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Zhang M, Zhu F, Jia F, Wu Y, Wang B, Gao L, Chu F, Tang W. Efficacy of brain-computer interfaces on upper extremity motor function rehabilitation after stroke: A systematic review and meta-analysis. NeuroRehabilitation 2024; 54:199-212. [PMID: 38143387 DOI: 10.3233/nre-230215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND The recovery of upper limb function is crucial to the daily life activities of stroke patients. Brain-computer interface technology may have potential benefits in treating upper limb dysfunction. OBJECTIVE To systematically evaluate the efficacy of brain-computer interfaces (BCI) in the rehabilitation of upper limb motor function in stroke patients. METHODS Six databases up to July 2023 were reviewed according to the PRSIMA guidelines. Randomized controlled trials of BCI-based upper limb functional rehabilitation for stroke patients were selected for meta-analysis by pooling standardized mean difference (SMD) to summarize the evidence. The Cochrane risk of bias tool was used to assess the methodological quality of the included studies. RESULTS Twenty-five studies were included. The studies showed that BCI had a small effect on the improvement of upper limb function after the intervention. In terms of total duration of training, < 12 hours of training may result in better rehabilitation, but training duration greater than 12 hours suggests a non significant therapeutic effect of BCI training. CONCLUSION This meta-analysis suggests that BCI has a slight efficacy in improving upper limb function and has favorable long-term outcomes. In terms of total duration of training, < 12 hours of training may lead to better rehabilitation.
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Affiliation(s)
- Ming Zhang
- Department of Mechatronic Engineering, China University of Mining and Technology, Jiangsu, China
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Medical University, Jiangsu, China
| | - Feilong Zhu
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Fan Jia
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Medical University, Jiangsu, China
| | - Yu Wu
- Department of Sports and Exercise Science, Zhejiang University, Hangzhou, China
| | - Bin Wang
- Departments of Rehabilitation Medicine, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ling Gao
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Medical University, Jiangsu, China
| | - Fengming Chu
- The Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou Medical University, Jiangsu, China
| | - Wei Tang
- Department of Mechatronic Engineering, China University of Mining and Technology, Jiangsu, China
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2
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Zhang M, Wei J, Wu X. Effects of whole-body vibration training on lower limb motor function and neural plasticity in patients with stroke: protocol for a randomised controlled clinical trial. BMJ Open 2022; 12:e060796. [PMID: 35768103 PMCID: PMC9240887 DOI: 10.1136/bmjopen-2022-060796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Lower limb motor dysfunction is common in patients with stroke, and usually caused by brain neural connectivity disorder. Previous studies have shown that the whole-body vibration training (WBVT) significantly improves the lower limb motor function in patients with stroke and may promote nerve remodelling. The prior purpose of this study is to explore effects of WBVT on lower limb motor function and neuroplasticity in patients with stroke. METHODS A single-blind randomised controlled trial will be conducted. Sixty patients with stroke will be recruited and allocated randomly to WBVT, routine rehabilitation training (RRT) and control group (CG). The WBVT and RRT interventions will be implemented as five 25 min sessions weekly for continuous 12 weeks; the CG will remain daily habitual living styles and routine treatments, in community or hospital, and will also receive telephone follow-up and health-related lectures. Transcranial magnetic stimulation will be used to assess neural plasticity while lower limb motor function is assessed using indicators of strength, walking ability and joint activity. The assessments will be conducted at the period of baseline, week 6, week 12 as well as on 4 and 8 weeks, respectively, after intervention completion. ETHICS AND DISSEMINATION This study has been approved by the Shanghai University of Sport Research Ethics Committee (102772021RT067) and will provide data on the effects of WBVT relative to RRT in terms of the improvement of stroke patients' lower limb motor function and neural plasticity. The results of this study will be disseminated via publications in peer-reviewed journals and presentations at international conference. TRIAL REGISTRATION NUMBER ChiCTR2200055143.
