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Urbin MA. Adaptation in the spinal cord after stroke: Implications for restoring cortical control over the final common pathway. J Physiol 2024. [PMID: 38787922 DOI: 10.1113/jp285563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Control of voluntary movement is predicated on integration between circuits in the brain and spinal cord. Although damage is often restricted to supraspinal or spinal circuits in cases of neurological injury, both spinal motor neurons and axons linking these cells to the cortical origins of descending motor commands begin showing changes soon after the brain is injured by stroke. The concept of 'transneuronal degeneration' is not new and has been documented in histological, imaging and electrophysiological studies dating back over a century. Taken together, evidence from these studies agrees more with a system attempting to survive rather than one passively surrendering to degeneration. There tends to be at least some preservation of fibres at the brainstem origin and along the spinal course of the descending white matter tracts, even in severe cases. Myelin-associated proteins are observed in the spinal cord years after stroke onset. Spinal motor neurons remain morphometrically unaltered. Skeletal muscle fibres once innervated by neurons that lose their source of trophic input receive collaterals from adjacent neurons, causing spinal motor units to consolidate and increase in size. Although some level of excitability within the distributed brain network mediating voluntary movement is needed to facilitate recovery, minimal structural connectivity between cortical and spinal motor neurons can support meaningful distal limb function. Restoring access to the final common pathway via the descending input that remains in the spinal cord therefore represents a viable target for directed plasticity, particularly in light of recent advances in rehabilitation medicine.
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Affiliation(s)
- Michael A Urbin
- Human Engineering Research Laboratories, VA RR&D Center of Excellence, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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2
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Vidaurre C, Irastorza-Landa N, Sarasola-Sanz A, Insausti-Delgado A, Ray AM, Bibián C, Helmhold F, Mahmoud WJ, Ortego-Isasa I, López-Larraz E, Lozano Peiteado H, Ramos-Murguialday A. Challenges of neural interfaces for stroke motor rehabilitation. Front Hum Neurosci 2023; 17:1070404. [PMID: 37789905 PMCID: PMC10543821 DOI: 10.3389/fnhum.2023.1070404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 08/28/2023] [Indexed: 10/05/2023] Open
Abstract
More than 85% of stroke survivors suffer from different degrees of disability for the rest of their lives. They will require support that can vary from occasional to full time assistance. These conditions are also associated to an enormous economic impact for their families and health care systems. Current rehabilitation treatments have limited efficacy and their long-term effect is controversial. Here we review different challenges related to the design and development of neural interfaces for rehabilitative purposes. We analyze current bibliographic evidence of the effect of neuro-feedback in functional motor rehabilitation of stroke patients. We highlight the potential of these systems to reconnect brain and muscles. We also describe all aspects that should be taken into account to restore motor control. Our aim with this work is to help researchers designing interfaces that demonstrate and validate neuromodulation strategies to enforce a contingent and functional neural linkage between the central and the peripheral nervous system. We thus give clues to design systems that can improve or/and re-activate neuroplastic mechanisms and open a new recovery window for stroke patients.
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Affiliation(s)
- Carmen Vidaurre
- TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
- Ikerbasque Science Foundation, Bilbao, Spain
| | | | | | | | - Andreas M. Ray
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Carlos Bibián
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Florian Helmhold
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Wala J. Mahmoud
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
| | - Iñaki Ortego-Isasa
- TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
| | - Eduardo López-Larraz
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
- Bitbrain, Zaragoza, Spain
| | | | - Ander Ramos-Murguialday
- TECNALIA, Basque Research and Technology Alliance (BRTA), San Sebastian, Spain
- Institute for Medical Psychology and Behavioral Neurobiology, University of Tübingen, Tübingen, Germany
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3
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Lim H, Madhavan S. Effects of Cross-Education on Neural Adaptations Following Non-Paretic Limb Training in Stroke: A Scoping Review with Implications for Neurorehabilitation. J Mot Behav 2022; 55:111-124. [PMID: 35940590 DOI: 10.1080/00222895.2022.2106935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Current stroke rehabilitation interventions focus on intensive task specific training of the paretic limb, which may not be feasible for individuals with higher levels of impairment or in the early phase of stroke. Cross-education, a mechanism that improves strength or skill of the untrained limb following unilateral motor training, has high clinical relevance for stroke rehabilitation. Despite its potential benefits, our knowledge on the application and efficacy of cross-education in stroke is limited. We performed a scoping review to synthesize the current evidence regarding neurophysiological and motor effects of cross-education training in stroke. Low to strong evidence from five studies demonstrated strength gains ranging from 31-200% in the untrained paretic limb following non-paretic muscle training. Neurophysiological mechanisms underlying cross-education were unclear as the three studies that used transcranial magnetic stimulation to probe functional connectivity demonstrated mixed results in low sample size. Our review suggests that cross-education is a promising clinical approach in stroke, however high quality studies focusing on neurophysiological mechanisms are required to establish the efficacy and underlying mechanisms of cross-education in stroke. Recommendations regarding future directions and clinical utility are provided.
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Affiliation(s)
- Hyosok Lim
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA.,Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
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Guggenberger R, Trunk BH, Canbolat S, Ziegler L, Gharabaghi A. Evaluation of signal analysis algorithms for ipsilateral motor-evoked potentials induced by transcranial magnetic stimulation. J Neural Eng 2022; 19. [PMID: 35525187 DOI: 10.1088/1741-2552/ac6dc4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Evaluating ipsilateral motor-evoked potentials (iMEP) induced by transcranial magnetic stimulation (TMS) is challenging. In healthy adults, isometric contraction is necessary to facilitate iMEP induction; therefore, the signal may be masked by the concurrent muscle activity. Signal analysis algorithms for iMEP evaluation need to be benchmarked and evaluated. APPROACH An open analysis toolbox for iMEP evaluation was implemented on the basis of eleven previously reported algorithms, which were all threshold based, and a new template-based method based on data-driven signal decomposition. The reliability and validity of these algorithms were evaluated with a dataset of 4244 iMEP from 55 healthy adults. MAIN RESULTS iMEP estimation varies drastically between algorithms. Several algorithms exhibit high reliability, but some appear to be influenced by background activity of muscle preactivation. Especially in healthy subjects, template-based approaches might be more valid than threshold-based ones. Measurement of iMEP persistence requires algorithms that reject some trials as MEP negative. The stricter the algorithms reject trials, the less reliable they generally are. Our evaluation identifies an optimally strict and reliable algorithm. SIGNIFICANCE We show different benchmarks and propose application for different use cases.
