1
|
Fedor BA, Sander NH, MacLaren M, Liddle LJ, MacLellan CL, Colbourne F. Motor Rehabilitation Provides Modest Functional Benefits After Intracerebral Hemorrhage: a Systematic Review and Meta-Analysis of Translational Rehabilitation Studies. Transl Stroke Res 2023:10.1007/s12975-023-01205-w. [PMID: 37981635 DOI: 10.1007/s12975-023-01205-w] [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: 08/06/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/21/2023]
Abstract
Few certainties exist regarding the optimal type, timing, or dosage of rehabilitation after stroke. Despite differing injury mechanisms and recovery patterns following ischemic and hemorrhagic stroke, most translational stroke research is conducted after ischemia. As we enter the era of personalized medicine, exploring subtype-specific treatment efficacy is essential to optimizing recovery. Our objective was to characterize common rehabilitation interventions used after in vivo preclinical intracerebral hemorrhage (ICH) and assess the impact of post-ICH rehabilitation (vs. no-rehabilitation) on recovery of motor function. Following PRISMA guidelines, a systematic review (Academic Search Complete, CINAHL, EMBASE, Medline, PubMed Central) identified eligible articles published up to December 2022. Risk of bias (SYRCLE) and study quality (CAMARADES) were evaluated, and random-effects meta-analysis was used to assess treatment efficacy in recovery of forelimb and locomotor functions. Thirty articles met inclusion criteria, and 48 rehabilitation intervention groups were identified. Most used collagenase to model striatal ICH in young, male rodents. Aerobic exercise, enriched rehabilitation, and constraint-induced movement therapy represented ~ 70% of interventions. Study quality was low (median 4/10, range 2-8), and risk of bias was unclear. Rehabilitation provided modest benefits in skilled reaching, spontaneous impaired forelimb use, and locomotor function; however, effects varied substantially by endpoint, treatment type, and study quality. Rehabilitation statistically improves motor function after preclinical ICH, but whether these effects are functionally meaningful is unclear. Incomplete reporting and variable research quality hinder our capacity to analyze and interpret how treatment factors influence rehabilitation efficacy and recovery after ICH.
Collapse
Affiliation(s)
- Britt A Fedor
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Noam H Sander
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Maxwell MacLaren
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Lane J Liddle
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| | - Crystal L MacLellan
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Frederick Colbourne
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- Department of Psychology, Faculty of Science, University of Alberta, Edmonton, Canada
| |
Collapse
|
2
|
Li C, Sun R, Chen J, Hong J, Sun J, Zeng Y, Zhang X, Dou Z, Wen H. Different training patterns at recovery stage improve cognitive function in ischemic stroke rats through regulation of the axonal growth inhibitor pathway. Behav Brain Res 2021; 421:113730. [PMID: 34971645 DOI: 10.1016/j.bbr.2021.113730] [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: 07/16/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 02/07/2023]
Abstract
Running wheel exercise training (RWE) and skilled reaching training (SRT) are physical training approaches with positive effects on cognitive function. However, few studies have compared the different effects of these exercises on long-term memory, and their mechanism remains unknown. This study investigated the effects of SRT and RWE, at the recovery stage, on the cognitive function of transient middle cerebral artery occlusion (tMCAO) rats and explored their association with NgR1/Rho-A/ROCK/LOTUS/LGI1 signaling. Adult Sprague-Dawley rats (n = 55) were divided into four groups after pretraining: SRT, RWE, tMCAO, and Sham. Rats were subjected to modified neurological severity score (mNSS) measurements and forelimb grip strength and the Morris water maze tests. Using immunofluorescence and western blotting, we evaluated axonal growth inhibitor expression in the peri-infarct cortex on days 28 and 56 after tMCAO. Results showed the mNSS reduced, whereas the grip strengths improved in RWE and SRT groups. The escape latency in the Morris water maze test was shorter, whereas the number of times of crossing the platform was higher in both the SRT and RWE groups than in the tMCAO group on day 56; furthermore, the parameters in the SRT group improved compared to those in the RWE group. Physical exercise training could improve cognitive functions by reducing the expression of the NgR1/RhoA/ROCK axon growth inhibitors and increasing the expression of the endogenous antagonists LOTUS/LGI1. Exercise training beginning at the recovery stage could improve the cognitive function in tMCAO rats through a mechanism probably associated with the axonal growth inhibitor pathway.