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Affiliation(s)
| | - Jianing Wei
- School of Psychology, Shanghai University of Sport, Shanghai, China
| | - Xueping Wu
- Shanghai University of Sport, Shanghai, China
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3
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Giulia L, Adolfo V, Julie C, Quentin D, Simon B, Fleury M, Leveque-Le Bars E, Bannier E, Lécuyer A, Barillot C, Bonan I. The impact of neurofeedback on effective connectivity networks in chronic stroke patients: an exploratory study. J Neural Eng 2021; 18. [PMID: 34551403 DOI: 10.1088/1741-2552/ac291e] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/22/2021] [Indexed: 11/12/2022]
Abstract
Objective.In this study, we assessed the impact of electroencephalography-functional magnetic resonance imaging (EEG-fMRI) neurofeedback (NF) on connectivity strength and direction in bilateral motor cortices in chronic stroke patients. Most of the studies using NF or brain computer interfaces for stroke rehabilitation have assessed treatment effects focusing on successful activation of targeted cortical regions. However, given the crucial role of brain network reorganization for stroke recovery, our broader aim was to assess connectivity changes after an NF training protocol targeting localized motor areas.Approach.We considered changes in fMRI connectivity after a multisession EEG-fMRI NF training targeting ipsilesional motor areas in nine stroke patients. We applied the dynamic causal modeling and parametric empirical Bayes frameworks for the estimation of effective connectivity changes. We considered a motor network including both ipsilesional and contralesional premotor, supplementary and primary motor areas.Main results.Our results indicate that NF upregulation of targeted areas (ipsilesional supplementary and primary motor areas) not only modulated activation patterns, but also had a more widespread impact on fMRI bilateral motor networks. In particular, inter-hemispheric connectivity between premotor and primary motor regions decreased, and ipsilesional self-inhibitory connections were reduced in strength, indicating an increase in activation during the NF motor task.Significance.To the best of our knowledge, this is the first work that investigates fMRI connectivity changes elicited by training of localized motor targets in stroke. Our results open new perspectives in the understanding of large-scale effects of NF training and the design of more effective NF strategies, based on the pathophysiology underlying stroke-induced deficits.
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Affiliation(s)
- Lioi Giulia
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France.,IMT Atlantique, Lab-STICC, UMR CNRS 6285, Brest, F-29238, France
| | - Veliz Adolfo
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
| | | | - Duché Quentin
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France.,Department of Physical and Rehabilitation Medicine, CHU Rennes, Rennes, France
| | - Butet Simon
- Department of Physical and Rehabilitation Medicine, CHU Rennes, Rennes, France
| | - Mathis Fleury
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
| | | | - Elise Bannier
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France.,Department of Radiology, CHU Rennes, Rennes, France
| | | | | | - Isabelle Bonan
- Department of Physical and Rehabilitation Medicine, CHU Rennes, Rennes, France
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Zhang M, You H, Zhang H, Zhao W, Han T, Liu J, Jiang S, Feng X. Effects of visual feedback balance training with the Pro-kin system on walking and self-care abilities in stroke patients. Medicine (Baltimore) 2020; 99:e22425. [PMID: 32991477 PMCID: PMC7523840 DOI: 10.1097/md.0000000000022425] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Some scholars' studies have demonstrated that Pro-kin balance system training is able to promote the recovery of the balance function in stroke patients. The present study has expanded on those studies, and was not merely limited to studying balance, but also encompassed walking and self-care abilities of the patients; furthermore, the association among balance and walking and self-care abilities was also explored.A total of 40 stroke patients were randomly and equally divided into 2 groups: the control group (n = 20) and the treatment group (n = 20). Both groups underwent conventional balance training, although the treatment group also underwent visual feedback balance training with the Pro-kin system. The balance function was assessed using the Berg Balance Scale (BBS), the Timed "Up & Go" (TUG) test, and Pro-kin system parameters. The Pro-kin system parameters included the perimeter and ellipse area, which were both tested once with eyes open (EO) and eyes closed (EC). Walking ability was assessed using the Holden Walking Ability Scale, according to the Functional Ambulation Classification (FAC). The self-care abilities were assessed with the Barthel Index (BI). The tests were conducted prior to training, and 3 weeks after the end of the training programme.No significant differences were noted among the groups before the training. After 3 weeks of training, for both the groups, significant improvements in balance and the walking and self-care abilities were noted: The BBS value was significantly increased (P < .05), whereas the TUG, perimeter, and ellipse area with EO and EC measurements were significantly decreased after treatment (P < .05). The FAC and BI readings were significantly increased after treatment (P < 0.05), and the treatment group outperformed the control group (P < .05). Furthermore, the balance function was shown to be strongly correlated with the walking and self-care abilities (P < .01).The present study has demonstrated that the use of the Pro-kin visual feedback balance training system in combination with conventional training is a viable method for improving walking and self-care abilities of stroke patients.
