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Cheng X, Huang X, Yu Q, Zheng Y, Zheng J, Zhao S, Lo WLA, Wang C, Zhang S. Associations between brain structures, cognition and dual-task performance in patients with mild cognitive impairment: A study based on voxel-based morphology. Hum Mov Sci 2024; 97:103257. [PMID: 39126810 DOI: 10.1016/j.humov.2024.103257] [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: 12/27/2023] [Revised: 07/08/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND This study aimed to explore the associations between brain structures, cognition, and motor control in participants with mild cognitive impairment (MCI), with a focus on dual-task performance. METHODS Thirty MCI patients and thirty healthy controls were enrolled. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Structural magnetic resonance imaging data were analyzed using voxel-based morphometry (VBM) to calculate brain parenchyma volume and gray matter volume (GMV). Participants performed single- and dual-task Timed Up and Go (TUG) tests, and the correlations between significant GMV differences and task execution time was analyzed. RESULTS MCI patients showed significantly lower MoCA scores, particularly in visuospatial/executive, attention, and delayed recall domains (p < 0.05). Dual-task TUG execution time was significantly increased in MCI patients (p < 0.05). The GMV in the right anterior lobe of the cerebellum and both insulae was positively correlated with visuospatial/executive scores (FDR-corrected, p < 0.05). The GMV of the right cerebellar anterior lobe and insula were significantly reduced in MCI patients (p < 0.05). The GMV of the right cerebellar anterior lobe was negatively correlated with dual-task execution time (r = -0.32, p = 0.012). CONCLUSION Smaller GMV in the right anterior lobe of the cerebellum was associated with impaired dual-task performance, which may provide more evidence for the neural mechanisms of cognitive and motor function impairments in MCI.
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Affiliation(s)
- Xue Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Xin Huang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Yiyi Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Jiaxuan Zheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Shuzhi Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; CAS Key Laboratory of Human-Machine Intelligence-Synergy Systems, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Engineering and Technology Research Centre for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Siyun Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Liu Q, Liu Y, Zhang Y. Effects of Cerebellar Non-Invasive Stimulation on Neurorehabilitation in Stroke Patients: An Updated Systematic Review. Biomedicines 2024; 12:1348. [PMID: 38927555 PMCID: PMC11201496 DOI: 10.3390/biomedicines12061348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
The cerebellum is emerging as a promising target for noninvasive brain stimulation (NIBS). A systematic review was conducted to evaluate the effects of cerebellar NIBS on both motor and other symptoms in stroke rehabilitation, its impact on functional ability, and potential side effects (PROSPERO number: CRD42022365697). A systematic electronic database search was performed by using PubMed Central (PMC), EMBASE, and Web of Science, with a cutoff date of November 2023. Data extracted included study details, NIBS methodology, outcome measures, and results. The risk of bias in eligible studies was also assessed. Twenty-two clinical studies involving 1016 participants were finally included, with a focus on outcomes related to post-stroke motor recovery (gait and balance, muscle spasticity, and upper limb dexterity) and other functions (dysphagia and aphasia). Positive effects were observed, especially on motor functions like gait and balance. Some efficiency was also observed in dysphagia rehabilitation. However, findings on language recovery were preliminary and inconsistent. A slight improvement in functional ability was noted, with no serious adverse effects reported. Further studies are needed to explore the effects of cerebellar NIBS on post-stroke non-motor deficits and to understand how cerebellar engagement can facilitate more precise treatment strategies for stroke rehabilitation.
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Affiliation(s)
- Qi Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yang Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yumei Zhang
- Department of Rehabilitation, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
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Fox-Hesling J, Wisseman D, Kantak S. Noninvasive cerebellar stimulation and behavioral interventions: A crucial synergy for post-stroke motor rehabilitation. NeuroRehabilitation 2024; 54:521-542. [PMID: 38943401 DOI: 10.3233/nre-230371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
BACKGROUND Improvement of functional movements after supratentorial stroke occurs through spontaneous biological recovery and training-induced reorganization of remnant neural networks. The cerebellum, through its connectivity with the cortex, brainstem and spinal cord, is actively engaged in both recovery and reorganization processes within the cognitive and sensorimotor systems. Noninvasive cerebellar stimulation (NiCBS) offers a safe, clinically feasible and potentially effective way to modulate the excitability of spared neural networks and promote movement recovery after supratentorial stroke. NiCBS modulates cerebellar connectivity to the cerebral cortex and brainstem, as well as influences the sensorimotor and frontoparietal networks. OBJECTIVE Our objective was twofold: (a) to conduct a scoping review of studies that employed NiCBS to influence motor recovery and learning in individuals with stroke, and (b) to present a theory-driven framework to inform the use of NiCBS to target distinct stroke-related deficits. METHODS A scoping review of current research up to August 2023 was conducted to determine the effect size of NiCBS effect on movement recovery of upper extremity function, balance, walking and motor learning in humans with stroke. RESULTS Calculated effect sizes were moderate to high, offering promise for improving upper extremity, balance and walking outcomes after stroke. We present a conceptual framework that capitalizes on cognitive-motor specialization of the cerebellum to formulate a synergy between NiCBS and behavioral interventions to target specific movement deficits. CONCLUSION NiCBS enhances recovery of upper extremity impairments, balance and walking after stroke. Physiologically-informed synergies between NiCBS and behavioral interventions have the potential to enhance recovery. Finally, we propose future directions in neurophysiological, behavioral, and clinical research to move NiCBS through the translational pipeline and augment motor recovery after stroke.
