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Lee KH, Jeong EH, Joa KL. Effects of Stroke Lesions and Timing of Rehabilitation on the Compensatory Movement Patterns During Stroke Recovery. Am J Phys Med Rehabil 2022; 101:1031-1037. [PMID: 35067555 DOI: 10.1097/phm.0000000000001968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aims of this study were to distinguish between behavioral compensation and behavioral recovery and to determine the role of stroke lesions and the optimal timing of rehabilitation in true recovery. DESIGN Single pellet reaching test has been performed to analyze both quantitative and qualitative measures of forelimb function in a stroke animal model with lesions in the motor cortex, somatosensory cortex, or sensorimotor cortex. The four gestures of compensatory movement patterns that comprised a reach were head lift, limb withdrawal, pellet chasing, and phantom grasp. RESULTS Functional recovery improved in all the stroke groups after rehabilitation ( P < 0.001). However, the compensatory movement patterns of the motor cortex and somatosensory cortex stroke groups initially increased and subsequently decreased ( P = 0.0054), whereas those of the sensorimotor cortex stroke group increased and persisted ( P = 0.0063). In the sensorimotor cortex stroke group, compensatory movement patterns significantly decreased when training was initiated 5 and 14 days after stroke ( P = 0.0083, P = 0.0226, respectively), while they increased and persisted when training was initiated 1 day after stroke. CONCLUSIONS These findings suggest that true recovery by task-specific training after stroke depends, probably, on the lesion size and the timing of rehabilitation.
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Affiliation(s)
- Kyoung-Hee Lee
- From the Department of Occupational Therapy, Baekseok University, Cheonan, Chungnam, South Korea (K-hL); Department of Occupational Therapy, College of Healthcare Sciences, Far East University, South Korea (E-HJ); and Department of Physical Medicine and Rehabilitation, Inha University Hospital, Incheon, South Korea (K-LJ)
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Batschelett M, Gibbs S, Holder CM, Holcombe B, Wheless JW, Narayana S. Plasticity in the developing brain: neurophysiological basis for lesion-induced motor reorganization. Brain Commun 2021; 4:fcab300. [PMID: 35174326 PMCID: PMC8842689 DOI: 10.1093/braincomms/fcab300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/10/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
The plasticity of the developing brain can be observed following injury to the
motor cortex and/or corticospinal tracts, the most commonly injured brain area
in the pre- or peri-natal period. Factors such as the timing of injury, lesion
size and lesion location may affect a single hemisphere’s ability to
acquire bilateral motor representation. Bilateral motor representation of single
hemisphere origin is most likely to occur if brain injury occurs before the age
of 2 years; however, the link between injury aetiology, reorganization type and
functional outcome is largely understudied. We performed a retrospective review
to examine reorganized cortical motor maps identified through transcranial
magnetic stimulation in a cohort of 52 patients. Subsequent clinical,
anthropometric and demographic information was recorded for each patient. Each
patient’s primary hand motor cortex centre of gravity, along with the
Euclidian distance between reorganized and normally located motor cortices, was
also calculated. The patients were classified into broad groups including
reorganization type (inter- and intrahemispheric motor reorganization), age at
the time of injury (before 2 years and after 2 years) and injury aetiology
(developmental disorders and acquired injuries). All measures were analysed to
find commonalities between motor reorganization type and injury aetiology,
function and centre of gravity distance. There was a significant effect of
injury aetiology on type of motor reorganization
(P < 0.01), with 60.7% of patients
with acquired injuries and 15.8% of patients with developmental disorders
demonstrating interhemispheric motor reorganization. Within the interhemispheric
motor reorganization group, ipsilaterally and contralaterally projecting hand
motor cortex centres of gravity overlapped, indicating shared cortical motor
representation. Furthermore, the data suggest significantly higher prevalence of
bilateral motor representation from a single hemisphere in cases of acquired
injuries compared to those of developmental origin. Functional outcome was found
to be negatively affected by acquired injuries and interhemispheric motor
reorganization relative to their respective counterparts with developmental
lesions and intrahemispheric motor reorganization. These results provide novel
information regarding motor reorganization in the developing brain via an
unprecedented cohort sample size and transcranial magnetic stimulation.
Transcranial magnetic stimulation is uniquely suited for use in understanding
the principles of motor reorganization, thereby aiding in the development of
more efficacious therapeutic techniques to improve functional recovery following
motor cortex injury.
