neurophysiological mechanisms. Structural neuroimaging features are potential biomarkers. However, only a few studies assessed their correlations with clinical severity and treatment response. This study aims to explore the association between brain gray matter volume (GMV) with phantom limb manifestations severity and PLP improvement after neuromodulatory treatments (transcranial direct current stimulation and mirror therapy). Voxel-based morphometry analyses and functional decoding using a reverse inference term-based meta-analytic approach were used. We included 24 lower limb traumatic amputees with moderate to severe PLP. We found that alterations of cortical GMV were correlated with PLP severity but not with other clinical manifestations. Less PLP severity was associated with larger brain clusters GMV in the non-affected prefrontal, insula (non-affected mid-anterior region), and bilateral thalamus. However, only the insula cluster survived adjustments. Moreover, the reverse inference meta-analytic approach revealed that the found insula cluster is highly functionally connected to the contralateral insula and premotor cortices, and the decoded psychological processes related to this cluster were "rating," "sustained attention," "impulsivity, " and "suffering." Moreover, we found that responders to neuromodulatory treatment have higher GMV in somatosensory areas (total volume of S1 and S2) in the affected hemisphere at baseline, compared to non-responders, even after adjustments.
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Affiliation(s)
| | | | - Faddi G Saleh Velez
- Department of Neurology, University of Chicago Medical Center, University of Chicago, Chicago, IL 60637, United States
| | - Muhammed E Gunduz
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, United States
| | - Marionna Münger
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, United States
| | - Felipe Fregni
- Corresponding author: Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, 96 13th Street, Charlestown, Boston, MA 02129, USA.
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12
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Gaetz W, Dockstader C, Furlong PL, Amaral S, Vossough A, Schwartz ES, Roberts TPL, Scott Levin L. Somatosensory and motor representations following bilateral transplants of the hands: A 6-year longitudinal case report on the first pediatric bilateral hand transplant patient. Brain Res 2023; 1804:148262. [PMID: 36706858 DOI: 10.1016/j.brainres.2023.148262] [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: 11/11/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/26/2023]
Abstract
A vascularized composite tissue allotransplantation (VCA) was performed at the Children's Hospital of Philadelphia (CHOP), on an 8-year-old patient in 2015, six years after bilateral hand and foot amputation. Hand VCA resulted in reafferentation of the medial, ulnar, and radial nerves serving hand somatosensation and motor function. We used magnetoencephalography (MEG) to assess somatosensory cortical plasticity following the post-transplantation recovery of the peripheral sensory nerves of the hands. Our 2-year postoperative MEG showed that somatosensory lip representations, initially observed at "hand areas", reverted to canonical, orthotopic lip locations with recovery of post-transplant hand function. Here, we continue the assessment of motor and somatosensory responses up to 6-years post-transplant. Magnetoencephalographic somatosensory responses were recorded eight times over a six-year period following hand transplantation, using a 275-channel MEG system. Somatosensory tactile stimuli were presented to the right lower lip (all 8 visits) as well as right and left index fingers (visits 3-8) and fifth digits (visits 4-8). In addition, left and right-hand motor responses were also recorded for left index finger and right thumb (visit 8 only).During the acute recovery phase (visits 3 and 4), somatosensory responses of the digits were observed to be significantly larger and more phasic (i.e., smoother) than controls. Subsequent measures showed that digit responses maintain this atypical response profile (evoked-response magnitudes typically exceed 1 picoTesla). Orthotopic somatosensory localization of the lip, D2, and D5 was preserved. Motor beta-band desynchrony was age-typical in localization and response magnitude; however, the motor gamma-band response was significantly larger than that observed in a reference population.These novel findings show that the restoration of somatosensory input of the hands resulted in persistent and atypically large cortical responses to digit stimulation, which remain atypically large at 6 years post-transplant; there is no known perceptual correlate, and no reports of phantom pain. Normal somatosensory organization of the lip, D2, and D5 representation remain stable following post-recovery reorganization of the lip's somatosensory response.
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Affiliation(s)
- W Gaetz
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - C Dockstader
- Human Biology Program, University of Toronto, Toronto ON, Canada
| | - P L Furlong
- Institute of Health and Neurodevelopment, Aston University, Birmingham, UK
| | - S Amaral
- Department of Pediatrics, Division of Nephrology, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA
| | - A Vossough
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - E S Schwartz
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Neuroradiology, Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - T P L Roberts
- Lurie Family Foundations' MEG Imaging Center, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia PA, USA; Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - L Scott Levin
- Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104, USA; Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, PA 19104, USA
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13
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Zhao Y, Li Z, Zhang Z, Qian K, Xie S. An EMG-driven musculoskeletal model for estimation of wrist kinematics using mirrored bilateral movement. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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14
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de Jongh Curry AL, Hunt ME, Pasquina PF, Waters RS, Tsao JW. Non-surgical Management of Phantom Limb Pain: Current and Emerging Clinical Approaches. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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15
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Pimenta DC, Lima D, Slawka E, Pacheco-Barrios K, Fregni F. Editorial: Bench to Bedside - the translation of intracortical inhibition marker to clinical practice. PRINCIPLES AND PRACTICE OF CLINICAL RESEARCH (2015) 2022; 8:92-97. [PMID: 37449292 PMCID: PMC10343941 DOI: 10.21801/ppcrj.2022.83.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Danielle Carolina Pimenta
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Daniel Lima
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eric Slawka
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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16
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Temporal and spatial goal-directed reaching in upper limb prosthesis users. Exp Brain Res 2022; 240:3011-3021. [PMID: 36222884 DOI: 10.1007/s00221-022-06476-7] [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: 04/15/2022] [Accepted: 09/30/2022] [Indexed: 11/04/2022]
Abstract
Understanding the fundamental characteristics of prosthetic movement control is imperative in improving prosthesis design and training. This study quantified how using an upper limb prosthesis affected performance during goal-directed reaching tasks. Nine prosthesis users with unilateral transradial limb absence and nine healthy controls completed a series of goal-directed reaching movements with different goals: one spatial and three temporal with different goal frequencies. We quantified end-point accuracy, smoothness, and peak speed for the spatial task and temporal accuracy, horizontal distance, and speed for the temporal task. For the temporal task, we also used a goal-equivalent manifold (GEM) approach to decompose variability in movement distance and speed into those perpendicular and tangential to the GEM. Detrended fluctuation analysis (DFA) quantified the temporal persistence of each time series. For the spatial task, movements made with prostheses were less smooth, had larger end-point errors, and had slower peak speed compared to those with control limbs (p < 0.041). For the temporal task, movements made with prostheses and intact limbs of prosthesis users and control limbs were similar in distance and speed and had similar timing errors (p > 0.138). Timing errors, distance, speed, and GEM deviations were corrected similarly between prosthetic limbs and control limbs (p > 0.091). The mean and variability of distance, speed, and perpendicular deviations decreased with increased goal frequency (p < 0.001). Our results suggest that prosthesis users have a sufficient internal model to successfully complete ballistic movements but are unable to accurately complete movements requiring substantial feedback.