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Sharini H, Riyahi Alam N, Khabiri H, Arabalibeik H, Hashemi H, Azimi AR, Masjoodi S. Novel FMRI-Compatible wrist robotic device for brain activation assessment during rehabilitation exercise. Med Eng Phys 2020; 83:112-122. [PMID: 32507416 DOI: 10.1016/j.medengphy.2020.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 04/26/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022]
Abstract
Magnetic Resonance Imaging (MRI) can be applied to study the effects of rehabilitation strategies for neuroscience research. An MRI-wrist robot is designed and used as a clinical tool to examine the process of the brain plasticity changes. In this robot, the patient actuation is accomplished with two standard air cylinders, located inside the MRI chamber with two degrees of freedom (flexion-extension and ulna-radial deviation) with pneumatic air transmission, consisting of simple mechanism converting rotary motion to linear independently. A pilot study of brain image aiming at revealing more effective therapeutic strategies carried out to confirm the technical aspects of the development and validation. In a healthy subject, both wrist movement of robot and subject demonstrated brain activity in the contralateral primary somatosensory cortex. Because the robot does not move during the patient's body, a stand was designed to allow the wrist robot and patient to fit comfortably within the MRI machine. While all the parts of the robot were carefully selected with strict MRI compatibility requirements, the robot was tested by presenting some pilot imaging data with null effects on the image quality, as well. Finally, the possible further development of the robot has been introduced for a rehabilitation assessment.
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Affiliation(s)
- H Sharini
- Department of Biomedical Engineering, Faculty of Medicine, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | - N Riyahi Alam
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran; PERFORM Center, Concordia University, Montreal, QC, Canada; Pharmaceutical Sciences Research Center (PSRC), The institute of Pharmaceutical Sciences, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - H Khabiri
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - H Arabalibeik
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Research Center for Science and Technology in Medicine (RCSTM), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - H Hashemi
- Department of Radiology, Faculty of Medicine, Tehran University of Medical Sciences(TUMS), Tehran, Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences(TUMS), Tehran, Iran
| | - A R Azimi
- Sina MS Research Center, Sina Hospital, Faculty of Medicine, Tehran University of Medical Sciences(TUMS), Tehran, Iran
| | - S Masjoodi
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran
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6
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A Review of Exercise-Induced Neuroplasticity in Ischemic Stroke: Pathology and Mechanisms. Mol Neurobiol 2020; 57:4218-4231. [PMID: 32691303 DOI: 10.1007/s12035-020-02021-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
After ischemic stroke, survivors experience motor dysfunction and deterioration of memory and cognition. These symptoms are associated with the disruption of normal neuronal function, i.e., the secretion of neurotrophic factors, interhemispheric connections, and synaptic activity, and hence the disruption of the normal neural circuit. Exercise is considered an effective and feasible rehabilitation strategy for improving cognitive and motor recovery following ischemic stroke through the facilitation of neuroplasticity. In this review, our aim was to discuss the mechanisms by which exercise-induced neuroplasticity improves motor function and cognitive ability after ischemic stroke. The associated mechanisms include increases in neurotrophins, improvements in synaptic structure and function, the enhancement of interhemispheric connections, the promotion of neural regeneration, the acceleration of neural function reorganization, and the facilitation of compensation beyond the infarcted tissue. We also discuss some common exercise strategies and a novel exercise therapy, robot-assisted movement, which might be widely applied in the clinic to help stroke patients in the future.