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Affiliation(s)
- Mitchell Batschelett
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Rhodes College, Memphis, TN, USA
| | - Savannah Gibbs
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
| | - Christen M. Holder
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Billy Holcombe
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - James W. Wheless
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shalini Narayana
- Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA
- Department of Pediatrics, Division of Pediatric Neurology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Anatomy and Neurobiology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
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Critical Period After Stroke Study (CPASS): A phase II clinical trial testing an optimal time for motor recovery after stroke in humans. Proc Natl Acad Sci U S A 2021; 118:2026676118. [PMID: 34544853 PMCID: PMC8488696 DOI: 10.1073/pnas.2026676118] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
Restoration of postinjury brain function is a signal neuroscience challenge. Animal models of stroke recovery demonstrate time-limited windows of heightened motor recovery, similar to developmental neuroplasticity. However, no equivalent windows have been demonstrated in humans. We report a randomized controlled trial applying essential elements of animal motor training paradigms to humans, to determine the existence of an analogous sensitive period in adults. We found a similar sensitive or optimal period 60 to 90 d after stroke, with lesser effects ≤30 d and no effect 6 mo or later after stroke. These findings prospectively demonstrated the existence of a sensitive period in adult humans. We urge the provision of more intensive motor rehabilitation within 60 to 90 d after stroke onset. Restoration of human brain function after injury is a signal challenge for translational neuroscience. Rodent stroke recovery studies identify an optimal or sensitive period for intensive motor training after stroke: near-full recovery is attained if task-specific motor training occurs during this sensitive window. We extended these findings to adult humans with stroke in a randomized controlled trial applying the essential elements of rodent motor training paradigms to humans. Stroke patients were adaptively randomized to begin 20 extra hours of self-selected, task-specific motor therapy at ≤30 d (acute), 2 to 3 mo (subacute), or ≥6 mo (chronic) after stroke, compared with controls receiving standard motor rehabilitation. Upper extremity (UE) impairment assessed by the Action Research Arm Test (ARAT) was measured at up to five time points. The primary outcome measure was ARAT recovery over 1 y after stroke. By 1 y we found significantly increased UE motor function in the subacute group compared with controls (ARAT difference = +6.87 ± 2.63, P = 0.009). The acute group compared with controls showed smaller but significant improvement (ARAT difference = +5.25 ± 2.59 points, P = 0.043). The chronic group showed no significant improvement compared with controls (ARAT = +2.41 ± 2.25, P = 0.29). Thus task-specific motor intervention was most effective within the first 2 to 3 mo after stroke. The similarity to rodent model treatment outcomes suggests that other rodent findings may be translatable to human brain recovery. These results provide empirical evidence of a sensitive period for motor recovery in humans.
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Differential effects of the cell cycle inhibitor, olomoucine, on functional recovery and on responses of peri-infarct microglia and astrocytes following photothrombotic stroke in rats. J Neuroinflammation 2021; 18:168. [PMID: 34332596 PMCID: PMC8325288 DOI: 10.1186/s12974-021-02208-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background Following stroke, changes in neuronal connectivity in tissue surrounding the infarct play an important role in both spontaneous recovery of neurological function and in treatment-induced improvements in function. Microglia and astrocytes influence this process through direct interactions with the neurons and as major determinants of the local tissue environment. Subpopulations of peri-infarct glia proliferate early after stroke providing a possible target to modify recovery. Treatment with cell cycle inhibitors can reduce infarct volume and improve functional recovery. However, it is not known whether these inhibitors can influence neurological function or alter the responses of peri-infarct glia without reducing infarction. The present study aimed to address these issues by testing the effects of the cell cycle inhibitor, olomoucine, on recovery and peri-infarct changes following photothrombotic stroke. Methods Stroke was induced by photothrombosis in the forelimb sensorimotor cortex in Sprague-Dawley rats. Olomoucine was administered at 1 h and 24 h after stroke induction. Forelimb function was monitored up to 29 days. The effects of olomoucine on glial cell responses in peri-infarct tissue were evaluated using immunohistochemistry and Western blotting. Results Olomoucine treatment did not significantly affect maximal infarct volume. Recovery of the affected forelimb on a placing test was impaired in olomoucine-treated rats, whereas recovery in a skilled reaching test was substantially improved. Olomoucine treatment produced small changes in aspects of Iba1 immunolabelling and in the number of CD68-positive cells in cerebral cortex but did not selectively modify responses in peri-infarct tissue. The content of the astrocytic protein, vimentin, was reduced by 30% in the region of the lesion in olomoucine-treated rats. Conclusions Olomoucine treatment modified functional recovery in the absence of significant changes in infarct volume. The effects on recovery were markedly test dependent, adding to evidence that skilled tasks requiring specific training and general measures of motor function can be differentially modified by some interventions. The altered recovery was not associated with specific changes in key responses of peri-infarct microglia, even though these cells were considered a likely target for early olomoucine treatment. Changes detected in peri-infarct reactive astrogliosis could contribute to the altered patterns of functional recovery. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02208-w.
