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Astrakas LG, Elbach S, Giannopulu I, Li S, Benjafield H, Tzika AA. The role of ventral tegmental area in chronic stroke rehabilitation: an exploratory study. Front Neurol 2023; 14:1270783. [PMID: 38116106 PMCID: PMC10728864 DOI: 10.3389/fneur.2023.1270783] [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: 08/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
Introduction The acknowledged role of external rewards in chronic stroke rehabilitation, offering positive reinforcement and motivation, has significantly contributed to patient engagement and perseverance. However, the exploration of self-reward's importance in this context remains limited. This study aims to investigate the functional connectivity of the ventral tegmental area (VTA), a key node in the brain's reward circuitry, during motor task-based rehabilitation and its correlation with the recovery process. Methods Twelve right-handed healthy volunteers (4 men, 8 women, aged 57.4 ± 11.3 years) and twelve chronic stroke patients (5 men, 7 women, aged 48.1 ± 11.1 years) with clinically significant right-sided motor impairment (mean FM-UE score of 27.6 ± 8.7) participated. The analysis employed the CONN toolbox to assess the association between motor tasks and VTA connectivity using psychophysiological interaction (PPI). Results PPI analysis revealed motor-dependent changes in VTA connectivity, particularly with regions within the motor circuitry, cerebellum, and prefrontal cortex. Notably, stronger connectivity between the ipsilesional VTA and cerebellum was observed in healthy controls compared to chronic stroke patients, highlighting the importance of VTA-cerebellum interactions in motor function. Stroke patients' motor performance was associated with VTA modulation in areas related to both motor tasks and reward processing, emphasizing the role of self-reward processes in rehabilitation. Changes in VTA influence on motor circuitry were linked to improvements in motor performance resulting from rehabilitation. Discussion Our findings underscore the potential of neuroimaging techniques in quantifying and predicting rehabilitation outcomes by examining self-reward processes. The observed associations between VTA connectivity and motor performance in both healthy and stroke-affected individuals emphasize the role of psychological factors, particularly self-reward, in the rehabilitation process. This study contributes valuable insights into the intricate interplay between reward circuits and motor function, highlighting the importance of addressing psychological dimensions in neurorehabilitation strategies.
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Affiliation(s)
- Loukas G. Astrakas
- Medical Physics, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Sabrina Elbach
- Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Shasha Li
- Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Howard Benjafield
- School of Social Sciences and Professions – Psychology, London Metropolitan University, London, United Kingdom
| | - A. Aria Tzika
- Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Astrakas LG, Li S, Ottensmeyer MP, Pusatere C, Moskowitz MA, Tzika AA. Peak Activation Shifts in the Sensorimotor Cortex of Chronic Stroke Patients Following Robot-assisted Rehabilitation Therapy. Open Neuroimag J 2021; 14:8-15. [PMID: 34434290 PMCID: PMC8384467 DOI: 10.2174/1874440002114010008] [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] [Indexed: 12/05/2022] Open
Abstract
Background: Ischemic stroke is the most common cause of complex chronic disability and the third leading cause of death worldwide. In recovering stroke patients, peak activation within the ipsilesional primary motor cortex (M1) during the performance of a simple motor task has been shown to exhibit an anterior shift in many studies and a posterior shift in other studies. Objective: We investigated this discrepancy in chronic stroke patients who completed a robot-assisted rehabilitation therapy program. Methods: Eight chronic stroke patients with an intact M1 and 13 Healthy Control (HC) volunteers underwent 300 functional magnetic resonance imaging (fMRI) scans while performing a grip task at different force levels with a robotic device. The patients were trained with the same robotic device over a 10-week intervention period and their progress was evaluated serially with the Fugl-Meyer and Modified Ashworth scales. Repeated measure analyses were used to assess group differences in locations of peak activity in the sensorimotor cortex (SM) and the relationship of such changes with scores on the Fugl-Meyer Upper Extremity (FM UE) scale. Results: Patients moving their stroke-affected hand had proportionally more peak activations in the primary motor area and fewer peak activations in the somatosensory cortex than the healthy controls (P=0.009). They also showed an anterior shift of peak activity on average of 5.3-mm (P<0.001). The shift correlated negatively with FM UE scores (P=0.002). Conclusion: A stroke rehabilitation grip task with a robotic device was confirmed to be feasible during fMRI scanning and thus amenable to be used to assess plastic changes in neurological motor activity. Location of peak activity in the SM is a promising clinical neuroimaging index for the evaluation and monitoring of chronic stroke patients.
