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Orcioli-Silva D, Vitório R, Beretta VS, Souza Oliveira A, Conceição NRD, Nóbrega-Sousa P, Santos PCRD, Gobbi LTB, Barela JA. Aerobic exercise acutely increases EEG gamma power in the motor/sensorimotor areas during walking in people with Parkinson's disease. Clin Neurophysiol 2025; 175:2110755. [PMID: 40413811 DOI: 10.1016/j.clinph.2025.2110755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 02/07/2025] [Accepted: 04/25/2025] [Indexed: 05/27/2025]
Abstract
OBJECTIVE This study investigated the effects of acute aerobic exercise on gait function and cortical activity during single and dual-task walking in people with Parkinson's disease (PwPD). METHODS Thirty PwPD were randomly assigned to the Experimental (EG) and Control Group (CG). Both groups completed a single 40-minute session of cycling. Exercise intensity was maintained at 65-70% of the maximum heart rate for EG and within 5% of the resting heart rate for CG. Participants performed five walking trials under each condition before and after exercise. EEG and accelerometers measured cortical activity and gait parameters. RESULTS In the post- vs. pre-exercise, the EG increased gamma power in the C and CP channels during single and dual-task walking. Increased step length during dual-task condition was positively associated with increased gamma power at the C and CP channels. CONCLUSION Acute exercise enhances movement control and sensorimotor integration during walking, evidenced by increased gamma power. Changes in gamma power in the motor/sensorimotor areas may improve step length during dual-task walking. SIGNIFICANCE This study underscores the potential of aerobic exercise to increase the involvement of motor and sensorimotor cortical regions, highlighting the relevance of aerobic exercise in the neurorehabilitation and gait functions in PwPD.
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Affiliation(s)
- Diego Orcioli-Silva
- São Paulo State University (UNESP), Institute of Biosciences, Rio Claro, SP, Brazil.
| | - Rodrigo Vitório
- Northumbria University, Faculty of Health and Life Sciences, Newcastle upon Tyne, UK
| | - Victor Spiandor Beretta
- São Paulo State University (UNESP), School of Technology and Sciences, Presidente Prudente, SP, Brazil
| | | | | | - Priscila Nóbrega-Sousa
- School of Health Sciences, University of New South Wales, Randwick, Sydney, NSW, Australia; Neuroscience Research Australia, University of New South Wales, Randwick, Sydney, NSW, Australia
| | - Paulo Cezar Rocha Dos Santos
- IDOR/Pioneer Science Initiative, Rio de Janeiro, RJ, Brazil; Weizmann Institute of Science, Department of Computer Science & Applied Mathematics, Rehovot, Israel; Center of Advanced Technologies in Rehabilitation - CATR, Sheba Tel-HaShomer Medical Center, Ramat Gan, Israel
| | | | - José Angelo Barela
- São Paulo State University (UNESP), Institute of Biosciences, Rio Claro, SP, Brazil
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2
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Wang L, Wang L, Wang Z, Zhao H, Wu J, Gao F, Tang H. Efficacy observation of combined transcutaneous vagus nerve stimulation and transcranial direct current stimulation on gait in 169 subacute stroke patients. J Rehabil Med 2024; 56:jrm40348. [PMID: 39508575 PMCID: PMC11558862 DOI: 10.2340/jrm.v56.40348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 09/03/2024] [Indexed: 11/15/2024] Open
Abstract
OBJECTIVE To investigate the combined effect of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation on improving lower limb function in stroke patients. DESIGN Randomized controlled trial. SUBJECTS/PATIENTS Subacute stroke patients. METHODS 169 post-stroke hemiplegia patients were randomly divided into 4 groups (control, transcranial direct current stimulation, transcutaneous auricular vagus nerve stimulation, and transcutaneous auricular vagus nerve stimulation combined with transcranial direct current stimulation) and evaluated using the Fugl-Meyer Assessment-Lower Extremity (FMA-LL), Timed Up-and-Go (TUG) test, Modified Barthel Index (MBI), Berg Balance Scale (BBS), gait parameters, and surface electromyography (sEMG). RESULTS Significant improvements in FMA-LL, MBI, BBS, TUG, gait parameters, and sEMG were noted in the intervention groups compared with the control, with the transcutaneous auricular vagus nerve stimulation combined with transcranial direct current stimulation group showing the most pronounced improvements. Differences in some outcomes were also notable between the transcutaneous auricular vagus nerve stimulation and transcranial direct current stimulation groups. CONCLUSION The combination of transcutaneous auricular vagus nerve stimulation and transcranial direct current stimulation effectively enhances gait, balance, and daily living activities in subacute stroke patients. These benefits are likely due to transcutaneous auricular vagus nerve stimulation activating the solitary and trigeminal nuclei and transcranial direct current stimulation stimulating the motor cortex. Wearable gait analysis systems and electromyography are valuable in clinical gait assessment for these patients.