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Affiliation(s)
- Robert Guggenberger
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Otfried-Müller-Straße 45, Tubingen, 72076, GERMANY
| | - Bettina Hanna Trunk
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Otfried-Müller-Straße 45, Tubingen, 72076, GERMANY
| | - Sine Canbolat
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Otfried-Müller-Straße 45, Tubingen, 72076, GERMANY
| | - Lukas Ziegler
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Tuebingen, Tubingen, Baden-Württemberg, 72076, GERMANY
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Tuebingen, Tubingen, Baden-Württemberg, 72076, GERMANY
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Taga M, Charalambous CC, Raju S, Lin J, Zhang Y, Stern E, Schambra HM. Corticoreticulospinal tract neurophysiology in an arm and hand muscle in healthy and stroke subjects. J Physiol 2021; 599:3955-3971. [PMID: 34229359 DOI: 10.1113/jp281681] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS The corticoreticulospinal tract (CReST) is a descending motor pathway that reorganizes after corticospinal tract (CST) injury in animals. In humans, the pattern of CReST innervation to upper limb muscles has not been carefully examined in healthy individuals or individuals with CST injury. In the present study, we assessed CReST projections to an arm and hand muscle on the same side of the body in healthy and chronic stoke subjects using transcranial magnetic stimulation. We show that CReST connection strength to the muscles differs between healthy and stroke subjects, with stronger connections to the hand than arm in healthy subjects, and stronger connections to the arm than hand in stroke subjects. These results help us better understand CReST innervation patterns in the upper limb, and may point to its role in normal motor function and motor recovery in humans. ABSTRACT The corticoreticulospinal tract (CReST) is a major descending motor pathway in many animals, but little is known about its innervation patterns in proximal and distal upper extremity muscles in humans. The contralesional CReST furthermore reorganizes after corticospinal tract (CST) injury in animals, but it is less clear whether CReST innervation changes after stroke in humans. We thus examined CReST functional connectivity, connection strength, and modulation in an arm and hand muscle of healthy (n = 15) and chronic stroke (n = 16) subjects. We delivered transcranial magnetic stimulation to the contralesional hemisphere (assigned in healthy subjects) to elicit ipsilateral motor evoked potentials (iMEPs) from the paretic biceps (BIC) and first dorsal interosseous (FDI) muscle. We operationalized CReST functional connectivity as iMEP presence/absence, CReST projection strength as iMEP size and CReST modulation as change in iMEP size by head rotation. We found comparable CReST functional connectivity to the BICs and FDIs in both subject groups. However, the pattern of CReST connection strength to the muscles diverged between groups, with stronger connections to FDIs than BICs in healthy subjects and stronger connections to BICs than FDIs in stroke subjects. Head rotation modulated only FDI iMEPs of healthy subjects. Our findings indicate that the healthy CReST does not have a proximal innervation bias, and its strong FDI connections may have functional relevance to finger individuation. The reversed CReST innervation pattern in stroke subjects confirms its reorganization after CST injury, and its strong BIC connections may indicate upregulation for particular upper extremity muscles or their functional actions.
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Affiliation(s)
- Myriam Taga
- Department of Neurology, School of Medicine, NYU Langone, New York, NY, USA
| | - Charalambos C Charalambous
- Department of Neurology, School of Medicine, NYU Langone, New York, NY, USA.,Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus.,Center for Neuroscience and Integrative Brain Research (CENIBRE), University of Nicosia Medical School, Nicosia, Cyprus
| | - Sharmila Raju
- Department of Neurology, School of Medicine, NYU Langone, New York, NY, USA
| | - Jing Lin
- Department of Neurology, School of Medicine, NYU Langone, New York, NY, USA
| | - Yian Zhang
- Division of Biostatistics, Department of Population Health, School of Medicine, New York University, New York, NY, USA
| | - Elisa Stern
- Department of Neurology, School of Medicine, NYU Langone, New York, NY, USA
| | - Heidi M Schambra
- Department of Neurology, School of Medicine, NYU Langone, New York, NY, USA
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Hammerbeck U, Tyson SF, Samraj P, Hollands K, Krakauer JW, Rothwell J. The Strength of the Corticospinal Tract Not the Reticulospinal Tract Determines Upper-Limb Impairment Level and Capacity for Skill-Acquisition in the Sub-Acute Post-Stroke Period. Neurorehabil Neural Repair 2021; 35:812-822. [PMID: 34219510 PMCID: PMC8414832 DOI: 10.1177/15459683211028243] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Upper-limb impairment in patients with
chronic stroke appears to be partly attributable to an
upregulated reticulospinal tract (RST). Here, we assessed whether the impact of
corticospinal (CST) and RST connectivity on motor impairment and
skill-acquisition differs in sub-acute stroke, using
transcranial magnetic stimulation (TMS)–based proxy measures.
Methods. Thirty-eight stroke survivors were randomized to
either reach training 3-6 weeks post-stroke (plus usual care) or usual care
only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and
contralesional cortical connectivity (surrogates for CST and RST connectivity,
respectively) to weak pre-activated triceps and deltoid muscles with single
pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity
Index) and synergies (Fugl-Meyer upper-limb score). Results.
Strength and presence of synergies were associated with ipsilesional (CST)
connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar
reaching skill beyond that expected from spontaneous recovery and occurred for
both weak and strong ipsilesional tract integrity. Reaching ability, presence of
synergies, skill-acquisition and strength were not affected by either the
presence or absence of contralesional (RST) connectivity.
Conclusion. The degree of ipsilesional CST connectivity is
the main determinant of proximal dexterity, upper-limb strength and synergy
expression in sub-acute stroke. In contrast, there is no evidence for enhanced
contralesional RST connectivity contributing to any of these components of
impairment. In the sub-acute post-stroke period, the balance of activity between
CST and RST may matter more for the paretic phenotype than RST upregulation per
se.