Collapse
Affiliation(s)
- Chao Li
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China
| | - Ruifang Sun
- Department of Rehabilitation Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, 89 Taoyuan Road, Nanshan District, Shenzhen 518000, Guangdong Province, China
| | - Jiemei Chen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China
| | - Jiena Hong
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China
| | - Ju Sun
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China; Department of Rehabilitation Medicine, Guangzhou Panyu Central Hospital, No.8 Fuyu east Road, Guangzhou 511400, Guangdong Province, China
| | - Yan Zeng
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China
| | - Xue Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China
| | - Zulin Dou
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China
| | - Hongmei Wen
- Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou 510630, Guangdong Province, China.
| |
Collapse
|
3
|
Alcantara CC, García-Salazar LF, Silva-Couto MA, Santos GL, Reisman DS, Russo TL. Post-stroke BDNF Concentration Changes Following Physical Exercise: A Systematic Review. Front Neurol 2018; 9:637. [PMID: 30210424 PMCID: PMC6121011 DOI: 10.3389/fneur.2018.00637] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 07/16/2018] [Indexed: 01/08/2023] Open
Abstract
Background: Research over the last two decades has highlighted the critical role of Brain-derived neurotrophic factor (BDNF) in brain neuroplasticity. Studies suggest that physical exercise may have a positive impact on the release of BDNF and therefore, brain plasticity. These results in animal and human studies have potential implications for the recovery from damage to the brain and for interventions that aim to facilitate neuroplasticity and, therefore, the rehabilitation process. Purpose: The aim of this study was to carry out a systematic review of the literature investigating how aerobic exercises and functional task training influence BDNF concentrations post-stroke in humans and animal models. Data Sources: Searches were conducted in PubMed (via National Library of Medicine), SCOPUS (Elsevier), CINAHL with Full Text (EBSCO), MEDLINE 1946-present with daily updates (Ovid) and Cochrane. Study Selection: All of the database searches were limited to the period from January, 2004 to May, 2017. Data Extraction: Two reviewers extracted study details and data. The methodological quality of the studies that used animal models was assessed using the ARRIVE Guidelines, and the study that evaluated human BDNF was assessed using the PEDro Scale. Data Synthesis: Twenty-one articles were included in this review. BDNF measurements were performed systemically (serum/plasma) or locally (central nervous system). Only one study evaluated human BDNF concentrations following physical exercise, while 20 studies were experimental studies using a stroke model in animals. A wide variation was observed in the training protocol between studies, although treadmill walking was the most common type of intervention among the studies. Studies were of variable quality: the studies that used animal models scored from 8/20 to 15/20 according to the ARRIVE Guidelines. The only study that evaluated human subjects scored 5/10 according to the PEDro scale and, which indicates a quality classified as "fair". Conclusions: The results of the current systematic review suggest that aerobic exercise promotes changes in central BDNF concentrations post-stroke. On the other hand, BDNF responses following functional exercises, such as reaching training and Constraint Induced Movement Therapy (CIMT), seem to be still controversial. Given the lack of studies evaluating post-stroke BDNF concentration following physical exercise in humans, these conclusions are based on animal work.
Collapse
Affiliation(s)
- Carolina C. Alcantara
- Laboratory of Neurological Physiotherapy Research, Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
| | - Luisa F. García-Salazar
- Laboratory of Neurological Physiotherapy Research, Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
- Escuela de Medicina y Ciencias de la Salud, GI Ciencias de la Rehabilitación, Universidad del Rosario, Bogotá, Colombia
| | - Marcela A. Silva-Couto
- Laboratory of Neurological Physiotherapy Research, Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
| | - Gabriela L. Santos
- Laboratory of Neurological Physiotherapy Research, Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
| | - Darcy S. Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Thiago L. Russo
- Laboratory of Neurological Physiotherapy Research, Physical Therapy Department, Federal University of São Carlos, São Carlos, Brazil
| |
Collapse
|
4
|
Hylin MJ, Kerr AL, Holden R. Understanding the Mechanisms of Recovery and/or Compensation following Injury. Neural Plast 2017; 2017:7125057. [PMID: 28512585 PMCID: PMC5415868 DOI: 10.1155/2017/7125057] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/24/2017] [Accepted: 03/26/2017] [Indexed: 11/30/2022] Open
Abstract
Injury due to stroke and traumatic brain injury result in significant long-term effects upon behavioral functioning. One central question to rehabilitation research is whether the nature of behavioral improvement observed is due to recovery or the development of compensatory mechanisms. The nature of functional improvement can be viewed from the perspective of behavioral changes or changes in neuroanatomical plasticity that follows. Research suggests that these changes correspond to each other in a bidirectional manner. Mechanisms surrounding phenomena like neural plasticity may offer an opportunity to explain how variables such as experience can impact improvement and influence the definition of recovery. What is more, the intensity of the rehabilitative experiences may influence the ability to recover function and support functional improvement of behavior. All of this impacts how researchers, clinicians, and medical professionals utilize rehabilitation.
Collapse
Affiliation(s)
- Michael J. Hylin
- Neurotrauma and Rehabilitation Laboratory, Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | - Abigail L. Kerr
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL, USA
| | - Ryan Holden
- Neurotrauma and Rehabilitation Laboratory, Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| |
Collapse
|
5
|
Park K, Lee S, Hong Y, Park S, Choi J, Chang KT, Kim JH, Hong Y. Therapeutic physical exercise in neural injury: friend or foe? J Phys Ther Sci 2015; 27:3933-5. [PMID: 26834383 PMCID: PMC4713822 DOI: 10.1589/jpts.27.3933] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 09/01/2015] [Indexed: 01/29/2023] Open
Abstract
[Purpose] The intensity of therapeutic physical exercise is complex and sometimes
controversial in patients with neural injuries. This review assessed whether therapeutic
physical exercise is beneficial according to the intensity of the physical exercise.