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Affiliation(s)
- Litong Wang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian, China; Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian, China
| | - Likai Wang
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian, China
| | - Zhan Wang
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian, China
| | - Hongyu Zhao
- Lab of Intelligent System, School of Control and Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Jingyi Wu
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian, China
| | - Fei Gao
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian, China
| | - Hong Tang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian, China.
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3
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Choi DS, Lee S. Optimizing electrode placement for transcranial direct current stimulation in nonsuperficial cortical regions: a computational modeling study. Biomed Eng Lett 2024; 14:255-265. [PMID: 38374912 PMCID: PMC10874366 DOI: 10.1007/s13534-023-00335-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 02/21/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique for modulating neuronal excitability by sending a weak current through electrodes attached to the scalp. For decades, the conventional tDCS electrode for stimulating the superficial cortex has been widely reported. However, the investigation of the optimal electrode to effectively stimulate the nonsuperficial cortex is still lacking. In the current study, the optimal tDCS electrode montage that can deliver the maximum electric field to nonsuperficial cortical regions is investigated. Two finite element head models were used for computational simulation to determine the optimal montage for four different nonsuperficial regions: the left foot motor cortex, the left dorsomedial prefrontal cortex (dmPFC), the left medial orbitofrontal cortex (mOFC), and the primary visual cortex (V1). Our findings showed a good consistency in the optimal montage between two models, which led to the anode and cathode being attached to C4-C3 for the foot motor, F4-F3 for the dmPFC, Fp2-F7 for the mOFC, and Oz-Cz for V1. Our suggested montages are expected to enhance the overall effectiveness of stimulation of nonsuperficial cortical areas. Supplementary Information The online version contains supplementary material available at 10.1007/s13534-023-00335-2.
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Affiliation(s)
- Da Som Choi
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN USA
| | - Sangjun Lee
- Department of Electronic Engineering, Hanyang University, Seoul, Republic of Korea
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN USA
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Omae E, Shima A, Tanaka K, Yamada M, Cao Y, Nakamura T, Hoshiai H, Chiba Y, Irisawa H, Mizushima T, Mima T, Koganemaru S. Case report: An N-of-1 study using amplitude modulated transcranial alternating current stimulation between Broca's area and the right homotopic area to improve post-stroke aphasia with increased inter-regional synchrony. Front Hum Neurosci 2024; 18:1297683. [PMID: 38454909 PMCID: PMC10917932 DOI: 10.3389/fnhum.2024.1297683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Over one-third of stroke survivors develop aphasia, and language dysfunction persists for the remainder of their lives. Brain language network changes in patients with aphasia. Recently, it has been reported that phase synchrony within a low beta-band (14-19 Hz) frequency between Broca's area and the homotopic region of the right hemisphere is positively correlated with language function in patients with subacute post-stroke aphasia, suggesting that synchrony is important for language recovery. Here, we employed amplitude-modulated transcranial alternating current stimulation (AM-tACS) to enhance synchrony within the low beta band frequency between Broca's area and the right homotopic area, and to improve language function in a case of chronic post-stroke aphasia. According to an N-of-1 study design, the patient underwent short-term intervention with a one-time intervention of 15 Hz-AM-tACS with Broca's and the right homotopic areas (real condition), sham stimulation (sham condition), and 15 Hz-AM-tACS with Broca's and the left parietal areas (control condition) and long-term intervention with sham and real conditions (10 sessions in total, each). In the short-term intervention, the reaction time and accuracy rate of the naming task improved after real condition, not after sham and control conditions. The synchrony between the stimulated areas evaluated by coherence largely increased after the real condition. In the long-term intervention, naming ability, verbal fluency and overall language function improved, with the increase in the synchrony, and those improvements were sustained for more than a month after real condition. This suggests that AM-tACS on Broca's area and the right homotopic areas may be a promising therapeutic approach for patients with poststroke aphasia.