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Nagy M, Aranyi C, Opposits G, Papp T, Lánczi L, Berényi E, Vér C, Csiba L, Katona P, Spisák T, Emri M. Effective connectivity differences in motor network during passive movement of paretic and non-paretic ankles in subacute stroke patients. PeerJ 2020; 8:e8942. [PMID: 32518713 PMCID: PMC7258895 DOI: 10.7717/peerj.8942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background A better understanding of the neural changes associated with paresis in stroke patients could have important implications for therapeutic approaches. Dynamic Causal Modeling (DCM) for functional magnetic resonance imaging (fMRI) is commonly used for analyzing effective connectivity patterns of brain networks due to its significant property of modeling neural states behind fMRI signals. We applied this technique to analyze the differences between motor networks (MNW) activated by continuous passive movement (CPM) of paretic and non-paretic ankles in subacute stroke patients. This study aimed to identify CPM induced connectivity characteristics of the primary sensory area (S1) and the differences in extrinsic directed connections of the MNW and to explain the hemodynamic differences of brain regions of MNW. Methods For the network analysis, we used ten stroke patients’ task fMRI data collected under CPMs of both ankles. Regions for the MNW, the primary motor cortex (M1), the premotor cortex (PM), the supplementary motor area (SMA) and the S1 were defined in a data-driven way, by independent component analysis. For the network analysis of both CPMs, we compared twelve models organized into two model-families, depending on the S1 connections and input stimulus modeling. Using DCM, we evaluated the extrinsic connectivity strengths and hemodynamic parameters of both stimulations of all patients. Results After a statistical comparison of the extrinsic connections and their modulations of the “best model”, we concluded that three contralateral self-inhibitions (cM1, cS1 and cSMA), one contralateral inter-regional connection (cSMA→cM1), and one interhemispheric connection (cM1→iM1) were significantly different. Our research shows that hemodynamic parameters can be estimated with the Balloon model using DCM but the parameters do not change with stroke. Conclusions Our results confirm that the DCM-based connectivity analyses combined with Bayesian model selection may be a useful technique for quantifying the alteration or differences in the characteristics of the motor network in subacute stage stroke patients and in determining the degree of MNW changes.
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Affiliation(s)
- Marianna Nagy
- Faculty of Medicine, Department of Medical Imaging, Division of Radiology and Imaging Science, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
| | - Csaba Aranyi
- Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
| | - Gábor Opposits
- Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
| | - Tamás Papp
- Faculty of Medicine, Department of Medical Imaging, Division of Radiology and Imaging Science, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
| | - Levente Lánczi
- Faculty of Medicine, Department of Medical Imaging, Division of Radiology and Imaging Science, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary.,Department of Diagnostic Radiology, Kenézy University Hospital, Debrecen, Hajdú-Bihar, Hungary
| | - Ervin Berényi
- Faculty of Medicine, Department of Medical Imaging, Division of Radiology and Imaging Science, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
| | - Csilla Vér
- Clinical Center, Department of Neurology, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
| | - László Csiba
- Clinical Center, Department of Neurology, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
| | - Péter Katona
- Department of Diagnostic Radiology, Kenézy University Hospital, Debrecen, Hajdú-Bihar, Hungary
| | - Tamás Spisák
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Miklós Emri
- Faculty of Medicine, Department of Medical Imaging, Division of Nuclear Medicine and Translational Imaging, University of Debrecen, Debrecen, Hajdú-Bihar, Hungary
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8
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Jones LM, Ginier E, Debbs J, Eaton JL, Renner C, Hawkins J, Rios-Spicer R, Tang E, Schertzing C, Giordani B. Exploring Representation of Diverse Samples in fMRI Studies Conducted in Patients With Cardiac-Related Chronic Illness: A Focused Systematic Review. Front Hum Neurosci 2020; 14:108. [PMID: 32477079 PMCID: PMC7240043 DOI: 10.3389/fnhum.2020.00108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/11/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction/Purpose: Cardiovascular disease (CVD) is the leading cause of death worldwide, and in the United States alone, CVD causes nearly 840,000 deaths annually. Using functional magnetic resonance imaging (fMRI), a tool to assess brain activity, researchers have identified some brain-behavior connections and predicted several self-management behaviors. The purpose of this study was to examine the sample characteristics of individuals with CVD who participated in fMRI studies. Methods: A literature search was conducted in PubMed, CINAHL, and Scopus. No date or language restrictions were applied and research methodology filters were used. In October 2017, 1659 titles and abstracts were identified. Inclusion criteria were: (1) utilized an empirical study design, (2) used fMRI to assess brain activity, and (3) focused on patients with CVD-related chronic illness. Articles were excluded if they: were theory or opinion articles, focused on mental or neuropathic illness, included non-human samples, or were not written in English. After duplicates were removed (230), 1,429 titles and abstracts were reviewed based on inclusion criteria; 1,243 abstracts were then excluded. A total of 186 studies were reviewed in their entirety; after additional review, 142 were further excluded for not meeting the inclusion criteria. Forty-four articles met criteria and were included in the final review. An evidence table was created to capture the demographics of each study sample. Results: Ninety eight percent of the studies did not report the racial or ethnic composition of their sample. Most studies (66%) contained more men than women. Mean age ranged from 38 to 78 years; 77% reported mean age ≥50 years. The most frequently studied CVD was stroke (86%), while hypertension was studied the least (2%). Conclusion: Understanding brain-behavior relationships can help researchers and practitioners tailor interventions to meet specific patient needs. These findings suggest that additional studies are needed that focus on populations historically underrepresented in fMRI research. Researchers should thoughtfully consider diversity and purposefully sample groups by including individuals that are: women, from diverse backgrounds, younger, and diagnosed with a variety of CVD-related illnesses. Identifying and addressing these gaps by studying more representative samples will help healthcare providers reduce disparities and tailor interventions for all CVD populations.