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Pathophysiological and Neuroplastic Changes in Postamputation and Neuropathic Pain: Review of the Literature. Plast Reconstr Surg Glob Open 2022; 10:e4549. [PMID: 36187278 PMCID: PMC9521753 DOI: 10.1097/gox.0000000000004549] [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: 02/01/2022] [Accepted: 08/05/2022] [Indexed: 10/24/2022]
Abstract
Despite advancements in surgical and rehabilitation strategies, extremity amputations are frequently associated with disability, phantom limb sensations, and chronic pain. Investigation into potential treatment modalities has focused on the pathophysiological changes in both the peripheral and central nervous systems to better understand the underlying mechanism in the development of chronic pain in persons with amputations. Methods Presented in this article is a discussion outlining the physiological changes that occur in the peripheral and central nervous systems following amputation. In this review, the authors examine the molecular and neuroplastic changes occurring in the nervous system, as well as the state-of-the-art treatment to help reduce the development of postamputation pain. Results This review summarizes the current literature regarding neurological changes following amputation. Development of both central sensitization and neuronal remodeling in the spinal cord and cerebral cortex allows for the development of neuropathic and phantom limb pain postamputation. Recently developed treatments targeting these pathophysiological changes have enabled a reduction in the severity of pain; however, complete resolution remains elusive. Conclusions Changes in the peripheral and central nervous systems following amputation should not be viewed as separate pathologies, but rather two interdependent mechanisms that underlie the development of pathological pain. A better understanding of the physiological changes following amputation will allow for improvements in therapeutic treatments to minimize pathological pain caused by amputation.
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18
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Tomeh A, Yusof Khan AHK, Inche Mat LN, Basri H, Wan Sulaiman WA. Repetitive Transcranial Magnetic Stimulation of the Primary Motor Cortex beyond Motor Rehabilitation: A Review of the Current Evidence. Brain Sci 2022; 12:brainsci12060761. [PMID: 35741646 PMCID: PMC9221422 DOI: 10.3390/brainsci12060761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 02/01/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) has emerged as a novel technique to stimulate the human brain through the scalp. Over the years, identifying the optimal brain region and stimulation parameters has been a subject of debate in the literature on therapeutic uses of repetitive TMS (rTMS). Nevertheless, the primary motor cortex (M1) has been a conventional target for rTMS to treat motor symptoms, such as hemiplegia and spasticity, as it controls the voluntary movement of the body. However, with an expanding knowledge base of the M1 cortical and subcortical connections, M1-rTMS has shown a therapeutic efficacy that goes beyond the conventional motor rehabilitation to involve pain, headache, fatigue, dysphagia, speech and voice impairments, sleep disorders, cognitive dysfunction, disorders of consciousness, anxiety, depression, and bladder dysfunction. In this review, we summarize the latest evidence on using M1-rTMS to treat non-motor symptoms of diverse etiologies and discuss the potential mechanistic rationale behind the management of each of these symptoms.
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Affiliation(s)
- Abdulhameed Tomeh
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
- Malaysian Research Institute on Ageing (MyAgeingTM), Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Liyana Najwa Inche Mat
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
| | - Hamidon Basri
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
| | - Wan Aliaa Wan Sulaiman
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia; (A.T.); (A.H.K.Y.K.); (L.N.I.M.); (H.B.)