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Affiliation(s)
- Erika Omae
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Neurobiology and Physiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Shima
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuki Tanaka
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masako Yamada
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yedi Cao
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoyuki Nakamura
- Department of Rehabilitation Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Hajime Hoshiai
- Department of Rehabilitation Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Yumi Chiba
- Department of Rehabilitation Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Hiroshi Irisawa
- Department of Rehabilitation Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Takashi Mizushima
- Department of Rehabilitation Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Satoko Koganemaru
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Rehabilitation Medicine, Hokkaido University Hospital, Sapporo, Japan
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5
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Nojima I, Horiba M, Sahashi K, Koganemaru S, Murakami S, Aoyama K, Matsukawa N, Ono Y, Mima T, Ueki Y. Gait-combined closed-loop brain stimulation can improve walking dynamics in Parkinsonian gait disturbances: a randomised-control trial. J Neurol Neurosurg Psychiatry 2023; 94:938-944. [PMID: 37295946 DOI: 10.1136/jnnp-2022-329966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 05/30/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Gait disturbance lowers activities of daily living in patients with Parkinson's disease (PD) and related disorders. However, the effectiveness of pharmacological, surgical and rehabilitative treatments is limited. We recently developed a novel neuromodulation approach using gait-combined closed-loop transcranial electrical stimulation (tES) for healthy volunteers and patients who are post-stroke, and achieved significant entrainment of gait rhythm and an increase in gait speed. Here, we tested the efficacy of this intervention in patients with Parkinsonian gait disturbances. METHODS Twenty-three patients were randomly assigned to a real intervention group using gait-combined closed-loop oscillatory tES over the cerebellum at the frequency of individualised comfortable gait rhythm, and to a sham control group. RESULTS Ten intervention sessions were completed for all patients and showed that the gait speed (F (1, 21)=13.0, p=0.002) and stride length (F (1, 21)=8.9, p=0.007) were significantly increased after tES, but not after sham stimulation. Moreover, gait symmetry measured by swing phase time (F (1, 21)=11.9, p=0.002) and subjective feelings about freezing (F (1, 21)=14.9, p=0.001) were significantly improved during gait. CONCLUSIONS These findings showed that gait-combined closed-loop tES over the cerebellum improved Parkinsonian gait disturbances, possibly through the modulation of brain networks generating gait rhythms. This new non-pharmacological and non-invasive intervention could be a breakthrough in restoring gait function in patients with PD and related disorders.
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Affiliation(s)
- Ippei Nojima
- Physical Therapy, Shinshu University Graduate School of Health Sciences School of Health Sciences, Matsumoto, Nagano, Japan
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mitsuya Horiba
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kento Sahashi
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoko Koganemaru
- Department of Regenerative Systems Neuroscience, Kyoto University, Kyoto, Japan
| | - Satona Murakami
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kiminori Aoyama
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | - Yumie Ono
- Department of Electronics and Bioinformatics, Meiji University, Chiyoda-ku, Japan
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Yoshino Ueki
- Department of Rehabilitation Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Baharlouei H, Ali Salehinejad M, Talimkhani A, Nitsche MA. The Effect of Non-invasive Brain Stimulation on Gait in Healthy Young and Older Adults: A Systematic Review of the Literature. Neuroscience 2023; 516:125-140. [PMID: 36720301 DOI: 10.1016/j.neuroscience.2023.01.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 12/26/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Walking is an important function which requires coordinated activity of sensory-motor neural networks. Noninvasive brain stimulation (NIBS) is a safe neuromodulatory technique with motor function-improving effects. This study aimed to determine the effect of different types of NIBS interventions explored in randomized controlled trials on gait in healthy young and older adults. METHODS Based on the PRISMA approach, we conducted an electronic search in PubMed, Web of Science, Scopus, and PEDro for randomized clinical trials assessing the effect of NIBS on gait in healthy young and older adults and performed a narrative review. RESULTS Fourteen studies were included in this systematic review. According to the outcomes, transcranial direct current stimulation (tDCS) over the motor cortex and transcranial alternating current stimulation (tACS) over the cerebellum seem to be promising for improving gait characteristics such as speed, synchronization, and variability. Furthermore, tDCS over the dorsolateral prefrontal cortex (DLPFC) improved gait speed and reduced gait parameter variability under dual-task conditions. Only one repetitive transcranial magnetic stimulation was available, which showed no effects. No studies were available for transcranial random noise stimulation, and transcranial pulsed current stimulation. Moreover, the intervention parameters of the included studies were heterogeneous, and studies comparing directly specific intervention protocols were missing. CONCLUSION NIBS is a promising approach to improve gait in healthy young and older adults. Anodal tDCS over the motor areas and DLPFC, and tACS over the cerebellum have shown positive effects on gait.