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Affiliation(s)
| | - Darrell Wisseman
- Moss Rehabilitation, Elkins Park, PA, USA
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
| | - Shailesh Kantak
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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Qurat-ul-ain, Ahmad Z, Ilyas S, Ishtiaq S, Tariq I, Nawaz Malik A, Liu T, Wang J. Comparison of a single session of tDCS on cerebellum vs. motor cortex in stroke patients: a randomized sham-controlled trial. Ann Med 2023; 55:2252439. [PMID: 38100750 PMCID: PMC10732189 DOI: 10.1080/07853890.2023.2252439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/20/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE The purpose of this study was to determine whether a single session of trans-cranial direct current stimulation (tDCS) of the cerebellum and M1 has any advantages over one another or sham stimulation in terms of balance, gait and lower limb function. METHODS A total of 66 patients who had experienced their first ever stroke were recruited into three groups for this double-blinded, parallel, randomized, sham-controlled trial: cerebellar stimulation group (CbSG), M1 stimulation group (MSG) and sham stimulation group (SSG). A single session of anodal tDCS with an intensity of 2 mA for a duration of 20 min was administered in addition to gait and balance training based on virtual reality using an Xbox 360 with Kinect. Balance, gait, cognition and risk of fall were assessed using outcome measures before intervention (T0), immediately after intervention (T1) and an hour after intervention (T2). RESULTS Across group analysis of all outcome measures showed statistically non-significant results (p > .05) except for Six Minute Walk Test (p value T0 = .003, p value T1 = .025, p value T2 = .016). The training effect difference showed a significant difference in balance, gait and cognition, as well as cerebral and cerebellar stimulation, in comparison to sham stimulation (p < .05). The risk of falls remained unaffected by any stimulation (p > .05). CONCLUSIONS In addition to Xbox Kinect-based rehabilitation training, a single session of anodal tDCS to the M1 or cerebellum may be beneficial for improving lower limb function, balance and gait performance.
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Affiliation(s)
- Qurat-ul-ain
- School of Life Science and Technology, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, Xi’an Jiaotong University, Xi’an, PR China
- National Engineering Research Center for Healthcare Devices, Guangzhou, PR China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi’an, PR China
| | - Zafran Ahmad
- Department of Logistics Engineering, Kunming University of Science & Technology, Kunming, China
| | - Saad Ilyas
- Faculty of Computing, Capital University of Science and Technology, Islamabad, Pakistan
- Department of Computing, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Summaiya Ishtiaq
- Faculty of Rehabilitation & Allied Health Sciences, Riphah College of Rehabilitation & Allied Health Sciences, Islamabad, Pakistan
| | - Iqbal Tariq
- Faculty of Rehabilitation & Allied Health Sciences, Riphah College of Rehabilitation & Allied Health Sciences, Islamabad, Pakistan
| | - Arshad Nawaz Malik
- Faculty of Rehabilitation & Allied Health Sciences, Riphah College of Rehabilitation & Allied Health Sciences, Islamabad, Pakistan
| | - Tian Liu
- School of Life Science and Technology, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, Xi’an Jiaotong University, Xi’an, PR China
- National Engineering Research Center for Healthcare Devices, Guangzhou, PR China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi’an, PR China
| | - Jue Wang
- School of Life Science and Technology, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, Xi’an Jiaotong University, Xi’an, PR China
- National Engineering Research Center for Healthcare Devices, Guangzhou, PR China
- The Key Laboratory of Neuro-informatics & Rehabilitation Engineering of Ministry of Civil Affairs, Xi’an, PR China
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