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Affiliation(s)
- Ulrike Hammerbeck
- Geoffrey Jefferson Brain Research Centre, 158986Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Healthy, 5292University of Manchester, Manchester, UK.,Department of Health Professions, Faculty of Health, Psychology and Social Care, 5289Manchester Metropolitan University, Manchester, UK
| | - Sarah F Tyson
- Department of Health Professions, Faculty of Health, Psychology and Social Care, 5289Manchester Metropolitan University, Manchester, UK
| | - Prawin Samraj
- Department of Medical Physics, Northern Care Alliance NHS Trust, Salford, UK
| | - Kristen Hollands
- Department of Health Sciences, 105168University of Salford, Salford, UK
| | - John W Krakauer
- Departments of Neurology, Neuroscience and Physical Medicine & Rehabilitation, 1500The John Hopkins University School of Medicine, Baltimore, MD, USA.,The Santa Fe Institute, Santa Fe, NM, USA
| | - John Rothwell
- Institute of Neurology, University College London, London, UK
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Cleland BT, Sisel E, Madhavan S. Motor evoked potential latency and duration from tibialis anterior in individuals with chronic stroke. Exp Brain Res 2021; 239:2251-2260. [PMID: 34059935 DOI: 10.1007/s00221-021-06144-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
Ipsilateral motor pathways from the contralesional hemisphere to the paretic limbs may be upregulated to compensate for impaired function after stroke. Onset latency and duration of motor evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS) provide insight into compensatory pathways but have been understudied in the lower limb. This study assessed MEP onset latency and duration in the lower limb after stroke, and compared ipsilateral and contralateral MEPs in the paretic and non-paretic limb. We hypothesized that: (1) onset latency would be longer for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb, and (2) duration would be shorter for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb. Data were collected as a part of a pre-test of a randomized controlled trial. TMS was applied to the ipsilateral and contralateral hemisphere of the paretic and non-paretic limb. MEP onset latency and duration were calculated from the tibialis anterior. Thirty-five participants with chronic stroke were included in the final analysis. Onset latency was longer in the paretic than the non-paretic limb (~ 6.0 ms) and longer after ipsilateral than contralateral stimulation (~ 1.8 ms). Duration was longer in the paretic than the non-paretic limb (~ 9.2 ms) and longer after contralateral than ipsilateral stimulation (~ 5.2 ms). Ipsilateral MEPs may be elicited through ipsilateral pathways with fewer fibers with a higher activation threshold and/or greater spinal branching. MEPs from the paretic limb may reflect slower central motor conduction, peripheral changes, or changes in motor pathway.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA
| | - Emily Sisel
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA.
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Abstract
BACKGROUND Stroke rehabilitation may be improved with a better understanding of the contribution of ipsilateral motor pathways to the paretic limb and alterations in transcallosal inhibition. Few studies have evaluated these factors during dynamic, bilateral lower limb movements, and it is unclear whether they relate to functional outcomes. OBJECTIVE Determine if lower limb ipsilateral excitability and transcallosal inhibition after stroke depend on target limb, task, or number of limbs involved, and whether these factors are related to clinical measures. METHODS In 29 individuals with stroke, ipsilateral and contralateral responses to transcranial magnetic stimulation were measured in the paretic and nonparetic tibialis anterior during dynamic (unilateral or bilateral ankle dorsiflexion/plantarflexion) and isometric (unilateral dorsiflexion) conditions. Relative ipsilateral excitability and transcallosal inhibition were assessed. Fugl-Meyer, ankle movement accuracy, and walking characteristics were assessed. RESULTS Relative ipsilateral excitability was greater during dynamic than isometric conditions in the paretic limb (P ≤ .02) and greater in the paretic than the nonparetic limb during dynamic conditions (P ≤ .004). Transcallosal inhibition was greater in the ipsilesional than contralesional hemisphere (P = .002) and during dynamic than isometric conditions (P = .03). Greater ipsilesional transcallosal inhibition was correlated with better ankle movement accuracy (R2 = 0.18, P = .04). Greater contralateral excitability to the nonparetic limb was correlated with improved walking symmetry (R2 = 0.19, P = .03). CONCLUSIONS Ipsilateral pathways have increased excitability to the paretic limb, particularly during dynamic tasks. Transcallosal inhibition is greater in the ipsilesional than contralesional hemisphere and during dynamic than isometric tasks. Ipsilateral pathways and transcallosal inhibition may influence walking asymmetry and ankle movement accuracy.
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9
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Guo F, Zhang T, Hanson NJ, Zhang R. Brain source imaging based on movement-related cortical potentials induced by fatigue during self-paced handgrip contractions. Neuroreport 2020; 31:300-4. [PMID: 31895748 DOI: 10.1097/WNR.0000000000001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE By using standard low resolution electromagnetic tomography (sLORETA), we sought to explore the changes in brain source localization when performing right handgrip contractions in the condition of muscular fatigue. METHODS Ten healthy adults volunteered for this study, and were asked to perform repeated and intermittent self-paced right handgrip contractions at 30% maximal voluntary contraction based on visual feedback leading to fatigue of right flexor digitorum profundus. Motor potentials from the movement-related cortical potentials were extracted from the electroencephalogram and were further analyzed by sLORETA. RESULTS The activated cortical regions were mainly the Brodmann area 6 on the superior frontal and medial frontal gyri, and the BA 10 on the frontal and medial frontal gyri. With the development of muscular fatigue, current density of the motor potential significantly increased and the activated cortical areas markedly enlarged. CONCLUSION In an attempt to maintain a target level of force during upper limb muscle fatigue induced by low intensity repetitive activation, the brain enhances the activation of sensorimotor cortex and enlarges the sensorimotor cortex area, especially in the ipsilateral hemisphere.