[Methods] The authors identified clinically or scientifically relevant articles from
PubMed that met the inclusion criteria. [Results] Exercise training can improve body
strength and lead to the physiological adaptation of skeletal muscles and the nervous
system after neural injuries. Furthermore, neurophysiological and neuropathological
studies show differences in the beneficial effects of forced therapeutic exercise in
patients with severe or mild neural injuries. Forced exercise alters the distribution of
muscle fiber types in patients with neural injuries. Based on several animal studies,
forced exercise may promote functional recovery following cerebral ischemia via signaling
molecules in ischemic brain regions. [Conclusions] This review describes several types of
therapeutic forced exercise and the controversy regarding the therapeutic effects in
experimental animals versus humans with neural injuries. This review also provides a
therapeutic strategy for physical therapists that grades the intensity of forced exercise
according to the level of neural injury.
Collapse
Affiliation(s)
- Kanghui Park
- Ubiquitous Healthcare and Anti-aging Research Center (u-HARC), Inje University, Republic of Korea; Department of Physical Therapy, Dong-Ju College, Republic of Korea
| | - Seunghoon Lee
- Ubiquitous Healthcare and Anti-aging Research Center (u-HARC), Inje University, Republic of Korea; Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea; Biohealth Products Research Center (BPRC), Inje University, Republic of Korea
| | - Yunkyung Hong
- Ubiquitous Healthcare and Anti-aging Research Center (u-HARC), Inje University, Republic of Korea; Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea; Biohealth Products Research Center (BPRC), Inje University, Republic of Korea
| | - Sookyoung Park
- Ubiquitous Healthcare and Anti-aging Research Center (u-HARC), Inje University, Republic of Korea; Department of Physical Therapy, College of Natural Sciences, Kyungnam University, Republic of Korea
| | - Jeonghyun Choi
- Ubiquitous Healthcare and Anti-aging Research Center (u-HARC), Inje University, Republic of Korea; Biohealth Products Research Center (BPRC), Inje University, Republic of Korea; Department of Physical Therapy, Graduate School of Inje University, Gimhae, Republic of Korea, Republic of Korea
| | - Kyu-Tae Chang
- National Primate Research Center (NPRC), Korea Research Institute of Bioscience and Biotechnology (KRIBB), Republic of Korea
| | - Joo-Heon Kim
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Republic of Korea
| | - Yonggeun Hong
- Ubiquitous Healthcare and Anti-aging Research Center (u-HARC), Inje University, Republic of Korea; Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea; Biohealth Products Research Center (BPRC), Inje University, Republic of Korea; Department of Physical Therapy, Graduate School of Inje University, Gimhae, Republic of Korea, Republic of Korea
| |
Collapse
|
6
|
Park J, Lee N, Cho Y, Yang Y. Modified constraint-induced movement therapy for clients with chronic stroke: interrupted time series (ITS) design. J Phys Ther Sci 2015; 27:963-6. [PMID: 25931770 PMCID: PMC4395754 DOI: 10.1589/jpts.27.963] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the impact that modified
constraint-induced movement therapy has on upper extremity function and the daily life of
chronic stroke patients. [Subjects and Methods] Modified constraint-induced movement
therapy was conduct for 2 stroke patients with hemiplegia. It was performed 5 days a week
for 2 weeks, and the participants performed their daily living activities wearing mittens
for 6 hours a day, including the 2 hours of the therapy program. The assessment was
conducted 5 times in 3 weeks before and after intervention. The upper extremity function
was measured using the box and block test and a dynamometer, and performance daily of
living activities was assessed using the modified Barthel index. The results were analyzed
using a scatterplot and linear regression. [Results] All the upper extremity functions of
the participants all improved after the modified constraint-induced movement therapy.
Performance of daily living activities by participant 1 showed no change, but the results
of participant 2 had improved after the intervention. [Conclusion] Through the results of
this research, it was identified that modified constraint-induced movement therapy is
effective at improving the upper extremity functions and the performance of daily living
activities of chronic stroke patients.
Collapse
Affiliation(s)
- JuHyung Park
- Department of Occupational Therapy, Kyungbuk College, Republic of Korea ; Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - NaYun Lee
- Department of Occupational Therapy, Kyungbuk College, Republic of Korea ; Department of Rehabilitation Science, Graduate School, Inje University, Republic of Korea
| | - YongHo Cho
- Department of Physical Therapy, Daegu Haany University, Republic of Korea
| | - YeongAe Yang
- Department of Occupational Therapy, College of Biomedical Science and Engineering, Inje University, Republic of Korea
| |
Collapse
|