- Malaysian Research Institute on Ageing (MyAgeingTM), Universiti Putra Malaysia, Serdang 43400, Malaysia
- Correspondence: ; Tel.: +60-3-9769-5560
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Fitzpatrick SM, Brogan D, Grover P. Hand Transplants, Daily Functioning, and the Human Capacity for Limb Regeneration. Front Cell Dev Biol 2022; 10:812124. [PMID: 35309909 PMCID: PMC8930848 DOI: 10.3389/fcell.2022.812124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 11/24/2022] Open
Abstract
Unlike some of our invertebrate and vertebrate cousins with the capacity to regenerate limbs after traumatic loss, humans do not have the ability to regrow arms or legs lost to injury or disease. For the millions of people worldwide who have lost a limb after birth, the primary route to regaining function and minimizing future complications is via rehabilitation, prosthetic devices, assistive aids, health system robustness, and social safety net structures. The majority of limbs lost are lower limbs (legs), with diabetes and vascular disorders being significant causal contributors. Upper limbs (arms) are lost primarily because of trauma; digits and hands are the most common levels of loss. Even if much of the arm remains intact, upper limb amputation significantly impacts function, largely due to the loss of the hand. Human hands are marvels of evolution and permit a dexterity that enables a wide variety of function not readily replaced by devices. It is not surprising, therefore, for some individuals, dissatisfaction with available prosthetic options coupled with remarkable advances in hand surgery techniques is resulting in patients undertaking the rigors of a hand transplantation. While not “regeneration” in the sense of the enviable ability with which Axolotls can replace a lost limb, hand transplants do require significant regeneration of tissues and nerves. Regaining sophisticated hand functions also depends on “reconnecting” the donated hand with the areas of the human brain responsible for the sensory and motor processing required for complex actions. Human hand transplants are not without controversy and raise interesting challenges regarding the human regenerative capacity and the status of transplants for enabling function. More investigation is needed to address medical and ethical questions prior to expansion of hand transplants to a wider patient population.
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Affiliation(s)
- Susan M. Fitzpatrick
- James S. McDonnell Foundation, St. Louis, MO, United States
- *Correspondence: Susan M. Fitzpatrick,
| | - David Brogan
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Prateek Grover
- Division of Neurorehabilitation, Orthopaedic Surgery and Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
- The Rehabilitation Institute of St Louis, St. Louis, MO, United States
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D'Agostino S, Colella M, Liberti M, Falsaperla R, Apollonio F. Systematic numerical assessment of occupational exposure to electromagnetic fields of Transcranial Magnetic Stimulation. Med Phys 2022; 49:3416-3431. [PMID: 35196394 PMCID: PMC9401858 DOI: 10.1002/mp.15567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose This study aims to perform a classification and rigorous numerical evaluation of the risks of occupational exposure in the health environment related to the administration of transcranial magnetic stimulation (TMS) treatment. The study investigates the numerically estimated induced electric field that occurs in the human tissues of an operator caused by exposure to the variable magnetic field produced by TMS during treatments. This could be a useful starting point for future risk assessment studies and safety indications in this context. Methods We performed a review of the actual positions assumed by clinicians during TMS treatments. Three different TMS coils (two circular and one figure‐of‐eight) were modeled and characterized numerically. Different orientations and positions of each coil with respect to the body of the operator were investigated to evaluate the induced electric (‐E) field in the body tissues. The collected data were processed to allow comparison with the safety standards for occupational exposure, as suggested by the International Commission on Non‐Ionizing Radiation Protection (ICNIRP) 2010 guidelines. Results Under the investigated conditions, exposure to TMS shows some criticalities for the operator performing the treatment. Depending on the model of the TMS coil and its relative position with respect to the operator's body, the numerically estimated E‐field could exceed the limits suggested by the ICNIRP 2010 guidelines. We established that the worst‐case scenario for the three coils occurs when they are placed in correspondence of the abdomen, with the handle oriented parallel to the body (II orientation). Working at a maximum TMS stimulator output (MSO), the induced E‐field is up to 7.32 V/m (circular coil) and up to 1.34 V/m (figure‐of‐eight coil). The induced E‐field can be modulated by the TMS percentage of MSO (%MSO) and by the distance between the source and the operator. At %MSO equal to or below 80%, the figure‐of‐eight coil was compliant with the ICNIRP limit (1.13 V/m). Conversely, the circular coil causes an induced E‐field above the limits, even when powered at a %MSO of 30%. Thus, in the investigated worst‐case conditions, an operator working with a circular coil should keep a distance from its edge to be compliant with the guidelines limit, which depends on the selected %MSO: 38 cm at 100%, 32 cm at 80%, 26.8 cm at 50%, and 19.8 cm at 30%. Furthermore, attention should be paid to the induced E‐field reached in the operator's hand as the operator typically holds the coil by hand. In fact in the hand, we estimated an induced E‐field up to 10 times higher than the limits. Conclusions Our numerical results indicate that coil positions, orientations, and distances with respect to the operator's body can determine the levels of induced E‐field that exceed the ICNIRP limits. The induced E‐field is also modulated by the choice of %MSO, which is related to the TMS application. Even under the best exposure conditions, attention should be paid to the exposure of the hand. These findings highlight the need for future risk assessment studies to provide more safety information for the correct and safe use of TMS devices.
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Affiliation(s)
- S D'Agostino
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Via Eudossiana 18, Rome, 00184, Italy.,INAIL, Italian Workers' Compensation Authority, via di Fontana Candida 1, Monte Porzio Catone, Rome, 00040, Italy
| | - M Colella
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Via Eudossiana 18, Rome, 00184, Italy
| | - M Liberti
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Via Eudossiana 18, Rome, 00184, Italy
| | - R Falsaperla
- INAIL, Italian Workers' Compensation Authority, via di Fontana Candida 1, Monte Porzio Catone, Rome, 00040, Italy
| | - F Apollonio
- Department of Information Engineering, Electronics and Telecommunications, Sapienza University of Rome, Via Eudossiana 18, Rome, 00184, Italy
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Kim S, Shin DY, Kim T, Lee S, Hyun JK, Park SM. Enhanced Recognition of Amputated Wrist and Hand Movements by Deep Learning Method Using Multimodal Fusion of Electromyography and Electroencephalography. SENSORS 2022; 22:s22020680. [PMID: 35062641 PMCID: PMC8778369 DOI: 10.3390/s22020680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 02/04/2023]
Abstract
Motion classification can be performed using biometric signals recorded by electroencephalography (EEG) or electromyography (EMG) with noninvasive surface electrodes for the control of prosthetic arms. However, current single-modal EEG and EMG based motion classification techniques are limited owing to the complexity and noise of EEG signals, and the electrode placement bias, and low-resolution of EMG signals. We herein propose a novel system of two-dimensional (2D) input image feature multimodal fusion based on an EEG/EMG-signal transfer learning (TL) paradigm for detection of hand movements in transforearm amputees. A feature extraction method in the frequency domain of the EEG and EMG signals was adopted to establish a 2D image. The input images were used for training on a model based on the convolutional neural network algorithm and TL, which requires 2D images as input data. For the purpose of data acquisition, five transforearm amputees and nine healthy controls were recruited. Compared with the conventional single-modal EEG signal trained models, the proposed multimodal fusion method significantly improved classification accuracy in both the control and patient groups. When the two signals were combined and used in the pretrained model for EEG TL, the classification accuracy increased by 4.18-4.35% in the control group, and by 2.51-3.00% in the patient group.
