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Noguchi KS, Mcleod JC, Phillips SM, Richardson J, Tang A. Differences in Skeletal Muscle Fiber Characteristics Between Affected and Nonaffected Limbs in Individuals With Stroke: A Scoping Review. Phys Ther 2023; 103:pzad095. [PMID: 37478464 DOI: 10.1093/ptj/pzad095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/04/2023] [Accepted: 06/19/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE The objective of this scoping review was to characterize and identify knowledge gaps about the changes in skeletal muscle fiber type proportion and cross-sectional area (CSA) after stroke. METHODS This scoping review followed previously proposed frameworks. A systematic search was conducted for articles examining muscle fiber type proportion and CSA in individuals with stroke in EMBASE, MEDLINE, PsycINFO, CINAHL, SPORTDiscus, and Web of Science databases from inception to December 20, 2022. Two independent authors screened and extracted the data. Results were discussed using theories proposed by the authors of the included studies. RESULTS Of 13 studies (115 participants), 6 (46%) were case studies or case series, 6 (46%) were cross-sectional studies, and 1 (8%) was an experimental study. Studies had small sample sizes (1-23 participants) and various muscle sampling sites (6 different muscles). All 13 studies examined muscle fiber type distributions, and 6 (46%) examined CSA. Ten (77%) studies examined differences between paretic and nonparetic muscles, and 5 (38%) compared people with stroke to people without stroke. Results from 9 of 13 studies (69%) supported a greater proportion of type II muscle fibers in the paretic limb. Of those, 4 studies (42 participants), 3 studies (17 participants), and 1 study (1 participant) saw no differences, preferential type II and type I CSA loss between limbs, respectively. CONCLUSION Of the limited available evidence, stroke appears to result in a shift to a higher proportion of type II muscle fibers in the paretic muscles. There are mixed results for effects on muscle fiber CSA, but there is some evidence of specific atrophy of type II muscle fibers. IMPACT Changes in paretic skeletal muscle fibers of individuals with stroke may explain, in part, the substantial losses in strength and power in this population. Interventions to restore type II muscle fiber size may benefit people with stroke.
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Affiliation(s)
- Kenneth S Noguchi
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Jonathan C Mcleod
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Stuart M Phillips
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ada Tang
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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2
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Cho KH, Park JB, Kang A. Metaverse for Exercise Rehabilitation: Possibilities and Limitations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085483. [PMID: 37107765 PMCID: PMC10138806 DOI: 10.3390/ijerph20085483] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/10/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES This study aimed to obtain a consensus agreement from an expert panel on the metaverse for exercise rehabilitation in stroke patients using the Delphi technique. METHODS This study recruited twenty-two experts and conducted three rounds of online surveys between January and February 2023. The Delphi consensus technique was performed online to review and evaluate the framework module. A panel of experts, including scholars, physicians, physical therapists, and physical education specialists in the Republic of Korea, was invited to participate in this study. For each round, the expert consensus was defined as more than 90% of the expert panel agreeing or strongly agreeing with the proposed items. RESULTS A total of twenty experts completed the three Delphi rounds. First, virtual reality-assisted (VR) treadmill walking could improve cognitive function, concentration, muscular endurance, stroke prevention, proper weight maintenance, and cardiorespiratory function. Second, related technology, safety, price, place, and securing experts would be obstacles or challenges in VR-assisted treadmill walking for stroke patients. Third, the role of exercise instructors in exercise planning, performance, and assessment for VR-assisted treadmill walking is equally important, and reeducation for them is required. Fourth, VR-assisted treadmill walking for stroke patients requires an exercise intensity of at least five times a week, about one hour each time. CONCLUSIONS This study showed that the metaverse for exercise rehabilitation for stroke patients could be successfully developed and would be feasible to be implemented in the future. However, it would have limitations in terms of technology, safety, price, place, and expert factors to be overcome in the future.
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Affiliation(s)
- Kyoung-Hwan Cho
- Department of Special Physical Education, Daelim University College, Anyang 13916, Republic of Korea
| | - Jeong-Beom Park
- Department of Special Physical Education, Daelim University College, Anyang 13916, Republic of Korea
| | - Austin Kang
- Department of Medicine, Seoul National University, Seoul 08826, Republic of Korea
- Correspondence: ; Tel.: +82-1027230519
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3
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Mota DMS, Moraes ÍAP, Papa DCR, Fernani DCGL, Almeida CS, Tezza MHS, Dantas MTAP, Fernandes SMS, Ré AHN, Silva TD, Monteiro CBM. Bilateral Transfer of Performance between Real and Non-Immersive Virtual Environments in Post-Stroke Individuals: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3301. [PMID: 36834000 PMCID: PMC9963577 DOI: 10.3390/ijerph20043301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Post-stroke presents motor function deficits, and one interesting possibility for practicing skills is the concept of bilateral transfer. Additionally, there is evidence that the use of virtual reality is beneficial in improving upper limb function. We aimed to evaluate the transfer of motor performance of post-stroke and control groups in two different environments (real and virtual), as well as bilateral transfer, by changing the practice between paretic and non-paretic upper limbs. (2) Methods: We used a coincident timing task with a virtual (Kinect) or a real device (touch screen) in post-stroke and control groups; both groups practiced with bilateral transference. (3) Results: Were included 136 participants, 82 post-stroke and 54 controls. The control group presented better performance during most parts of the protocol; however, it was more evident when compared with the post-stroke paretic upper limb. We found bilateral transference mainly in Practice 2, with the paretic upper limb using the real interface method (touch screen), but only after Practice 1 with the virtual interface (Kinect), using the non-paretic upper limb. (4) Conclusions: The task with the greatest motor and cognitive demand (virtual-Kinect) provided transfer into the real interface, and bilateral transfer was observed in individuals post-stroke. However, this is more strongly observed when the virtual task was performed using the non-paretic upper limb first.