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Affiliation(s)
- Loukas G Astrakas
- Medical Physics, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Shasha Li
- Harvard Medical School, Boston, MA, USA.,NMR Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark P Ottensmeyer
- Harvard Medical School, Boston, MA, USA.,Medical Device & Simulation Laboratory, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Christian Pusatere
- NMR Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael A Moskowitz
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Neuroscience Center, Departments of Neurology and Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - A Aria Tzika
- Harvard Medical School, Boston, MA, USA.,NMR Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Astrakas LG, De Novi G, Ottensmeyer MP, Pusatere C, Li S, Moskowitz MA, Tzika AA. Improving motor function after chronic stroke by interactive gaming with a redesigned MR-compatible hand training device. Exp Ther Med 2021; 21:245. [PMID: 33603853 PMCID: PMC7851602 DOI: 10.3892/etm.2021.9676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/04/2020] [Indexed: 12/01/2022] Open
Abstract
New rehabilitation strategies enabled by technological developments are challenging the prevailing concept of there being a limited window for functional recovery after stroke. In this study, we examined the utility of a robot-assisted therapy used in combination with a serious game as a rehabilitation and motor assessment tool in patients with chronic stroke. We evaluated 928 game rounds from 386 training sessions of 8 patients who had suffered an ischemic stroke affecting middle cerebral artery territory that incurred at least 6 months prior. Motor function was assessed with clinical motor scales, including the Fugl-Meyer upper extremity (FM UE) scale, Action Research Arm Test, Modified Ashworth scale and the Box and Blocks test. Robotic device output measures (mean force, force-position correlation) and serious game score elements (collisions, rewards and total score) were calculated. A total of 2 patients exhibited a marginal improvement after a 10-week training protocol according to the FM UE scale and an additional patient exhibited a significant improvement according to Box and Blocks test. Motor scales showed strong associations of robotic device parameters and game metrics with clinical motor scale scores, with the strongest correlations observed for the mean force (0.677<Ρ<0.869), followed by the number of collisions (-0.670<Ρ<-0.585). Linear regression analysis showed that these indices were independent predictors of motor scale scores. In conclusion, a robotic device linked to a serious game can be used by patients with chronic stroke and induce at least some clinical improvements in motor performance. Robotic device output parameters and game score elements associate strongly with clinical motor scales and have the potential to be used as predictors in models of rehabilitation progress.
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Affiliation(s)
- Loukas G Astrakas
- Medical Physics Laboratory, Faculty of Medicine, University of Ioannina, Ioannina 45110, Greece
| | - Gianluca De Novi
- Medical Device and Simulation Laboratory, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Mark P Ottensmeyer
- Medical Device and Simulation Laboratory, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Radiology, Harvard Medical School, Boston, MA 02115, USA
| | - Christian Pusatere
- Nuclear Magnetic Resonance Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Boston, MA 02114, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Charlestown, MA 02129, USA
| | - Shasha Li
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA.,Nuclear Magnetic Resonance Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Boston, MA 02114, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Charlestown, MA 02129, USA
| | - Michael A Moskowitz
- Athinoula A. Martinos Center of Biomedical Imaging, Charlestown, MA 02129, USA.,Department of Neurology, Neuroscience Center, Massachusetts General Hospital, Boston, MA 02114, USA.,Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
| | - A Aria Tzika
- Nuclear Magnetic Resonance Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Boston, MA 02114, USA.,Athinoula A. Martinos Center of Biomedical Imaging, Charlestown, MA 02129, USA.,Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
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Butt M, Naghdy G, Naghdy F, Murray G, Du H. Patient-Specific Robot-Assisted Stroke Rehabilitation Guided by EEG - A Feasibility Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:2841-2844. [PMID: 33018598 DOI: 10.1109/embc44109.2020.9175459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Multi-session robot-assisted stroke rehabilitation program requires patients to perform repetitive tasks. It is challenging for the patient to maintain concentration during training sessions. A novel intervention strategy using Electroencephalography (EEG) signals is proposed to maintain concentration during training by enhancing the engagement of stroke patients using robot-assisted multi-session rehabilitation. The approach is illustrated by applying it to one stroke patient undergoing 12 training sessions of hand motor training on the AMADEO rehabilitation device. AMADEO offers four modes of training programs of increased intensity comprising passive training, passive training with biofeedback, assistive training as well as active 2D training games. The EEG signals are measured over eight electrode sites: FC4, C4, CP4, FC3, C3, CP3, Cz, and CPz during each training day to extract movement-related cortical potential (MRCP) signals. Moreover, functional hand recovery parameters are determined using the AMADEO assessment tool. The patient's level of engagement is determined by the negative amplitude of the MRCP signal. The rehabilitation program is switched to a more intense training mode when a consistent decrease is observed in the negative amplitude of MRCP signals from the monitored electrodes. Using this approach, the rehabilitation program becomes patient-specific and adaptive. In addition, it is shown that each training mode exhibits a different recovery level of the affected hand and maximum recovery is achieved when MRCP signals indicate that the patient is actively participating in the training.
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