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Schambra HM, Xu J, Branscheidt M, Lindquist M, Uddin J, Steiner L, Hertler B, Kim N, Berard J, Harran MD, Cortes JC, Kitago T, Luft A, Krakauer JW, Celnik PA. Differential Poststroke Motor Recovery in an Arm Versus Hand Muscle in the Absence of Motor Evoked Potentials. Neurorehabil Neural Repair 2019; 33:568-580. [PMID: 31170880 DOI: 10.1177/1545968319850138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. After stroke, recovery of movement in proximal and distal upper extremity (UE) muscles appears to follow different time courses, suggesting differences in their neural substrates. Objective. We sought to determine if presence or absence of motor evoked potentials (MEPs) differentially influences recovery of volitional contraction and strength in an arm muscle versus an intrinsic hand muscle. We also related MEP status to recovery of proximal and distal interjoint coordination and movement fractionation, as measured by the Fugl-Meyer Assessment (FMA). Methods. In 45 subjects in the year following ischemic stroke, we tracked the relationship between corticospinal tract (CST) integrity and behavioral recovery in the biceps (BIC) and first dorsal interosseous (FDI) muscle. We used transcranial magnetic stimulation to probe CST integrity, indicated by MEPs, in BIC and FDI. We used electromyography, dynamometry, and UE FMA subscores to assess muscle-specific contraction, strength, and inter-joint coordination, respectively. Results. Presence of MEPs resulted in higher likelihood of muscle contraction, greater strength, and higher FMA scores. Without MEPs, BICs could more often volitionally contract, were less weak, and had steeper strength recovery curves than FDIs; in contrast, FMA recovery curves plateaued below normal levels for both the arm and hand. Conclusions. There are shared and separate substrates for paretic UE recovery. CST integrity is necessary for interjoint coordination in both segments and for overall recovery. In its absence, alternative pathways may assist recovery of volitional contraction and strength, particularly in BIC. These findings suggest that more targeted approaches might be needed to optimize UE recovery.
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Affiliation(s)
- Heidi M Schambra
- 1 New York University School of Medicine, New York, NY, USA.,2 Columbia University, New York, NY, USA
| | - Jing Xu
- 3 Johns Hopkins University, Baltimore, MD, USA
| | - Meret Branscheidt
- 3 Johns Hopkins University, Baltimore, MD, USA.,4 University Hospital of Zurich, Zurich, Switzerland
| | | | | | - Levke Steiner
- 4 University Hospital of Zurich, Zurich, Switzerland
| | | | - Nathan Kim
- 3 Johns Hopkins University, Baltimore, MD, USA
| | | | - Michelle D Harran
- 2 Columbia University, New York, NY, USA.,3 Johns Hopkins University, Baltimore, MD, USA
| | - Juan C Cortes
- 2 Columbia University, New York, NY, USA.,3 Johns Hopkins University, Baltimore, MD, USA
| | | | - Andreas Luft
- 4 University Hospital of Zurich, Zurich, Switzerland.,5 cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
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11
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Hammerbeck U, Hoad D, Greenwood R, Rothwell JC. The unsolved role of heightened connectivity from the unaffected hemisphere to paretic arm muscles in chronic stroke. Clin Neurophysiol 2019; 130:781-8. [PMID: 30925310 DOI: 10.1016/j.clinph.2019.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/06/2019] [Accepted: 02/27/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Ipsilateral connectivity from the non-stroke hemisphere to paretic arm muscles appears to play little role in functional recovery, which instead depends on contralateral connectivity from the stroke hemisphere. Yet the incidence of ipsilateral projections in stroke survivors is often reported to be higher than normal. We tested this directly using a sensitive measure of connectivity to proximal arm muscles. METHOD TMS of the stroke and non-stroke motor cortex evoked responses in pre-activated triceps and deltoid muscles of 17 stroke survivors attending reaching training. Connectivity was defined as a clear MEP or a short-latency silent period in ongoing EMG in ≥ 50% of stimulations. We measured reaching accuracy at baseline, improvement after training and upper limb Fugl-Meyer (F-M) score. RESULTS Incidence of ipsilateral connections to triceps (47%) and deltoid (58%) was high, but unrelated to baseline reaching accuracy and F-M scores. Instead, these were related to contralateral connectivity from the stroke hemisphere. Absolute but not proportional improvement after training was greater in patients with ipsilateral responses. CONCLUSIONS Despite enhanced ipsilateral connectivity, arm function and learning was related most strongly to contralateral pathway integrity from the stroke hemisphere. SIGNIFICANCE Further work is needed to decipher the role of ipsilateral connections.
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12
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Palmer JA, Zarzycki R, Morton SM, Kesar TM, Binder-Macleod SA. Characterizing differential poststroke corticomotor drive to the dorsi- and plantarflexor muscles during resting and volitional muscle activation. J Neurophysiol 2017; 117:1615-1624. [PMID: 28077661 DOI: 10.1152/jn.00393.2016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 12/16/2016] [Accepted: 01/08/2017] [Indexed: 12/20/2022] Open
Abstract
Imbalance of corticomotor excitability between the paretic and nonparetic limbs has been associated with the extent of upper extremity motor recovery poststroke, is greatly influenced by specific testing conditions such as the presence or absence of volitional muscle activation, and may vary across muscle groups. However, despite its clinical importance, poststroke corticomotor drive to lower extremity muscles has not been thoroughly investigated. Additionally, whereas conventional gait rehabilitation strategies for stroke survivors focus on paretic limb foot drop and dorsiflexion impairments, most contemporary literature has indicated that paretic limb propulsion and plantarflexion impairments are the most significant limiters to poststroke walking function. The purpose of this study was to compare corticomotor excitability of the dorsi- and plantarflexor muscles during resting and active conditions in individuals with good and poor poststroke walking recovery and in neurologically intact controls. We found that plantarflexor muscles showed reduced corticomotor symmetry between paretic and nonparetic limbs compared with dorsiflexor muscles in individuals with poor poststroke walking recovery during active muscle contraction but not during rest. Reduced plantarflexor corticomotor symmetry during active muscle contraction was a result of reduced corticomotor drive to the paretic muscles and enhanced corticomotor drive to the nonparetic muscles compared with the neurologically intact controls. These results demonstrate that atypical corticomotor drive exists in both the paretic and nonparetic lower limbs and implicate greater severity of corticomotor impairments to plantarflexor vs. dorsiflexor muscles during muscle activation in stroke survivors with poor walking recovery.NEW & NOTEWORTHY The present study observed that lower-limb corticomotor asymmetry resulted from both reduced paretic and enhanced nonparetic limb corticomotor excitability compared with neurologically intact controls. The most asymmetrical corticomotor drive was observed in the plantarflexor muscles of individuals with poor poststroke walking recovery. This suggests that neural function of dorsi- and plantarflexor muscles in both paretic and nonparetic limbs may play a role in poststroke walking function, which may have important implications when developing targeted poststroke rehabilitation programs to improve walking ability.