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Affiliation(s)
- Hamzeh Baharlouei
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
| | - Ailin Talimkhani
- Department of Physical Therapy, School of Rehabilitation Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany.
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7
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Shima A, Miyake T, Tanaka K, Ogawa A, Omae E, Nagamori Y, Miyata Y, Ohata K, Maki T, Ono Y, Mima T, Takahashi R, Koganemaru S. Case report: A novel approach of closed-loop brain stimulation combined with robot gait training in post-stroke gait disturbance. Front Hum Neurosci 2023; 17:1082556. [PMID: 36778037 PMCID: PMC9911819 DOI: 10.3389/fnhum.2023.1082556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
Most post-stroke patients have long-lasting gait disturbances that reduce their daily activities. They often show impaired hip and knee joint flexion and ankle dorsiflexion of the lower limbs during the swing phase of gait, which is controlled by the corticospinal tract from the primary motor cortex (M1). Recently, we reported that gait-synchronized closed-loop brain stimulation targeting swing phase-related activity in the affected M1 can improve gait function in post-stroke patients. Subsequently, a gait-training robot (Orthobot®) was developed that could assist lower-limb joint movements during the swing phase of gait. Therefore, we investigated whether gait-synchronized closed-loop brain stimulation combined with robot-assisted training targeting the swing phase could enhance the recovery of post-stroke gait disturbance. A 57-year-old female patient with chronic post-stroke hemiparesis underwent closed-loop brain stimulation combined with robot-assisted training for 10 min 2 years after left pons infarction. For closed-loop brain stimulation, we used transcranial oscillatory electrical current stimulation over the lesioned M1 foot area with 1.5 mA of DC offset and 0-3 mA of sine-wave formed currents triggered by the paretic heel contact to set the maximum current just before the swing phase (intervention A; two times repeated, A1 and A2). According to the N-of-1 study design, we also performed sham stimulation (intervention B) and control stimulation not targeting the swing phase (intervention C) combined with robot-assisted training in the order of A1-B-A2-C interventions. As a result, we found larger improvements in gait speed, the Timed Up and Go test result, and muscle strength after the A1 and A2 interventions than after the B and C interventions. After confirming the short-term effects, we performed an additional long-term intervention twice a week for 5 weeks, for a total of 10 sessions. Gait parameters also largely improved after long-term intervention. Gait-synchronized closed-loop brain stimulation combined with robot-assisted training targeting the swing phase of gait may promote the recovery of gait function in post-stroke patients. Further studies with a larger number of patients are necessary.