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Affiliation(s)
- Sehyeon Kim
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea;
| | - Dae Youp Shin
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea;
| | - Taekyung Kim
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul 03063, Korea;
| | - Sangsook Lee
- Department of Rehabilitation Medicine, Daejeon Hospital, Daejeon 34383, Korea;
| | - Jung Keun Hyun
- Department of Rehabilitation Medicine, College of Medicine, Dankook University, Cheonan 31116, Korea;
- Department of Nanobiomedical Science & BK21 NBM Global Research Center for Regenerative Medicine, Dankook University, Cheonan 31116, Korea
- Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan 31116, Korea
- Correspondence: (J.K.H.); (S.-M.P.); Tel.: +82-10-2293-3415 (J.K.H.); +82-10-7208-7740 (S.-M.P.)
| | - Sung-Min Park
- Department of Convergence IT Engineering, Pohang University of Science and Technology, Pohang 37673, Korea;
- Department of Electrical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
- Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang 37673, Korea
- Correspondence: (J.K.H.); (S.-M.P.); Tel.: +82-10-2293-3415 (J.K.H.); +82-10-7208-7740 (S.-M.P.)
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22
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Jadidi AF, Stevenson AJT, Zarei AA, Jensen W, Lontis R. Effect of Modulated TENS on Corticospinal Excitability in Healthy Subjects. Neuroscience 2022; 485:53-64. [PMID: 35031397 DOI: 10.1016/j.neuroscience.2022.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
Conventional transcutaneous electrical nerve stimulation (TENS) has been reported to effectively alleviate chronic pain, including phantom limb pain (PLP). Recently, literature has focused on modulated TENS patterns, such as pulse width modulation (PWM) and burst modulation (BM), as alternatives to conventional, non-modulated (NM) sensory neurostimulation to increase the efficiency of rehabilitation. However, there is still limited knowledge of how these modulated TENS patterns affect corticospinal (CS) and motor cortex activity. Therefore, our aim was to first investigate the effect of modulated TENS patterns on CS activity and corticomotor map in healthy subjects. Motor evoked potentials (MEP) elicited by transcranial magnetic stimulation (TMS) were recorded from three muscles before and after the application of TENS interventions. Four different TENS patterns (PWM, BM, NM 40 Hz, and NM 100 Hz) were applied. The results revealed significant facilitation of CS excitability following the PWM intervention. We also found an increase in the volume of the motor cortical map following the application of the PWM and NM (40 Hz). Although PLP alleviation has been reported to be associated with an enhancement of corticospinal excitability, the efficiency of the PWM intervention to induce pain alleviation should be validated in a future clinical study in amputees with PLP.
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Affiliation(s)
- Armita Faghani Jadidi
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark.
| | | | - Ali Asghar Zarei
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
| | - Winnie Jensen
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
| | - Romulus Lontis
- Center for Neuroplasticity and Pain (CNAP) Department of Health Science and Technology, Aalborg University, Denmark
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23
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Khoodoruth MAS, Estudillo-Guerra MA, Pacheco-Barrios K, Nyundo A, Chapa-Koloffon G, Ouanes S. Glutamatergic System in Depression and Its Role in Neuromodulatory Techniques Optimization. Front Psychiatry 2022; 13:886918. [PMID: 35492692 PMCID: PMC9047946 DOI: 10.3389/fpsyt.2022.886918] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Depressive disorders are among the most common psychiatric conditions and contribute to significant morbidity. Even though the use of antidepressants revolutionized the management of depression and had a tremendous positive impact on the patient's outcome, a significant proportion of patients with major depressive disorder (MDD) show no or partial or response even with adequate treatment. Given the limitations of the prevailing monoamine hypothesis-based pharmacotherapy, glutamate and glutamatergic related pathways may offer an alternative and a complementary option for designing novel intervention strategies. Over the past few decades, there has been a growing interest in understanding the neurobiological underpinnings of glutamatergic dysfunctions in the pathogenesis of depressive disorders and the development of new pharmacological and non-pharmacological treatment options. There is a growing body of evidence for the efficacy of neuromodulation techniques, including transcranial magnetic stimulation, transcutaneous direct current stimulation, transcranial alternating current stimulation, and photo-biomodulation on improving connectivity and neuroplasticity associated with depression. This review attempts to revisit the role of glutamatergic neurotransmission in the etiopathogenesis of depressive disorders and review the current neuroimaging, neurophysiological and clinical evidence of these neuromodulation techniques in the pathophysiology and treatment of depression.