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Affiliation(s)
- Jacqueline A Palmer
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, Georgia
| | - Ryan Zarzycki
- Department of Physical Therapy, University of Delaware, Newark, Delaware.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware; and
| | - Susanne M Morton
- Department of Physical Therapy, University of Delaware, Newark, Delaware.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware; and
| | - Trisha M Kesar
- Division of Physical Therapy, School of Medicine, Emory University, Atlanta, Georgia
| | - Stuart A Binder-Macleod
- Department of Physical Therapy, University of Delaware, Newark, Delaware.,Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware; and
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Plow EB, Sankarasubramanian V, Cunningham DA, Potter-Baker K, Varnerin N, Cohen LG, Sterr A, Conforto AB, Machado AG. Models to Tailor Brain Stimulation Therapies in Stroke. Neural Plast 2016; 2016:4071620. [PMID: 27006833 DOI: 10.1155/2016/4071620] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 12/30/2015] [Accepted: 01/04/2016] [Indexed: 11/18/2022] Open
Abstract
A great challenge facing stroke rehabilitation is the lack of information on how to derive targeted therapies. As such, techniques once considered promising, such as brain stimulation, have demonstrated mixed efficacy across heterogeneous samples in clinical studies. Here, we explain reasons, citing its one-type-suits-all approach as the primary cause of variable efficacy. We present evidence supporting the role of alternate substrates, which can be targeted instead in patients with greater damage and deficit. Building on this groundwork, this review will also discuss different frameworks on how to tailor brain stimulation therapies. To the best of our knowledge, our report is the first instance that enumerates and compares across theoretical models from upper limb recovery and conditions like aphasia and depression. Here, we explain how different models capture heterogeneity across patients and how they can be used to predict which patients would best respond to what treatments to develop targeted, individualized brain stimulation therapies. Our intent is to weigh pros and cons of testing each type of model so brain stimulation is successfully tailored to maximize upper limb recovery in stroke.
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Abstract
In acute stroke, the major factor for recovery is the early use of thrombolysis aimed at arterial recanalization and reperfusion of ischemic brain tissue. Subsequently, neurorehabilitative training critically improves clinical recovery due to augmention of postlesional plasticity. Neuroimaging and electrophysiology studies have revealed that the location and volume of the stroke lesion, the affection of nerve fiber tracts, as well as functional and structural changes in the perilesional tissue and in large-scale bihemispheric networks are relevant biomarkers of post-stroke recovery. However, associated disorders, such as mood disorders, epilepsy, and neurodegenerative diseases, may induce secondary cerebral changes or aggravate the functional deficits and, thereby, compromise the potential for recovery.
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Affiliation(s)
- Rüdiger J Seitz
- Department of Neurology, Centre of Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany ; Biomedical Research Centre, Heinrich-Heine-University Düsseldorf , Düsseldorf , Germany ; Florey Institute of Neuroscience and Mental Health, University of Melbourne , Parkville, VIC , Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne , Parkville, VIC , Australia
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15
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Kim KH, Kim YH, Kim MS, Park CH, Lee A, Chang WH. Prediction of Motor Recovery Using Diffusion Tensor Tractography in Supratentorial Stroke Patients With Severe Motor Involvement. Ann Rehabil Med 2015; 39:570-6. [PMID: 26361593 PMCID: PMC4564704 DOI: 10.5535/arm.2015.39.4.570] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/03/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate whether early stage diffusion tensor tractography (DTT) values predict motor function at 3 months after onset in supratentorial stroke patients with severe motor involvement. METHODS A retrospective study design was used to analyze medical records and neuroimaging data of 49 supratentorial stroke patients with severe motor involvement. Diffusion tensor imaging was assessed within 3 weeks after stroke in all patients. Three-dimensional tractography of the ipsilateral corticospinal tract (CST) was performed using the fiber assignment of the continuous tracking algorithm. The two-step DTT analysis was used. The first step was classification according to ipsilateral CST visualization. The second step was a quantitative analysis of the visible-CST group parameters. Motor function was assessed at 2 weeks and at 3 months after stroke. Comparative and correlation analyses were performed between DTT-derived measures and motor assessment scores. RESULTS Motor function of the upper extremity at 3 months after stroke was significantly higher in the visible-CST group than that in the nonvisible-CST group (p<0.05). Early stage fractional anisotropy was of DTT correlated significantly with upper extremity motor function at 3 months after stroke in the visible-CST group (p<0.05). CONCLUSION These results demonstrate that early DTT-derived measures predict motor recovery in the upper extremity at 3 months after onset in supratentorial stroke patients with severe motor involvement.