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Affiliation(s)
- Lenette M. Jones
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Emily Ginier
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, United States
| | - Joseph Debbs
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jarrod L. Eaton
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Catherine Renner
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jaclynn Hawkins
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | | | - Emily Tang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Bruno Giordani
- Psychiatry, Neurology, Psychology, and Nursing, University of Michigan, Ann Arbor, MI, United States
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Ottensmeyer MP, Li S, De Novi G, Tzika AA. Functional MRI in Conjunction with a Novel MRI-compatible Hand-induced Robotic Device to Evaluate Rehabilitation of Individuals Recovering from Hand Grip Deficits. J Vis Exp 2019. [PMID: 31814610 DOI: 10.3791/59420] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) is a non-invasive magnetic resonance imaging technique that images brain activation in vivo, using endogenous deoxyhemoglobin as an endogenous contrast agent to detect changes in blood-level-dependent oxygenation (BOLD effect). We combined fMRI with a novel robotic device (MR-compatible hand-induced robotic device [MR_CHIROD]) so that a person in the scanner can execute a controlled motor task, hand-squeezing, which is a very important hand movement to study in neurological motor disease. We employed parallel imaging (generalized auto-calibrating partially parallel acquisitions [GRAPPA]), which allowed higher spatial resolution resulting in increased sensitivity to BOLD. The combination of fMRI with the hand-induced robotic device allowed precise control and monitoring of the task that was executed while a participant was in the scanner; this may prove to be of utility in rehabilitation of hand motor function in patients recovering from neurological deficits (e.g., stroke). Here we outline the protocol for using the current prototype of the MR_CHIROD during an fMRI scan.
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Affiliation(s)
- Mark P Ottensmeyer
- Medical Device & Simulation Laboratory, Department of Radiology, Massachusetts General Hospital; Harvard Medical School
| | - Shasha Li
- Harvard Medical School; NMR Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Harvard Medical School; Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School
| | - Gianluca De Novi
- Medical Device & Simulation Laboratory, Department of Radiology, Massachusetts General Hospital; Harvard Medical School
| | - A Aria Tzika
- Harvard Medical School; NMR Surgical Laboratory, Department of Surgery, Center for Surgery, Innovation and Bioengineering, Massachusetts General Hospital, Harvard Medical School; Athinoula A. Martinos Center of Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School;
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10
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Dynamics of brain connectivity after stroke. Rev Neurosci 2019; 30:605-623. [DOI: 10.1515/revneuro-2018-0082] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/18/2018] [Indexed: 01/04/2023]
Abstract
Abstract
Recovery from a stroke is a dynamic time-dependent process, in which the central nervous system reorganises to accommodate for the impact of the injury. The purpose of this paper is to review recent longitudinal studies of changes in brain connectivity after stroke. A systematic review of research papers reporting functional or effective connectivity at two or more time points in stroke patients was conducted. Stroke leads to an early reduction of connectivity in the motor network. With recovery time, the connectivity increases and can reach the same levels as in healthy participants. The increase in connectivity is correlated with functional motor gains. A new, more randomised pattern of connectivity may then emerge in the longer term. In some instances, a pattern of increased connectivity even higher than in healthy controls can be observed, and is related either to a specific time point or to a specific neural structure. Rehabilitation interventions can help improve connectivity between specific regions. Moreover, motor network connectivity undergoes reorganisation during recovery from a stroke and can be related to behavioural recovery. A detailed analysis of changes in connectivity pattern may enable a better understanding of adaptation to a stroke and how compensatory mechanisms in the brain may be supported by rehabilitation.