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Affiliation(s)
| | - Maria Anayali Estudillo-Guerra
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, United States
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Harvard Medical School, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA, United States.,Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Azan Nyundo
- Department of Psychiatry and Mental Health, School of Medicine and Dental Health, The University of Dodoma, Dodoma, Tanzania
| | | | - Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
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24
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Pacheco-Barrios K, de Melo PS, Vasquez-Avila K, Cardenas-Rojas A, Gonzalez-Mego P, Marduy A, Parente J, Sanchez IR, Cortez P, Whalen M, Castelo-Branco L, Fregni F. Accelerating the translation of research findings to clinical practice: insights from phantom limb pain clinical trials. PRINCIPLES AND PRACTICE OF CLINICAL RESEARCH (2015) 2021; 7:1-7. [PMID: 35434310 PMCID: PMC9009529 DOI: 10.21801/ppcrj.2021.74.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Paulo Sampaio de Melo
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Karen Vasquez-Avila
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Alejandra Cardenas-Rojas
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Paola Gonzalez-Mego
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Anna Marduy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Joao Parente
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Ingrid Rebello Sanchez
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Pablo Cortez
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Meghan Whalen
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Luis Castelo-Branco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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25
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Janssens SEW, Sack AT. Spontaneous Fluctuations in Oscillatory Brain State Cause Differences in Transcranial Magnetic Stimulation Effects Within and Between Individuals. Front Hum Neurosci 2021; 15:802244. [PMID: 34924982 PMCID: PMC8674306 DOI: 10.3389/fnhum.2021.802244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 01/01/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) can cause measurable effects on neural activity and behavioral performance in healthy volunteers. In addition, TMS is increasingly used in clinical practice for treating various neuropsychiatric disorders. Unfortunately, TMS-induced effects show large intra- and inter-subject variability, hindering its reliability, and efficacy. One possible source of this variability may be the spontaneous fluctuations of neuronal oscillations. We present recent studies using multimodal TMS including TMS-EMG (electromyography), TMS-tACS (transcranial alternating current stimulation), and concurrent TMS-EEG-fMRI (electroencephalography, functional magnetic resonance imaging), to evaluate how individual oscillatory brain state affects TMS signal propagation within targeted networks. We demonstrate how the spontaneous oscillatory state at the time of TMS influences both immediate and longer-lasting TMS effects. These findings indicate that at least part of the variability in TMS efficacy may be attributable to the current practice of ignoring (spontaneous) oscillatory fluctuations during TMS. Ignoring this state-dependent spread of activity may cause great individual variability which so far is poorly understood and has proven impossible to control. We therefore also compare two technical solutions to directly account for oscillatory state during TMS, namely, to use (a) tACS to externally control these oscillatory states and then apply TMS at the optimal (controlled) brain state, or (b) oscillatory state-triggered TMS (closed-loop TMS). The described multimodal TMS approaches are paramount for establishing more robust TMS effects, and to allow enhanced control over the individual outcome of TMS interventions aimed at modulating information flow in the brain to achieve desirable changes in cognition, mood, and behavior.
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Affiliation(s)
- Shanice E W Janssens
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands
| | - Alexander T Sack
- Section Brain Stimulation and Cognition, Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands.,Maastricht Brain Imaging Centre (MBIC), Maastricht, Netherlands.,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Brain + Nerve Centre, Maastricht University Medical Centre+ (MUMC+), Maastricht, Netherlands.,Centre for Integrative Neuroscience (CIN), Maastricht University, Maastricht, Netherlands
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26
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Rothwell J, Antal A, Burke D, Carlsen A, Georgiev D, Jahanshahi M, Sternad D, Valls-Solé J, Ziemann U. Central nervous system physiology. Clin Neurophysiol 2021; 132:3043-3083. [PMID: 34717225 PMCID: PMC8863401 DOI: 10.1016/j.clinph.2021.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 12/15/2022]
Abstract
This is the second chapter of the series on the use of clinical neurophysiology for the study of movement disorders. It focusses on methods that can be used to probe neural circuits in brain and spinal cord. These include use of spinal and supraspinal reflexes to probe the integrity of transmission in specific pathways; transcranial methods of brain stimulation such as transcranial magnetic stimulation and transcranial direct current stimulation, which activate or modulate (respectively) the activity of populations of central neurones; EEG methods, both in conjunction with brain stimulation or with behavioural measures that record the activity of populations of central neurones; and pure behavioural measures that allow us to build conceptual models of motor control. The methods are discussed mainly in relation to work on healthy individuals. Later chapters will focus specifically on changes caused by pathology.