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Affiliation(s)
- Kang Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ; Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Su Kim
- Department of Rehabilitation Medicine, Wonkwang University School of Medicine, Iksan, Korea
| | - Chang-Hyun Park
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ahee Lee
- Samsung Advanced Institute for Health Science and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Morecraft RJ, Ge J, Stilwell-Morecraft KS, McNeal DW, Hynes SM, Pizzimenti MA, Rotella DL, Darling WG. Frontal and frontoparietal injury differentially affect the ipsilateral corticospinal projection from the nonlesioned hemisphere in monkey (Macaca mulatta). J Comp Neurol 2015. [PMID: 26224429 DOI: 10.1002/cne.23861] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Upper extremity hemiplegia is a common consequence of unilateral cortical stroke. Understanding the role of the unaffected cerebral hemisphere in the motor recovery process has been encouraged, in part, by the presence of ipsilateral corticospinal projections (iCSP). We examined the neuroplastic response of the iCSP from the contralesional primary motor cortex (cM1) hand/arm area to spinal levels C5-T1 after spontaneous long-term recovery from isolated frontal lobe injury and isolated frontoparietal injury. High-resolution tract tracing, stereological, and behavioral methodologies were applied. Recovery from frontal motor injury resulted in enhanced numbers of terminal labeled boutons in the iCSP from cM1 compared with controls. Increases occurred in lamina VIII and the adjacent ventral sectors of lamina VII, which are involved in axial/proximal limb sensorimotor processing. Larger frontal lobe lesions were associated with greater numbers of terminal boutons than smaller frontal lobe lesions. In contrast, frontoparietal injury blocked this response; total bouton number was similar to controls, demonstrating that disruption of somatosensory input to one hemisphere has a suppressive effect on the iCSP from the nonlesioned hemisphere. However, compared with controls, elevated bouton numbers occurred in lamina VIII, at the expense of lamina VII bouton labeling. Lamina IX boutons were also elevated in two frontoparietal lesion cases with extensive cortical injury. Because laminae VIII and IX collectively harbor axial, proximal, and distal motoneurons, therapeutic intervention targeting the ipsilateral corticospinal linkage from cM1 may promote proximal, and possibly distal, upper-limb motor recovery following frontal and frontoparietal injury.
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Affiliation(s)
- R J Morecraft
- Division of Basic Biomedical Sciences, Laboratory of Neurological Sciences, The University of South Dakota Sanford School of Medicine, Vermillion, South Dakota, 57069
| | - J Ge
- Division of Basic Biomedical Sciences, Laboratory of Neurological Sciences, The University of South Dakota Sanford School of Medicine, Vermillion, South Dakota, 57069
| | - K S Stilwell-Morecraft
- Division of Basic Biomedical Sciences, Laboratory of Neurological Sciences, The University of South Dakota Sanford School of Medicine, Vermillion, South Dakota, 57069
| | - D W McNeal
- Division of Basic Biomedical Sciences, Laboratory of Neurological Sciences, The University of South Dakota Sanford School of Medicine, Vermillion, South Dakota, 57069
| | - S M Hynes
- Department of Health and Human Physiology, Motor Control Laboratories, The University of Iowa, Iowa City, Iowa, 52242
| | - M A Pizzimenti
- Department of Health and Human Physiology, Motor Control Laboratories, The University of Iowa, Iowa City, Iowa, 52242.,Department of Anatomy and Cell Biology, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, 52242
| | - D L Rotella
- Department of Health and Human Physiology, Motor Control Laboratories, The University of Iowa, Iowa City, Iowa, 52242
| | - W G Darling
- Department of Health and Human Physiology, Motor Control Laboratories, The University of Iowa, Iowa City, Iowa, 52242
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17
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Liao CF, Liaw LJ, Wang RY, Su FC, Hsu AT. Relationship between trunk stability during voluntary limb and trunk movements and clinical measurements of patients with chronic stroke. J Phys Ther Sci 2015; 27:2201-6. [PMID: 26311954 PMCID: PMC4540849 DOI: 10.1589/jpts.27.2201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/13/2015] [Indexed: 11/26/2022] Open
Abstract
[Purpose] The purposes of this study were to investigate differences between patients
with chronic stroke and age matched healthy controls in trunk stability, by assessing the
kinematics of the center of mass and moving body segments during voluntary limb and trunk
movement, and the relationship between trunk stability and clinical measurements.
[Subjects and Methods] Fifteen stroke patients and 15 age- and gender-matched healthy
subjects participated. Each subject performed flexion of the hip and shoulder of the
non-paretic or matched side as fast as possible, as well as trunk flexion and extension at
a self-selected speed. A Qualisys motion system was employed to track the kinematics of
the trunk and limbs. [Results] Patients presented larger mediolateral displacement of the
center of mass during all limb and trunk movements, and larger velocity of center of mass
during hip flexion movement. Healthy subjects showed greater movement velocity during
shoulder flexion, trunk flexion and extension. Patients’ clinical measurements only
correlated with movement characteristics during voluntary trunk motions. [Conclusion]
Trunk stability in patients with chronic stroke was compromised during voluntary trunk as
well as non-paretic limb movements, and the voluntary trunk movements reflected the trunk
deficits measured using clinical measurements. Rehabilitation of patients with chronic
stroke should include programs to improve trunk stability.
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Affiliation(s)
- Chien-Fen Liao
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan
| | - Lih-Jiun Liaw
- Department of Physical Therapy, College of Health Science, Kaohsiung Medical University, Taiwan ; Department of Rehabilitation Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taiwan
| | - Fong-Chin Su
- Department of Biomedical Engineering, National Cheng Kung University, Taiwan ; Medical Device Innovation Center, National Cheng Kung University, Taiwan
| | - Ar-Tyan Hsu
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Taiwan ; Department of Physical Therapy, College of Medicine, National Cheng Kung University, Taiwan
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18
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Levin MF. Deficits in spatial threshold control of muscle activation as a window for rehabilitation after brain injury. Adv Exp Med Biol 2014; 826:229-49. [PMID: 25330894 DOI: 10.1007/978-1-4939-1338-1_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Mindy F Levin
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade SirWilliam Osler, Montreal, QC, H3G 1Y5, Canada,
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19
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Bradnam LV, Stinear CM, Byblow WD. Ipsilateral motor pathways after stroke: implications for non-invasive brain stimulation. Front Hum Neurosci 2013; 7:184. [PMID: 23658541 PMCID: PMC3647244 DOI: 10.3389/fnhum.2013.00184] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 04/23/2013] [Indexed: 12/17/2022] Open
Abstract
In humans the two cerebral hemispheres have essential roles in controlling the upper limb. The purpose of this article is to draw attention to the potential importance of ipsilateral descending pathways for functional recovery after stroke, and the use of non-invasive brain stimulation (NBS) protocols of the contralesional primary motor cortex (M1). Conventionally NBS is used to suppress contralesional M1, and to attenuate transcallosal inhibition onto the ipsilesional M1. There has been little consideration of the fact that contralesional M1 suppression may also reduce excitability of ipsilateral descending pathways that may be important for paretic upper limb control for some patients. One such ipsilateral pathway is the cortico-reticulo-propriospinal pathway (CRPP). In this review we outline a neurophysiological model to explain how contralesional M1 may gain control of the paretic arm via the CRPP. We conclude that the relative importance of the CRPP for motor control in individual patients must be considered before using NBS to suppress contralesional M1. Neurophysiological, neuroimaging, and clinical assessments can assist this decision making and facilitate the translation of NBS into the clinical setting.