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Jiang L, Liu J, Wang C, Guo J, Cheng J, Han T, Miao P, Cao C, Yu C. Structural Alterations in Chronic Capsular versus Pontine Stroke. Radiology 2017; 285:214-222. [PMID: 28777703 DOI: 10.1148/radiol.2017161055] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lin Jiang
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China (L.J., J.L., C.Y.); School of Medical Imaging, Tianjin Medical University, Tianjin, China (L.J.); Department of MR imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (C.W., J.C., P.M.); and Department of Radiology, Tianjin
| | - Jingchun Liu
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China (L.J., J.L., C.Y.); School of Medical Imaging, Tianjin Medical University, Tianjin, China (L.J.); Department of MR imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (C.W., J.C., P.M.); and Department of Radiology, Tianjin
| | - Caihong Wang
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China (L.J., J.L., C.Y.); School of Medical Imaging, Tianjin Medical University, Tianjin, China (L.J.); Department of MR imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (C.W., J.C., P.M.); and Department of Radiology, Tianjin
| | - Jun Guo
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China (L.J., J.L., C.Y.); School of Medical Imaging, Tianjin Medical University, Tianjin, China (L.J.); Department of MR imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (C.W., J.C., P.M.); and Department of Radiology, Tianjin
| | - Jingliang Cheng
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China (L.J., J.L., C.Y.); School of Medical Imaging, Tianjin Medical University, Tianjin, China (L.J.); Department of MR imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (C.W., J.C., P.M.); and Department of Radiology, Tianjin
| | - Tong Han
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China (L.J., J.L., C.Y.); School of Medical Imaging, Tianjin Medical University, Tianjin, China (L.J.); Department of MR imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (C.W., J.C., P.M.); and Department of Radiology, Tianjin
| | - Peifang Miao
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China (L.J., J.L., C.Y.); School of Medical Imaging, Tianjin Medical University, Tianjin, China (L.J.); Department of MR imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (C.W., J.C., P.M.); and Department of Radiology, Tianjin
| | - Chen Cao
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China (L.J., J.L., C.Y.); School of Medical Imaging, Tianjin Medical University, Tianjin, China (L.J.); Department of MR imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (C.W., J.C., P.M.); and Department of Radiology, Tianjin
| | - Chunshui Yu
- From the Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China (L.J., J.L., C.Y.); School of Medical Imaging, Tianjin Medical University, Tianjin, China (L.J.); Department of MR imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China (C.W., J.C., P.M.); and Department of Radiology, Tianjin
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Cerebral Reorganization in Subacute Stroke Survivors after Virtual Reality-Based Training: A Preliminary Study. Behav Neurol 2017; 2017:6261479. [PMID: 28720981 PMCID: PMC5506482 DOI: 10.1155/2017/6261479] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/12/2017] [Accepted: 05/31/2017] [Indexed: 11/17/2022] Open
Abstract
Background Functional magnetic resonance imaging (fMRI) is a promising method for quantifying brain recovery and investigating the intervention-induced changes in corticomotor excitability after stroke. This study aimed to evaluate cortical reorganization subsequent to virtual reality-enhanced treadmill (VRET) training in subacute stroke survivors. Methods Eight participants with ischemic stroke underwent VRET for 5 sections per week and for 3 weeks. fMRI was conducted to quantify the activity of selected brain regions when the subject performed ankle dorsiflexion. Gait speed and clinical scales were also measured before and after intervention. Results Increased activation in the primary sensorimotor cortex of the lesioned hemisphere and supplementary motor areas of both sides for the paretic foot (p < 0.01) was observed postintervention. Statistically significant improvements were observed in gait velocity (p < 0.05). The change in voxel counts in the primary sensorimotor cortex of the lesioned hemisphere is significantly correlated with improvement of 10 m walk time after VRET (r = −0.719). Conclusions We observed improved walking and increased activation in cortical regions of stroke survivors after VRET training. Moreover, the cortical recruitment was associated with better walking function. Our study suggests that cortical networks could be a site of plasticity, and their recruitment may be one mechanism of training-induced recovery of gait function in stroke. This trial is registered with ChiCTR-IOC-15006064.