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Affiliation(s)
- John Rothwell
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK,Corresponding author at: Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK, (J. Rothwell)
| | - Andrea Antal
- Department of Neurology, University Medical Center Göttingen, Germany
| | - David Burke
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney 2050, Australia
| | - Antony Carlsen
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Dejan Georgiev
- Department of Neurology, University Medical Centre Ljubljana, Slovenia
| | - Marjan Jahanshahi
- Department of Clinical and Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Dagmar Sternad
- Departments of Biology, Electrical & Computer Engineering, and Physics, Northeastern University, Boston, MA 02115, USA
| | - Josep Valls-Solé
- Institut d’Investigació Biomèdica August Pi I Sunyer, Villarroel, 170, Barcelona, Spain
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research, Eberhard Karls University, Tübingen, Germany
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27
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Faghihpirayesh R, Yarossi M, Imbiriba T, Brooks DH, Tunik E, Erdogmus D. Efficient TMS-Based Motor Cortex Mapping Using Gaussian Process Active Learning. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1679-1689. [PMID: 34406942 PMCID: PMC8452135 DOI: 10.1109/tnsre.2021.3105644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Transcranial Magnetic Stimulation (TMS) can be used to map cortical motor topography by spatially sampling the sensorimotor cortex while recording Motor Evoked Potentials (MEP) with surface electromyography (EMG). Traditional sampling strategies are time-consuming and inefficient, as they ignore the fact that responsive sites are typically sparse and highly spatially correlated. An alternative approach, commonly employed when TMS mapping is used for presurgical planning, is to leverage the expertise of the coil operator to use MEPs elicited by previous stimuli as feedback to decide which loci to stimulate next. In this paper, we propose to automatically infer optimal future stimulus loci using active learning Gaussian Process-based sampling in place of user expertise. We first compare the user-guided (USRG) method to the traditional grid selection method and randomized sampling to verify that the USRG approach has superior performance. We then compare several novel active Gaussian Process (GP) strategies with the USRG approach. Experimental results using real data show that, as expected, the USRG method is superior to the grid and random approach in both time efficiency and MEP map accuracy. We also found that an active warped GP entropy and a GP random-based strategy performed equally as well as, or even better than, the USRG method. These methods were completely automatic, and succeeded in efficiently sampling the regions in which the MEP response variations are largely confined. This work provides the foundation for highly efficient, fully automatized TMS mapping, especially when considered in the context of advances in robotic coil operation.
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28
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Gunduz ME, Pacheco-Barrios K, Bonin Pinto C, Duarte D, Vélez FGS, Gianlorenco ACL, Teixeira PEP, Giannoni-Luza S, Crandell D, Battistella LR, Simis M, Fregni F. Effects of Combined and Alone Transcranial Motor Cortex Stimulation and Mirror Therapy in Phantom Limb Pain: A Randomized Factorial Trial. Neurorehabil Neural Repair 2021; 35:704-716. [PMID: 34060934 PMCID: PMC10042175 DOI: 10.1177/15459683211017509] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Phantom limb pain (PLP) is a frequent complication in amputees, which is often refractory to treatments. We aim to assess in a factorial trial the effects of transcranial direct current stimulation (tDCS) and mirror therapy (MT) in patients with traumatic lower limb amputation; and whether the motor cortex plasticity changes drive these results. In this large randomized, blinded, 2-site, sham-controlled, 2 × 2 factorial trial, 112 participants with traumatic lower limb amputation were randomized into treatment groups. The interventions were active or covered MT for 4 weeks (20 sessions, 15 minutes each) combined with 2 weeks of either active or sham tDCS (10 sessions, 20 minutes each) applied to the contralateral primary motor cortex. The primary outcome was PLP changes on the visual analogue scale at the end of interventions (4 weeks). Motor cortex excitability and cortical mapping were assessed by transcranial magnetic stimulation (TMS). We found no interaction between tDCS and MT groups (F = 1.90, P = .13). In the adjusted models, there was a main effect of active tDCS compared to sham tDCS (beta coefficient = -0.99, P = .04) on phantom pain. The overall effect size was 1.19 (95% confidence interval: 0.90, 1.47). No changes in depression and anxiety were found. TDCS intervention was associated with increased intracortical inhibition (coefficient = 0.96, P = .02) and facilitation (coefficient = 2.03, P = .03) as well as a posterolateral shift of the center of gravity in the affected hemisphere. MT induced no motor cortex plasticity changes assessed by TMS. These findings indicate that transcranial motor cortex stimulation might be an affordable and beneficial PLP treatment modality.
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Affiliation(s)
- Muhammed Enes Gunduz
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin Pacheco-Barrios
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Universidad San Ignacio de Loyola, Lima, Peru
| | - Camila Bonin Pinto
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Northwestern University, Chicago, IL, USA
| | - Dante Duarte
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,McMaster University, Hamilton, Ontario, Canada
| | - Faddi Ghassan Saleh Vélez
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,University of Chicago Medical Center, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Anna Carolyna Lepesteur Gianlorenco
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Paulo Eduardo Portes Teixeira
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefano Giannoni-Luza
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Crandell
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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29
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Teixeira PEP, Pacheco-Barrios K, Gunduz ME, Gianlorenço AC, Castelo-Branco L, Fregni F. Understanding intracortical excitability in phantom limb pain: A multivariate analysis from a multicenter randomized clinical trial. Neurophysiol Clin 2021; 51:161-173. [PMID: 33648819 DOI: 10.1016/j.neucli.2020.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES To explore associations of intracortical excitability with clinical characteristics in a large sample of subjects with phantom limb pain (PLP). METHODS Ancillary study using baseline and longitudinal data from a large multicenter randomized trial that investigated the effects of non-invasive brain stimulation combined with sensorimotor training on PLP. Multivariate regression modeling analyses were used to investigate the association of intracortical excitability, measured by percentages of intracortical inhibition (ICI) and facilitation (ICF) with clinical variables. RESULTS Ninety-eight subjects were included. Phantom sensation of itching was positively associated with ICI changes and at baseline in the affected hemisphere (contralateral to PLP). However, in the non-affected hemisphere (ipsilateral to PLP), the phantom sensation of warmth and PLP intensity were negatively associated with ICI (both models). For the ICF, PLP intensity (baseline model only) and age (longitudinal model) were negatively associated, while time since amputation and amputation level (both for longitudinal model only) were positively associated in the affected hemisphere. Additionally, use of antidepressants led to lower ICF in the non-affected hemisphere for the baseline model while higher amputation level also led to less changes in the ICF. CONCLUSION Results revealed clear associations of clinical variables and cortical excitability in a large chronic pain sample. ICI and ICF changes appear not to be mainly explained by PLP intensity. Instead, other variables associated with duration of neuroplasticity changes (such as age and duration of amputation) and compensatory mechanisms (such as itching and phantom limb sensation) seem to be more important in explaining these variables.