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Affiliation(s)
- Atsushi Shima
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoaki Miyake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuki Tanaka
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akari Ogawa
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Omae
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Neuroscience, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yui Nagamori
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Miyata
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Ohata
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takakuni Maki
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yumie Ono
- Department of Electronics and Bioinformatics, Meiji University, Kanagawa, Japan
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoko Koganemaru
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan,Department of Rehabilitation Medicine, Hokkaido University Hospital, Hokkaido, Japan,*Correspondence: Satoko Koganemaru ✉
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8
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Shima A, Tanaka K, Ogawa A, Omae E, Miyake T, Nagamori Y, Miyata Y, Ohata K, Ono Y, Mima T, Takahashi R, Koganemaru S. Case report: Backward gait training combined with gait-synchronized cerebellar transcranial alternating current stimulation in progressive supranuclear palsy. Front Hum Neurosci 2023; 17:1082555. [PMID: 36908713 PMCID: PMC9992165 DOI: 10.3389/fnhum.2023.1082555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
Progressive supranuclear palsy (PSP) is characterized by recurrent falls caused by postural instability, and a backward gait is considered beneficial for postural instability. Furthermore, a recent approach for rehabilitation combined with gait-oriented synchronized stimulation using non-invasive transcranial patterned stimulation could be promising for balance function. Here, we present a case of PSP with backward gait training combined with gait-synchronized transcranial alternating current stimulation (tACS). A 70-year-old woman with PSP-Richardson's syndrome underwent backward gait training combined with synchronized cerebellar tACS. Initially, she underwent short-term intervention with combined training of backward gait with synchronized cerebellar tACS, asynchronized, or sham stimulation according to the N-of-1 study design. Synchronized tACS training demonstrated a decrease in postural instability, whereas asynchronized or sham stimulation did not. The additional long-term interventions of combined backward gait training with synchronized cerebellar tACS demonstrated further decrease in postural instability with improvements in gait speed, balance function, and fall-related self-efficacy in daily life. The present case describes a novel approach for motor symptoms in a patient with PSP. Backward gait training with synchronized cerebellar tACS may be a promising therapeutic approach.
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Affiliation(s)
- Atsushi Shima
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kazuki Tanaka
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akari Ogawa
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Erika Omae
- Division of Neurobiology and Physiology, Department of Neuroscience, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoaki Miyake
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yui Nagamori
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yusuke Miyata
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Ohata
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yumie Ono
- Department of Electronics and Bioinformatics, Meiji University, Tokyo, Kanagawa, Japan
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Ryosuke Takahashi
- Department of Neurology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Satoko Koganemaru
- Department of Regenerative Systems Neuroscience, Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Rehabilitation and Physical Medicine, Hokkaido University Hospital, Sapporo, Japan
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9
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Parkinson's disease: Alterations of motor plasticity and motor learning. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:135-151. [PMID: 35034730 DOI: 10.1016/b978-0-12-819410-2.00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This chapter reviews the alterations in motor learning and motor cortical plasticity in Parkinson's disease (PD), the most common movement disorder. Impairments in motor learning, which is a hallmark of basal ganglia disorders, influence the performance of motor learning-related behavioral tasks and have clinical implications for the management of disturbance in gait and posture, and for rehabilitative management of PD. Although plasticity is classically induced and assessed in sliced preparation in animal models, in this review we have concentrated on the results from non-invasive brain stimulation techniques such as transcranial magnetic stimulation (TMS), transcranial alternating current stimulation (tACS) and transcranial direct current stimulation (tDCS) in patients with PD, in addition to a few animal electrophysiologic studies. The chapter summarizes the results from different cortical and subcortical plasticity investigations. Plasticity induction protocols reveal deficient plasticity in PD and these plasticity measures are modulated by medications and deep brain stimulation. There is considerable variability in these measures that are related to inter-individual variations, different disease characteristics and methodological considerations. Nevertheless, these pathophysiologic studies expand our knowledge of cortical excitability, plasticity and the effects of different treatments in PD. These tools of modulating plasticity and motor learning improve our understanding of PD pathophysiology and help to develop new treatments for this disabling condition.