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Iaci JF, Parry TJ, Huang Z, Pavlopoulos E, Finklestein SP, Ren J, Caggiano A. An optimized dosing regimen of cimaglermin (neuregulin 1β3, glial growth factor 2) enhances molecular markers of neuroplasticity and functional recovery after permanent ischemic stroke in rats. J Neurosci Res 2015; 94:253-65. [PMID: 26660233 PMCID: PMC4737294 DOI: 10.1002/jnr.23699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/16/2015] [Accepted: 11/09/2015] [Indexed: 12/14/2022]
Abstract
Cimaglermin (neuregulin 1β3, glial growth factor 2) is a neuregulin growth factor family member in clinical development for chronic heart failure. Previously, in a permanent middle cerebral artery occlusion (pMCAO) rat stroke model, systemic cimaglermin treatment initiated up to 7 days after ischemia onset promoted recovery without reduced lesion volume. Presented here to extend the evidence are two studies that use a rat stroke model to evaluate the effects of cimaglermin dose level and dose frequency initiated 24 hr after pMCAO. Forelimb‐ and hindlimb‐placing scores (proprioceptive behavioral tests), body‐swing symmetry, and infarct volume were compared between treatment groups (n = 12/group). Possible mechanisms underlying cimaglermin‐mediated neurologic recovery were examined through axonal growth and synapse formation histological markers. Cimaglermin was evaluated over a wider dose range (0.02, 0.1, or 1.0 mg/kg) than doses previously shown to be effective but used the same dosing regimen (2 weeks of daily intravenous administration, then 1 week without treatment). The dose‐frequency study used the dose‐ranging study's most effective dose (1.0 mg/kg) to compare daily, once per week, and twice per week dosing for 3 weeks (then 1 week without treatment). Dose‐ and frequency‐dependent functional improvements were observed with cimaglermin without reduced lesion volume. Cimaglermin treatment significantly increased growth‐associated protein 43 expression in both hemispheres (particularly somatosensory and motor cortices) and also increased synaptophysin expression. These data indicate that cimaglermin enhances recovery after stroke. Immunohistochemical changes were consistent with axonal sprouting and synapse formation but not acute neuroprotection. Cimaglermin represents a potential clinical development candidate for ischemic stroke treatment. © 2015 The Authors. Journal of Neuroscience Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
| | - Tom J Parry
- Acorda Therapeutics, Inc., Ardsley, New York
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Abstract
The field of regenerative medicine has experienced considerable growth in recent years as the translation of pre-clinical biomaterials and cell- and gene-based therapies begin to reach clinical application. Until recently, the ability to monitor the serial responses to therapeutic treatments has been limited to post-mortem tissue analyses. With improvements in existing imaging modalities and the emergence of hybrid imaging systems, it is now possible to combine information related to structural remodeling with associated molecular events using non-invasive imaging. This review summarizes the established and emerging imaging modalities that are available for in vivo monitoring of clinical regenerative medicine therapies and discusses the strengths and limitations of each imaging modality.
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Affiliation(s)
- Mitchel R. Stacy
- Department of Internal Medicine, Yale University School of Medicine, P.O. Box 208017, Dana-3, New Haven, CT 06520 USA
| | - Albert J. Sinusas
- Departments of Internal Medicine & Diagnostic Radiology, Yale University School of Medicine, P.O. Box 208017, Dana-3, New Haven, CT 06520 USA
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15
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Zhang M, Lin Q, Lu J, Rong D, Zhao Z, Ma Q, Liu H, Shu N, He Y, Li K. Pontine infarction: diffusion-tensor imaging of motor pathways-a longitudinal study. Radiology 2014; 274:841-50. [PMID: 25356962 DOI: 10.1148/radiol.14140373] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To investigate the dynamic evolution of diffusion indexes in the corticospinal tract (CST) distal to a pontine infarct by using diffusion-tensor imaging, to determine the relationship of these indexes with clinical prognosis, and to explore the structural changes in the motor pathway during recovery. MATERIALS AND METHODS This study was approved by the institutional ethics committee, and written informed consent was obtained from each participant. Seventeen patients with pontine infarct underwent five diffusion-tensor imaging examinations during a period of 6 months (within 7 days of onset, 14, 30, 90, and 180 after onset). Fractional anisotropic values were measured in the medulla, cerebral peduncle, internal capsule, and centrum semiovale. Fractional anisotropic values of the CST in the ipsilateral side of the infarct were compared with those in the contralateral sides and those in control subjects by using the Student t test and one-way analysis of variance, and their relationships with clinical scores were analyzed by using Pearson correlation analysis. Reconstructions of the CST were performed. Structural changes of the damaged CST were followed up. RESULTS Fractional anisotropic ratios in the CST above the pons decreased significantly compared with those in the contralateral side and those in control subjects within 7 days, on day 14, and on day 30 after onset (P < .001). Fractional anisotropic ratios above the pons on day 14 correlated positively with Fugl-Meyer scores on day 90 (r = 0.771, P < .001) and day 180 (r = 0.730, P = .001). Follow-up diffusion-tensor tractographic images showed regeneration and reorganization of the motor pathways. CONCLUSION Secondary degeneration of the CST can be detected at diffusion-tensor imaging in the early stages after pontine infarction, which could help predict the motor outcomes. Diffusion-tensor tractography can allow detection of regeneration and reorganization of the motor pathways during recovery.