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Affiliation(s)
- Lynley V Bradnam
- Brain Research Laboratory, Centre for Neuroscience, School of Medicine, Flinders University Adelaide, SA, Australia ; Effectiveness of Therapy Group, Centre for Clinical Change and Healthcare Research, School of Medicine, Flinders University Adelaide, SA, Australia
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20
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Huynh W, Krishnan AV, Lin CS, Vucic S, Katrak P, Hornberger M, Kiernan MC. Botulinum toxin modulates cortical maladaptation in post-stroke spasticity: Botulinum Toxin in Post-Stroke Spasticity. Muscle Nerve 2013; 48:93-9. [DOI: 10.1002/mus.23719] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 12/25/2022]
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Pandian S, Arya KN. Motor impairment of the ipsilesional body side in poststroke subjects. J Bodyw Mov Ther 2013; 17:495-503. [PMID: 24139009 DOI: 10.1016/j.jbmt.2013.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 02/10/2013] [Accepted: 03/10/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND In poststroke hemiparetic patients, motor weakness usually occurs on the contralesional body side to the brain. Impairment on the ipsilateral body side also occurs, but less than the contralateral side. The level and type of deficits on the less-affected side is still unclear. Clinicians usually do not consider the less-affected side for assessment and management. OBJECTIVE The main purpose is to explore the motor weakness (coordination, gross and fine motor dexterity, and muscle strength) of the less-affected side. The secondary aim is to determine the relationship between the impairments of both body sides (affected and less-affected). METHOD A prospective, cross-sectional, and nonexperimental study was conducted at an outpatient occupational therapy unit of a rehabilitation institute. A convenient sample of 27 poststroke (19.0 ± 14.28 months) subjects (21 males and 6 females, 22 right-sided and 5 left-sided hemiparesis) was recruited. Outcome measures for the less-affected side were Minnesota Manual Dexterity Test (MMDT), Purdue PegBoard Test (PPBT) and Manual Muscle Testing (MMT). Brunnstrom Recovery Stage (BRS) and Fugl-Meyer Assessment (FMA) were applied for the affected side. The less-affected side of the poststroke subjects was compared with the side-, age-, and gender-matched controls. RESULT The results showed highly significant (p < 0.001) difference between the scores of the ipsilesional body side of the poststroke subjects (MMDT = 105.21 ± 22.70 s, PPBT = 9.30 ± 2.47, and median MMT grade range from 3 to 4) and the matched side of the controls (MMDT = 72.41 ± 11.69 s, PPBT = 13.78 ± 1.76, and median MMT grade 5). The findings also suggested no significant relation between the motor deficits of the less-affected and affected sides. CONCLUSION The ipsilesional body side of poststroke subjects had impaired coordination, gross and fine motor dexterity, and the upper and lower limb muscle strength. The side must be assessed and managed accordingly. Management would promote motor and functional recovery on both the sides.
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Affiliation(s)
- Shanta Pandian
- Pt. Deendayal Upadhyaya Institute for the Physically Handicapped (University of Delhi), Ministry of Social Justice & Empowerment, Govt. of India, New Delhi 110002, India
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22
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Takeuchi N, Tada T, Matsuo Y, Ikoma K. Low-Frequency Repetitive TMS Plus Anodal Transcranial DCS Prevents Transient Decline in Bimanual Movement Induced by Contralesional Inhibitory rTMS After Stroke. Neurorehabil Neural Repair 2012; 26:988-98. [DOI: 10.1177/1545968311433295] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background. Low-frequency repetitive transcranial magnetic stimulation (rTMS) over the unaffected motor cortex may improve motor function of the paretic hand after stroke. However, low-frequency rTMS might adversely affect bimanual movement by decreasing transcallosal function. Objective. The authors investigated whether combined administration of rTMS and transcranial direct current stimulation (tDCS) prevents deterioration of bimanual movement induced by low-frequency rTMS over the unaffected hemisphere. Methods. A total of 27 participants with chronic subcortical stroke were randomly assigned to receive either 1 Hz rTMS over the unaffected hemisphere, anodal tDCS over the affected hemisphere, or a combination of rTMS and tDCS. All patients performed a pinching motor-training task after stimulation. Bimanual movement and transcallosal inhibition (TCI) were evaluated after stimulation. Results. rTMS and rTMS-tDCS enhanced the motor training effect on the paretic hand. rTMS decreased bimanual coordination and reduced TCI from the unaffected to the affected hemisphere (TCIunaff-aff). rTMS-tDCS changed TCI balance of both hemispheres but did not affect bimanual coordination or TCIunaff-aff. The change in bimanual coordination was negatively correlated with TCIunaff-aff. Following stimulation, improvement in the pinch force in the paretic hand was negatively correlated with TCI balance. Conclusions. Inhibitory rTMS over the unaffected hemisphere transiently caused deterioration of bimanual movements for the current task in stroke patients. This short-term decline was prevented by combined administration of low-frequency rTMS over the unaffected hemisphere and anodal tDCS over the affected hemisphere. These responses to bihemispheric stimulation suggest possible caution and opportunities for the rehabilitation of hand function after stroke.