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10
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Orcioli-Silva D, Islam A, Baker MR, Gobbi LTB, Rochester L, Pantall A. Bi-Anodal Transcranial Direct Current Stimulation Combined With Treadmill Walking Decreases Motor Cortical Activity in Young and Older Adults. Front Aging Neurosci 2021; 13:739998. [PMID: 34924993 PMCID: PMC8681021 DOI: 10.3389/fnagi.2021.739998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/01/2021] [Indexed: 01/05/2023] Open
Abstract
Background: Walking in the "real world" involves motor and cognitive processes. In relation to this, declines in both motor function and cognition contribute to age-related gait dysfunction. Transcranial direct current stimulation (tDCS) and treadmill walking (STW) have potential to improve gait, particularly during dual-task walking (DTW); walking whilst performing a cognitive task. Our aims were to analyze effects of combined anodal tDCS + STW intervention on cortical activity and gait during DTW. Methods: Twenty-three young adults (YA) and 21 older adults (OA) were randomly allocated to active or sham tDCS stimulation groups. Participants performed 5-min of mixed treadmill walking (alternating 30 s bouts of STW and DTW) before and after a 20-min intervention of active or sham tDCS + STW. Anodal electrodes were placed over the left prefrontal cortex (PFC) and the vertex (Cz) using 9 cm2 electrodes at 0.6 mA. Cortical activity of the PFC, primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA) bilaterally were recorded using a functional near-infrared spectroscopy (fNIRS) system. Oxygenated hemoglobin (HbO2) levels were analyzed as indicators of cortical activity. An accelerometer measured gait parameters. We calculated the difference between DTW and STW for HbO2 and gait parameters. We applied linear mixed effects models which included age group (YA vs. OA), stimulation condition (sham vs. active), and time (pre- vs. post-intervention) as fixed effects. Treadmill belt speed was a covariate. Partial correlation tests were also performed. Results: A main effect of age group was observed. OA displayed higher activity bilaterally in the PFC and M1, unilaterally in the right PMC and higher gait variability than YA. M1 activity decreased in both YA and OA following active tDCS + STW. There was no overall effect of tDCS + STW on PFC activity or gait parameters. However, negative correlations were observed between changes in left PFC and stride length variability following active tDCS + STW intervention. Conclusion: Increased activity in multiple cortical areas during DTW in OA may act as a compensatory mechanism. Reduction in M1 activity following active tDCS + STW with no observed gait changes suggests improved neural efficiency.
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Affiliation(s)
- Diego Orcioli-Silva
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Aisha Islam
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mark R Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lilian Teresa Bucken Gobbi
- Institute of Biosciences, São Paulo State University (UNESP), Rio Claro, Brazil.,Graduate Program in Movement Sciences, São Paulo State University (UNESP), Rio Claro, Brazil
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Annette Pantall
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
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11
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Nakagawa K, Kadono N, Shimoda T, Mitsuhara T, Tanaka E, Yuge L. Intramuscular Coherence of the Lower Flexor Muscles during Robotic Ankle-Assisted Gait. J Mot Behav 2021; 54:344-353. [PMID: 34558390 DOI: 10.1080/00222895.2021.1965527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A close-fitting assisted walking device (RE-Gait) designed to assist ankle movements might be a novel approach for acquiring the forefoot rocker function in the gait cycle. The purpose of the present study was to investigate the effects of using RE-Gait by evaluating the intramuscular coherence (IMC) of the two parts of the tibialis anterior muscles (TA), which could indicate whether a common synaptic drive is present. Seventeen healthy volunteers walked on a treadmill at a comfortable speed before, during, and immediately after 15-minute RE-Gait intervention. After RE-Gait intervention, IMC of the two parts of the TA muscles in the beta frequency band in the initial swing phase was significantly enhanced during RE-Gait intervention. In addition, IMCs in the beta and low-gamma frequency bands were significantly correlated with the enhancement ratio of the step length. These results suggest that robotic ankle plantar flexion and dorsiflexion assistance in the initial swing phase may be effective for improving gait function with enhancement of the functioning of the sensorimotor loop.