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Affiliation(s)
- Paulo E P Teixeira
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; MGH Institute of Health Professions, Boston, MA, USA; Instituto Wilson Mello, Campinas, SP, Brazil.
| | - Kevin Pacheco-Barrios
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Muhammed Enes Gunduz
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Anna Carolyna Gianlorenço
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Laboratory of neuroscience, Department of Physical Therapy, Federal University of Sao Carlos, SP, Brazil
| | - Luis Castelo-Branco
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Felipe Fregni
- Neuromodulation and Clinical Research Learning Center, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard T. H. Chan School of Public Health, Boston, MA, USA
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30
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Muret D, Makin TR. The homeostatic homunculus: rethinking deprivation-triggered reorganisation. Curr Opin Neurobiol 2020; 67:115-122. [PMID: 33248404 DOI: 10.1016/j.conb.2020.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 12/16/2022]
Abstract
While amputation was considered a prominent model for cortical reorganisation, recent evidence highlights persistent representation of the missing hand. We offer a new perspective on the literature of amputation-triggered sensorimotor plasticity, by emphasising the need for homeostasis and emerging evidence of latent activity distributed across the homunculus. We argue that deprivation uncovers pre-existing latent activity, which can manifest as remapping, but that since this activity was already there, remapping could in some instances correspond to functional stability of the system rather than reorganisation. Adaptive behaviour and Hebbian-like plasticity may also play crucial roles in maintaining the functional organisation of the homunculus when deprivation occurs in adulthood or in early development. Collectively, we suggest that the brain's need for stability may underlie several key phenotypes for brain remapping, previously interpreted as consequential to reorganisation. Nevertheless, reorganisation may still be possible, especially when cortical changes contribute to the stability of the system.
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Affiliation(s)
- Dollyane Muret
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Tamar R Makin
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom.
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31
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Duarte D, Bauer CCC, Pinto CB, Saleh Velez FG, Estudillo-Guerra MA, Pacheco-Barrios K, Gunduz ME, Crandell D, Merabet L, Fregni F. Cortical plasticity in phantom limb pain: A fMRI study on the neural correlates of behavioral clinical manifestations. Psychiatry Res Neuroimaging 2020; 304:111151. [PMID: 32738724 PMCID: PMC9394643 DOI: 10.1016/j.pscychresns.2020.111151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 12/29/2022]
Abstract
The neural mechanism of phantom limb pain (PLP) is related to the intense brain reorganization process implicating plasticity after deafferentation mostly in sensorimotor system. There is a limited understanding of the association between the sensorimotor system and PLP. We used a novel task-based functional magnetic resonance imaging (fMRI) approach to (1) assess neural activation within a-priori selected regions-of-interested (motor cortex [M1], somatosensory cortex [S1], and visual cortex [V1]), (2) quantify the cortical representation shift in the affected M1, and (3) correlate these changes with baseline clinical characteristics. In a sample of 18 participants, we found a significantly increased activity in M1 and S1 as well as a shift in motor cortex representation that was not related to PLP intensity. In an exploratory analyses (not corrected for multiple comparisons), they were directly correlated with time since amputation; and there was an association between increased activity in M1 with a lack of itching sensation and V1 activation was negatively correlated with PLP. Longer periods of amputation lead to compensatory changes in sensory-motor areas; and itching seems to be a protective marker for less signal changes. We confirmed that PLP intensity is not associated with signal changes in M1 and S1 but in V1.
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Affiliation(s)
- D Duarte
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA; Department of Psychiatry and Behavioural Neurosciences, McMaster University. 100 West 5th Street, Hamilton, ON L8N 3K7, Canada
| | - C C C Bauer
- McGovern Institute for Brain Research, MIT. 43 Vassar St, Cambridge, MA 02139, USA; Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus UNAM 3001, 76230 Juriquilla, Querétaro, 76230, México; Department of Psychology, Northeastern University, 805 Columbus Avenue, Boston, MA 02139, USA.
| | - C B Pinto
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA
| | - F G Saleh Velez
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA; University of Chicago Medical Center, Department of Neurology, University of Chicago. 5841 S Maryland Ave # C411, Chicago, IL 60637, USA
| | - M A Estudillo-Guerra
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA
| | - K Pacheco-Barrios
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud. Lima, Peru. Av. La Fontana 750 Edificio El Cubo, La Molina - Perú
| | - M E Gunduz
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA
| | - D Crandell
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA
| | - L Merabet
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School. 243 Charles St, Boston, MA 02114, USA
| | - F Fregni
- Spaulding Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School. 96 13th Street, Charlestown, Boston, MA 02129, USA; Massachusetts General Hospital, Harvard Medical School. 55 Fruit St, Boston, MA 02114, USA.