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Affiliation(s)
- Miao Zhang
- From the Departments of Radiology (M.Z., J.L., D.R., Z.Z., K.L.) and Neurology (Q.M.), Xuanwu Hospital of Capital Medical University, 45 Changchun Street, 100053 Beijing, China; Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China (M.Z., J.L., D.R., Z.Z., K.L.); State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China (Q.L., N.S., Y.H.); Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing, China (Q.L., N.S., Y.H.); and Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology and Department of Psychiatry, Massachusetts General Hospital, Charlestown, Mass (H.L.)
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Non-invasive Brain Stimulation in Physical Medicine and Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0060-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Naumova AV, Modo M, Moore A, Murry CE, Frank JA. Clinical imaging in regenerative medicine. Nat Biotechnol 2014; 32:804-18. [PMID: 25093889 PMCID: PMC4164232 DOI: 10.1038/nbt.2993] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 07/15/2014] [Indexed: 01/09/2023]
Abstract
In regenerative medicine, clinical imaging is indispensable for characterizing damaged tissue and for measuring the safety and efficacy of therapy. However, the ability to track the fate and function of transplanted cells with current technologies is limited. Exogenous contrast labels such as nanoparticles give a strong signal in the short term but are unreliable long term. Genetically encoded labels are good both short- and long-term in animals, but in the human setting they raise regulatory issues related to the safety of genomic integration and potential immunogenicity of reporter proteins. Imaging studies in brain, heart and islets share a common set of challenges, including developing novel labeling approaches to improve detection thresholds and early delineation of toxicity and function. Key areas for future research include addressing safety concerns associated with genetic labels and developing methods to follow cell survival, differentiation and integration with host tissue. Imaging may bridge the gap between cell therapies and health outcomes by elucidating mechanisms of action through longitudinal monitoring.
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Affiliation(s)
- Anna V Naumova
- Department of Radiology, University of Washington, Seattle, Washington, USA,Center for Cardiovascular Biology, University of Washington, Seattle, Washington, USA,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington, USA
| | - Michel Modo
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Centre for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Department of Radiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anna Moore
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Charles E Murry
- Center for Cardiovascular Biology, University of Washington, Seattle, Washington, USA,Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, Washington, USA,Department of Pathology, University of Washington, Seattle, Washington, USA,Department of Bioengineering, University of Washington, Seattle, Washington, USA,Department of Medicine/Cardiology, University of Washington, Seattle, Washington, USA
| | - Joseph A Frank
- Radiology and Imaging Sciences, Clinical, National Institutes of Health, Bethesda, Maryland, USA,National Institutes of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, Maryland, USA
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The effects of poststroke aerobic exercise on neuroplasticity: a systematic review of animal and clinical studies. Transl Stroke Res 2014; 6:13-28. [PMID: 25023134 DOI: 10.1007/s12975-014-0357-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 06/02/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
Aerobic exercise may be a catalyst to promote neuroplasticity and recovery following stroke; however, the optimal methods to measure neuroplasticity and the effects of training parameters have not been fully elucidated. We conducted a systematic review and synthesis of clinical trials and studies in animal models to determine (1) the extent to which aerobic exercise influences poststroke markers of neuroplasticity, (2) the optimal parameters of exercise required to induce beneficial effects, and (3) consistent outcomes in animal models that could help inform the design of future trials. Synthesized findings show that forced exercise at moderate to high intensity increases brain-derived neurotrophic factor (BDNF), insulin-like growth factor-I (IGF-I), nerve growth factor (NGF), and synaptogenesis in multiple brain regions. Dendritic branching was most responsive to moderate rather than intense training. Disparity between clinical stroke and stroke models (timing of initiation of exercise, age, gender) and clinically viable methods to measure neuroplasticity are some of the areas that should be addressed in future research.
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