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Affiliation(s)
- Kei Nakagawa
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoto Kadono
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Takafumi Mitsuhara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Eiichiro Tanaka
- Graduate School of Information, Production and Systems, Faculty of Science and Engineering, Waseda University, Kita-Kyushu, Japan
| | - Louis Yuge
- Division of Bio-Environmental Adaptation Sciences, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.,Space Bio-Laboratories Co., Ltd, Hiroshima, Japan
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12
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Kitatani R, Koganemaru S, Maeda A, Mikami Y, Matsuhashi M, Mima T, Yamada S. Gait-combined transcranial alternating current stimulation modulates cortical control of muscle activities during gait. Eur J Neurosci 2020; 52:4791-4802. [PMID: 32726506 DOI: 10.1111/ejn.14919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 11/29/2022]
Abstract
Non-invasive brain stimulation has been of interest as a therapeutic tool to modulate cortical excitability. However, there is little evidence that oscillatory brain stimulation can modulate the cortical control of muscle activities during gait, which can be assessed using coherence analysis of paired surface electromyographic (EMG) recordings. This study aimed to investigate the effects of gait-combined transcranial alternating current stimulation (tACS) at the gait cycle frequency on the cortical control of muscle activities during gait using EMG-EMG coherence analysis. Fourteen healthy young adults participated in this study. All participants underwent 2 test conditions (real tACS and sham stimulation over the leg area of the primary motor cortex during 10-min treadmill walking). The average peak-to-peak amplitudes of the motor evoked potentials (MEPs) from the tibialis anterior (TA) and lateral gastrocnemius muscles in the sitting position and EMG-EMG coherences in the TA muscle, triceps surae muscles, quadriceps muscles, and hamstring muscles during gait were measured before and after stimulation. Entrainment effect was significantly higher during real tACS than during sham stimulation. After real tACS, the MEP amplitude and beta band (13-33 Hz) coherence area increased in the TA muscle. The change in MEP amplitude from the TA muscle was positively correlated with the change in beta band coherence area in the TA muscle. Gait-combined tACS can modulate the strength of descending neural drive to TA motoneurons during gait. This suggests that oscillatory brain stimulation is a useful therapeutic tool to modulate the cortical control of muscle activities during gait.
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Affiliation(s)
- Ryosuke Kitatani
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Rehabilitation, Kansai Rehabilitation Hospital, Osaka, Japan
| | - Satoko Koganemaru
- Department of Physiology and Biological Information, Dokkyo Medical University, Tochigi, Japan
| | - Ayaka Maeda
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Mikami
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Mima
- Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Shigehito Yamada
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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13
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Entrainment of chewing rhythm by gait speed during treadmill walking in humans. Neurosci Res 2020; 156:88-94. [PMID: 32097675 DOI: 10.1016/j.neures.2020.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 02/02/2020] [Accepted: 02/15/2020] [Indexed: 11/23/2022]
Abstract
It remains unclear whether the rhythmic processes of chewing and gait synchronize during concurrent execution in humans. To evaluate the entrainment of chewing rhythm by gait speed, we measured electromyography from the masseter and tibialis anterior muscles during chewing at a habitual rhythm while walking on a linear treadmill in 12 healthy volunteers. Vertical movement of the head was also measured using an accelerometer. Each 5-min session included gait tasks using a treadmill at three speeds: Auto: the participant's self-selected gait speed, High: Auto × 1.3, and Low: Auto ÷ 1.3. Electromyography from the masseter muscles were also measured during chewing while stationary (Chew-Only). Chewing rhythm during walking was the same as that for head movement, occurring at twice the speed of the walking rhythm, in nine participants (Low), eight participants (Auto), and eight participants (High). For these participants, chewing rhythm in the Auto and High conditions differed significantly from that in the Chew-Only condition. Significant differences in chewing rhythm were also observed among gait speeds (Low vs. Auto vs. High). Our findings demonstrate that entrainment of habitual chewing rhythm to gait speed is a significant phenomenon, and that the dominant ratio of chewing-walking-head movement rhythms is 2:1:2.
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14
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Kitatani R, Koganemaru S, Maeda A, Mikami Y, Matsuhashi M, Mima T, Yamada S. Gait-synchronized oscillatory brain stimulation modulates common neural drives to ankle muscles in patients after stroke: A pilot study. Neurosci Res 2019; 156:256-264. [PMID: 31726081 DOI: 10.1016/j.neures.2019.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/02/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022]
Abstract
The present study aimed to investigate the long-term effects of gait intervention with transcranial alternating current stimulation (tACS) synchronized with gait cycle frequency on the cortical control of muscle activity during gait, using coherence analyses, in patients after stroke. Eight chronic post-stroke patients participated in a single-blinded crossover study, and 7 patients completed the long-term intervention. Each patient received tACS over the primary motor cortex foot area on the affected side, which was synchronized with individual gait cycle frequency, and sham stimulation during treadmill gait in a random order. Electrical neuromuscular stimulation was used to assist the paretic ankle movement in both conditions. After gait intervention with tACS, beta band (15-35 Hz) coherence, which is considered to have a cortical origin, significantly increased in the paretic tibialis anterior (TA) muscle during 6-min of over-ground gait. The change in beta band coherence in the paretic TA muscle was positively correlated with the change in gait distance. These results indicate that gait intervention with tACS synchronized with gait cycle frequency may induce gait-specific plasticity that modulates the common neural drive to the TA motoneurons on the paretic side during gait and leads to changes in gait function in patients after stroke.