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Postural Control during Progressively Increased Balance-Task Difficulty in Athletes with Unilateral Transfemoral Amputation: Effect of Ocular Mobility and Visuomotor Processing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176242. [PMID: 32867306 PMCID: PMC7503799 DOI: 10.3390/ijerph17176242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022]
Abstract
This study examined postural control during single leg stance test with progressively increased balance-task difficulty in soccer players with unilateral transfemoral amputation (n = 11) compared to able-bodied soccer players (n = 11). The overall stability index (OSI), the anterior/posterior stability index, and the medial/lateral stability index during three balance tasks with increasing surface instability were estimated. The oculomotor and visuomotor contribution to postural control in disabled athletes was analyzed. Oculomotor function, simple and choice reaction times, and peripheral perception were assessed in a series of visuomotor tests. The variation in OSI demonstrated significantly greater increases during postural tests with increased balance-task difficulty in the able-bodied soccer players compared to amputees (F(2,40) = 3.336, p < 0.05). Ocular mobility index correlated (p < 0.05) with OSI in conditions of increasing balance-task difficulty. Moreover, speed of eye-foot reaction has positive influence (p < 0.05) on stability indexes in tasks with an unstable surface. Amputee soccer players displayed comparable postural stability to able-bodied soccer players. Disabled athletes had better adaptability in restoring a state of balance in conditions of increased balance-task difficulty than the controls. The speed of visuomotor processing, characterized mainly by speed of eye-foot reaction, significantly contributed to these results.
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Nakajima R, Kinoshita M, Nakada M. Motor Functional Reorganization Is Triggered by Tumor Infiltration Into the Primary Motor Area and Repeated Surgery. Front Hum Neurosci 2020; 14:327. [PMID: 32922279 PMCID: PMC7457049 DOI: 10.3389/fnhum.2020.00327] [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: 03/20/2020] [Accepted: 07/23/2020] [Indexed: 12/22/2022] Open
Abstract
In patients with gliomas, motor deficits are not always observed, even though tumor cells infiltrate into the motor area. Currently, it is recognized that this phenomenon can occur through the neuroplasticity potential. The aim of this study is to investigate the characteristics of motor functional reorganization in gliomas. Out of 100 consecutive patients who underwent awake surgery, 29 patients were assessed as regards their motor function and were retrospectively explored to determine whether positive motor responses were elicited. A total of 73 positive mapping sites from 27 cases were identified, and their spatial anatomical locations and activated region by functional MRI were analyzed. Additionally, the factors promoting neuroplasticity were analyzed through multiple logistic regression analysis. As a result, a total of 60 points (21 cases) were found in place, while 13 points (17.8%) were found to be shifted from anatomical localization. Reorganizations were classified into three categories: Type 1 (move to ipsilateral different gyrus) was detected at nine points (four cases), and they moved into the postcentral gyrus. Type 2 (move within the ipsilateral precentral gyrus) was detected at four points (two cases). Unknown type (two cases) was categorized as those whose motor functional cortex was moved to other regions, although we could not find the compensated motor area. Two factors for the onset of reorganization were identified: tumor cells infiltrate into the primary motor area and repeated surgery (p < 0.0001 and p = 0.0070, respectively). Our study demonstrated that compensation can occur mainly in two ways, and it promoted repeated surgery and infiltration of tumor into the primary motor area.
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Affiliation(s)
- Riho Nakajima
- Department of Occupational Therapy, Faculty of Health Science, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Masashi Kinoshita
- Department of Neurosurgery, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
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Pacheco-Barrios K, Pinto CB, Saleh Velez FG, Duarte D, Gunduz ME, Simis M, Lepesteur Gianlorenco AC, Barouh JL, Crandell D, Guidetti M, Battistella L, Fregni F. Structural and functional motor cortex asymmetry in unilateral lower limb amputation with phantom limb pain. Clin Neurophysiol 2020; 131:2375-2382. [PMID: 32828040 DOI: 10.1016/j.clinph.2020.06.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/27/2020] [Accepted: 06/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The role of motor cortex reorganization in the development and maintenance of phantom limb pain (PLP) is still unclear. This study aims to evaluate neurophysiological and structural motor cortex asymmetry in patients with PLP and its relationship with pain intensity. METHODS Cross-sectional analysis of an ongoing randomized-controlled trial. We evaluated the motor cortex asymmetry through two techniques: i) changes in cortical excitability indexed by transcranial magnetic stimulation (motor evoked potential, paired-pulse paradigms and cortical mapping), and ii) voxel-wise grey matter asymmetry analysis by brain magnetic resonance imaging. RESULTS We included 62 unilateral traumatic lower limb amputees with a mean PLP of 5.9 (SD = 1.79). We found, in the affected hemisphere, an anterior shift of the hand area center of gravity (23 mm, 95% CI 6 to 38, p = 0.005) and a disorganized and widespread representation. Regarding voxel-wise grey matter asymmetry analysis, data from 21 participants show a loss of grey matter volume in the motor area of the affected hemisphere. This asymmetry seems negatively associated with time since amputation. For TMS data, only the ICF ratio is negatively correlated with PLP intensity (r = -0.25, p = 0.04). CONCLUSION There is an asymmetrical reorganization of the motor cortex in patients with PLP, characterized by a disorganized, widespread, and shifted hand cortical representation and a loss in grey matter volume in the affected hemisphere. This reorganization seems to reduce across time since amputation. However, it is not associated with pain intensity. SIGNIFICANCE These findings are significant to understand the role of the motor cortex reorganization in patients with PLP, showing that the pain intensity may be related with other neurophysiological factors, not just cortical reorganization.
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Affiliation(s)
- K Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - C B Pinto
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - F G Saleh Velez
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; University of Chicago Medical Center, Department of Neurology, University of Chicago, Chicago, IL, USA
| | - D Duarte
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - M E Gunduz
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - M Simis
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - A C Lepesteur Gianlorenco
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - J L Barouh
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - D Crandell
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - M Guidetti
- Università degli Studi di Milano, Dipartimento di scienze della Salute, "Aldo Ravelli" Center for Neurotechnolgy and Experimental Brain Therapeutics, Milano, Italy
| | - L Battistella
- Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - F Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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