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Liu Z, Xin H, Chopp M. Axonal remodeling of the corticospinal tract during neurological recovery after stroke. Neural Regen Res 2021; 16:939-943. [PMID: 33229733 PMCID: PMC8178784 DOI: 10.4103/1673-5374.297060] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Stroke remains the leading cause of long-term disability. Hemiparesis is one of the most common post-stroke motor deficits and is largely attributed to loss or disruption of the motor signals from the affected motor cortex. As the only direct descending motor pathway, the corticospinal tract (CST) is the primary pathway to innervate spinal motor neurons, and thus, forms the neuroanatomical basis to control the peripheral muscles for voluntary movements. Here, we review evidence from both experimental animals and stroke patients, regarding CST axonal damage, functional contribution of CST axonal integrity and remodeling to neurological recovery, and therapeutic approaches aimed to enhance CST axonal remodeling after stroke. The new insights gleaned from preclinical and clinical studies may encourage the development of more rational therapeutics with a strategy targeted to promote axonal rewiring for corticospinal innervation, which will significantly impact the current clinical needs of subacute and chronic stroke treatment.
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Affiliation(s)
- Zhongwu Liu
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Hongqi Xin
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Michael Chopp
- Department of Neurology, Henry Ford Hospital, Detroit; Department of Physics, Oakland University, Rochester, MI, USA
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Zhao C, Zhao S, Guan M, Cheng X, Wang H, Liu C, Zhong S, Zhou Z, Liang Y. Forced forelimb use following stroke enhances oligodendrogenesis and functional recovery in the rat. Brain Res 2020; 1746:147016. [PMID: 32679116 DOI: 10.1016/j.brainres.2020.147016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/23/2020] [Accepted: 07/10/2020] [Indexed: 12/21/2022]
Abstract
Forced limb use, which forces the use of the impaired arm following stroke, improves functional recovery. The study was designed to investigate the mechanisms of recovery underlying forced impaired limbuse. Furthermore, forced unimpaired arm use was also performed in order to explore its effect on functional behavior. We hypothesized that forced forelimb use could improve functional recovery in rats that have had an experimentally induced ischemic stroke, through promoting the recruitment and differentiation of the oligodendrocyte progenitor cells (OPCs). Indeed the proliferation of Olig2 and NG2 positive cells, as well as the expression of myelin basic protein (MBP)were increased in the perilesional striatum, whereas quantitative changes of Olig2+ and NG2+ oligodendrocyte progenitor cells was not observed in the subventricular zone. Through comparing rats forced to rely on affected or unaffected forelimb, the results demonstrated that forced impaired limb use boosted functional recovery. At the same time forced unimpaired limb use deteriorated limb movement of injured side. In addition, the expression of NogoA is reduced, when the injured limb was used more, suggesting that it played a role in the repair of white matter.
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Affiliation(s)
- Chuansheng Zhao
- The First Hospital of China Medical University, Shenyang, China.
| | - Shanshan Zhao
- The First Hospital of China Medical University, Shenyang, China.
| | - Meiting Guan
- The First Hospital of China Medical University, Shenyang, China.
| | - Xi Cheng
- The First Hospital of China Medical University, Shenyang, China.
| | - Huibin Wang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Chang Liu
- The First Hospital of China Medical University, Shenyang, China.
| | - Shanshan Zhong
- The First Hospital of China Medical University, Shenyang, China.
| | - Zhike Zhou
- The First Hospital of China Medical University, Shenyang, China.
| | - Yifan Liang
- The First Hospital of China Medical University, Shenyang, China.
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