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Affiliation(s)
- Ryosuke Kitatani
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Rehabilitation, Kansai Rehabilitation Hospital, Osaka, Japan.
| | - Satoko Koganemaru
- Department of Physiology and Biological Information, Dokkyo Medical University, Tochigi, Japan
| | - Ayaka Maeda
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yusuke Mikami
- Human Brain Research Center, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masao Matsuhashi
- Department of Epilepsy, Movement Disorders and Physiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tatsuya Mima
- Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan
| | - Shigehito Yamada
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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15
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Koganemaru S, Kitatani R, Fukushima-Maeda A, Mikami Y, Okita Y, Matsuhashi M, Ohata K, Kansaku K, Mima T. Gait-Synchronized Rhythmic Brain Stimulation Improves Poststroke Gait Disturbance: A Pilot Study. Stroke 2019; 50:3205-3212. [PMID: 31500557 DOI: 10.1161/strokeaha.119.025354] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Gait disturbance is one of serious impairments lowering activity of daily life in poststroke patients. The patients often show reduced hip and knee joint flexion and ankle dorsiflexion of the lower limbs during the swing phase of gait, which is partly controlled by the primary motor cortex (M1). In the present study, we investigated whether gait-synchronized rhythmic brain stimulation targeting swing phase-related M1 activity can improve gait function in poststroke patients. Methods- Eleven poststroke patients in the chronic phase participated in this single-blind crossover study. Each patient received oscillatory transcranial direct current stimulation over the affected M1 foot area and sham stimulation during treadmill gait. The brain stimulation was synchronized with individual gait rhythm, and the electrical current peaks reached immediately before initiation of the swing phase of the paretic lower limb. Ankle dorsiflexion was assisted by electrical neuromuscular stimulation in both real and sham conditions. Results- Regarding the effects of a single intervention, the speed of self-paced gait was significantly increased after oscillatory transcranial direct current stimulation, but not after sham stimulation (paired t test, P=0.009). After we administered the intervention repeatedly, self- and maximally paced gait speed and timed up and go test performance were significantly improved (self-paced: F(1,21)=8.91, P=0.007, maximally paced: F(1,21)=7.09, P=0.015 and timed up and go test: F(1,21)=12.27, P=0.002), along with improved balance function and increased joint flexion of the paretic limbs during gait. Conclusions- These findings suggest that rhythmic brain stimulation synchronized with gait rhythm might be a promising approach to induce gait recovery in poststroke patients. Clinical Trial Registration- URL: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000013676.
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Affiliation(s)
- Satoko Koganemaru
- From the Department of Physiology and Biological Information, Dokkyo Medical University, Tochigi, Japan (S.K., K.K.)
| | - Ryosuke Kitatani
- Kansai Rehabilitation Hospital, Osaka, Japan (R.K., A.F.-M.).,Department of Physical Therapy (R.K., Y.O., K.O.), The Graduate School of Medicine, Kyoto University, Japan
| | | | - Yusuke Mikami
- Human Brain Research Center (Y.M., M.M.), The Graduate School of Medicine, Kyoto University, Japan
| | - Yusuke Okita
- Department of Physical Therapy (R.K., Y.O., K.O.), The Graduate School of Medicine, Kyoto University, Japan
| | - Masao Matsuhashi
- Human Brain Research Center (Y.M., M.M.), The Graduate School of Medicine, Kyoto University, Japan
| | - Koji Ohata
- Department of Physical Therapy (R.K., Y.O., K.O.), The Graduate School of Medicine, Kyoto University, Japan
| | - Kenji Kansaku
- From the Department of Physiology and Biological Information, Dokkyo Medical University, Tochigi, Japan (S.K., K.K.)
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan (T.M.)
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