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23
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Rogers LM, Stinear JW, Lewis GN, Brown DA. Descending control to the nonparetic limb degrades the cyclic activity of paretic leg muscles. Hum Mov Sci 2011; 30:1225-44. [PMID: 21601300 DOI: 10.1016/j.humov.2011.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 03/25/2011] [Accepted: 03/29/2011] [Indexed: 11/30/2022]
Abstract
During anti-phased locomotor tasks such as cycling or walking, hemiparetic phasing of muscle activity is characterized by inappropriate early onset of activity for some paretic muscles and prolonged activity in others. Pedaling with the paretic limb alone reduces inappropriate prolonged activity, suggesting a combined influence of contralesional voluntary commands and movement-related sensory feedback. Five different non-target leg movement state conditions were performed by 15 subjects post-stroke and 15 nonimpaired controls while they pedaled with the target leg and EMG was recorded bilaterally. Voluntary engagement of the non-lesioned motor system increased prolonged paretic vastus medialis (VM) activity and increased phase-advanced rectus femoris (RF) activity. We suggest bilateral descending commands are primarily responsible for the inappropriate activity in the paretic VM during anti-phase pedaling, and contribute to the dysfunctional motor output in the paretic RF. Findings from controls suggest that even an undamaged motor system can contribute to this phenomenon.
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Affiliation(s)
- Lynn M Rogers
- Department of Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, IL, USA.
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24
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Neurology in the European Journal of Neurology. Eur J Neurol 2010; 17:1397-1406. [DOI: 10.1111/j.1468-1331.2010.03248.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Affiliation(s)
- Rüdiger J Seitz
- Department of Neurology, University Hospital Düsseldorf, and Biomedical Research Centre, Heinrich-Heine-University Düsseldorf, Germany.
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26
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Bradnam LV, Stinear CM, Lewis GN, Byblow WD. Task-Dependent Modulation of Inputs to Proximal Upper Limb Following Transcranial Direct Current Stimulation of Primary Motor Cortex. J Neurophysiol 2010; 103:2382-9. [DOI: 10.1152/jn.01046.2009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cathodal transcranial DC stimulation (c-tDCS) suppresses excitability of primary motor cortex (M1) controlling contralateral hand muscles. This study assessed whether c-tDCS would have similar effects on ipsi- and contralateral M1 projections to a proximal upper limb muscle. Transcranial magnetic stimulation (TMS) of left M1 was used to elicit motor evoked potentials (MEPs) in the left and right infraspinatus (INF) muscle immediately before and after c-tDCS of left M1, and at 20 and 40 min, post-c-tDCS. TMS was delivered as participants preactivated each INF in isolation (left, right) or both INF together (bilateral). After c-tDCS, ipsilateral MEPs in left INF and contralateral MEPs in right INF were suppressed in the left task but not in the bilateral or right tasks, indicative of task-dependent modulation. Ipsilateral silent period duration in the left INF was reduced after c-tDCS, indicative of altered transcallosal inhibition. These findings may have implications for the use of tDCS as an adjunct to therapy for the proximal upper limb after stroke.
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Affiliation(s)
- Lynley V. Bradnam
- Movement Neuroscience Laboratory,
- Centre for Brain Research, University of Auckland; and
| | - Cathy M. Stinear
- Movement Neuroscience Laboratory,
- Department of Medicine, and
- Centre for Brain Research, University of Auckland; and
| | - Gwyn N. Lewis
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Winston D. Byblow
- Movement Neuroscience Laboratory,
- Centre for Brain Research, University of Auckland; and
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Kaeser M, Wyss AF, Bashir S, Hamadjida A, Liu Y, Bloch J, Brunet JF, Belhaj-Saif A, Rouiller EM. Effects of Unilateral Motor Cortex Lesion on Ipsilesional Hand's Reach and Grasp Performance in Monkeys: Relationship With Recovery in the Contralesional Hand. J Neurophysiol 2010; 103:1630-45. [DOI: 10.1152/jn.00459.2009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Manual dexterity, a prerogative of primates, is under the control of the corticospinal (CS) tract. Because 90–95% of CS axons decussate, it is assumed that this control is exerted essentially on the contralateral hand. Consistently, unilateral lesion of the hand representation in the motor cortex is followed by a complete loss of dexterity of the contralesional hand. During the months following lesion, spontaneous recovery of manual dexterity takes place to a highly variable extent across subjects, although largely incomplete. In the present study, we tested the hypothesis that after a significant postlesion period, manual performance in the ipsilesional hand is correlated with the extent of functional recovery in the contralesional hand. To this aim, ten adult macaque monkeys were subjected to permanent unilateral motor cortex lesion. Monkeys' manual performance was assessed for each hand during several months postlesion, using our standard behavioral test (modified Brinkman board task) that provides a quantitative measure of reach and grasp ability. The ipsilesional hand's performance was found to be significantly enhanced over the long term (100–300 days postlesion) in six of ten monkeys, with the six exhibiting the best, though incomplete, recovery of the contralesional hand. There was a statistically significant correlation ( r = 0.932; P < 0.001) between performance in the ipsilesional hand after significant postlesion period and the extent of recovery of the contralesional hand. This observation is interpreted in terms of different possible mechanisms of recovery, dependent on the recruitment of motor areas in the lesioned and/or intact hemispheres.
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Affiliation(s)
- Mélanie Kaeser
- Unit of Physiology and Program in Neurosciences, Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg; and
- Department of Neurosurgery, Neurosurgery Clinic, University Hospital of Lausanne, Lausanne, Switzerland
| | - Alexander F. Wyss
- Unit of Physiology and Program in Neurosciences, Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg; and
| | - Shahid Bashir
- Unit of Physiology and Program in Neurosciences, Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg; and
| | - Adjia Hamadjida
- Unit of Physiology and Program in Neurosciences, Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg; and
| | - Yu Liu
- Unit of Physiology and Program in Neurosciences, Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg; and
| | - Jocelyne Bloch
- Department of Neurosurgery, Neurosurgery Clinic, University Hospital of Lausanne, Lausanne, Switzerland
| | - Jean-François Brunet
- Department of Neurosurgery, Neurosurgery Clinic, University Hospital of Lausanne, Lausanne, Switzerland
| | - Abderaouf Belhaj-Saif
- Unit of Physiology and Program in Neurosciences, Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg; and
| | - Eric M. Rouiller
- Unit of Physiology and Program in Neurosciences, Department of Medicine, Faculty of Sciences, University of Fribourg, Fribourg; and
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