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Affiliation(s)
- Deise M. S. Mota
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Íbis A. P. Moraes
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
- Faculty of Medicine, University City of Sao Paulo (UNICID), São Paulo 03071-000, Brazil
| | - Denise C. R. Papa
- Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04021-001, Brazil
| | - Deborah C. G. L. Fernani
- Department of Physiotherapy, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Caroline S. Almeida
- Department of Physiotherapy, University of Medical Sciences of Santa Casa of São Paulo, São Paulo 01224-001, Brazil
| | - Maria H. S. Tezza
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Maria T. A. P. Dantas
- Department of Physiotherapy, Universidade do Oeste Paulista (UNOESTE), Presidente Prudente 19050-920, Brazil
| | - Susi M. S. Fernandes
- Department of Physiotherapy, Mackenzie Presbyterian University (UPM), São Paulo 01302-907, Brazil
| | - Alessandro H. N. Ré
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
| | - Talita D. Silva
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
- Faculty of Medicine, University City of Sao Paulo (UNICID), São Paulo 03071-000, Brazil
- Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo 04021-001, Brazil
| | - Carlos B. M. Monteiro
- Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo 03828-000, Brazil
- Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo 01246-903, Brazil
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4
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Ortelli P, Ferrazzoli D, Sebastianelli L, Maestri R, Dezi S, Spampinato D, Saltuari L, Alibardi A, Engl M, Kofler M, Quartarone A, Koch G, Oliviero A, Versace V. Altered motor cortex physiology and dysexecutive syndrome in patients with fatigue and cognitive difficulties after mild COVID-19. Eur J Neurol 2022; 29:1652-1662. [PMID: 35138693 PMCID: PMC9111319 DOI: 10.1111/ene.15278] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/02/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Fatigue and cognitive difficulties are reported as the most frequently persistent symptoms in patients after mild SARS‐CoV‐2 infection. An extensive neurophysiological and neuropsychological assessment of such patients was performed focusing on motor cortex physiology and executive cognitive functions. Methods Sixty‐seven patients complaining of fatigue and/or cognitive difficulties after resolution of mild SARS‐CoV‐2 infection were enrolled together with 22 healthy controls (HCs). Persistent clinical symptoms were investigated by means of a 16‐item questionnaire. Fatigue, exertion, cognitive difficulties, mood and ‘well‐being’ were evaluated through self‐administered tools. Utilizing transcranial magnetic stimulation of the primary motor cortex (M1) resting motor threshold, motor evoked potential amplitude, cortical silent period duration, short‐interval intracortical inhibition, intracortical facilitation, long‐interval intracortical inhibition and short‐latency afferent inhibition were evaluated. Global cognition and executive functions were assessed with screening tests. Attention was measured with computerized tasks. Results Post COVID‐19 patients reported a mean of 4.9 persistent symptoms, high levels of fatigue, exertion, cognitive difficulties, low levels of well‐being and reduced mental well‐being. Compared to HCs, patients presented higher resting motor thresholds, lower motor evoked potential amplitudes and longer cortical silent periods, concurring with reduced M1 excitability. Long‐interval intracortical inhibition and short‐latency afferent inhibition were also impaired, indicating altered GABAB‐ergic and cholinergic neurotransmission. Short‐interval intracortical inhibition and intracortical facilitation were not affected. Patients also showed poorer global cognition and executive functions compared to HCs and a clear impairment in sustained and executive attention. Conclusions Patients with fatigue and cognitive difficulties following mild COVID‐19 present altered excitability and neurotransmission within M1 and deficits in executive functions and attention.
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Affiliation(s)
- Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Roberto Maestri
- IRCCS Istituti Clinici Scientifici Maugeri, Montescano, Italy
| | - Sabrina Dezi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Danny Spampinato
- Non-invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, United Kingdom
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Alessia Alibardi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Michael Engl
- Medical Direction, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Angelo Quartarone
- Department of Biomedical Science and Morphological and Functional Images, University of Messina, Italy.,IRCCS Centro "Bonino Pulejo", Messina, Italy.,The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, Department of Neurology, NYU School of Medicine, New York, NY, USA
| | - Giacomo Koch
- Non-invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, Servicio de Salud de Castilla La Mancha, Toledo, Spain
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
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5
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Temporal Changes in Electromyographic Activity and Gait Ability during Extended Walking in Individuals Post-Stroke: A Pilot Study. Healthcare (Basel) 2021; 9:healthcare9040444. [PMID: 33920156 PMCID: PMC8070003 DOI: 10.3390/healthcare9040444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Abnormal gait, particularly in patients with stroke, causes neuromuscular fatigue. We aimed to clarify temporal changes in gait performance and lower limb muscle activity during extended walking in people with stroke hemiplegia. Twelve adults with stroke and eleven healthy controls performed an extended trial involving 20-min continuous walk at a comfortable speed. The primary outcome was electromyography amplitude during the trial and secondary outcomes were walking performance and the instantaneous mean frequency of electromyography during the trial. Data at 1, 6, 12, and 18 min after initiating walking were compared. Performance during extended walking in people with stroke was maintained over time. The electromyography amplitude decreased in the tibialis anterior during the pre-swing phase and increased in the rectus femoris during the single-support phase over time; these changes were similar on the paretic and nonparetic sides. Instantaneous mean frequency decreased over time on the nonparetic side in the tibialis anterior and on the paretic side in the rectus femoris. Healthy subjects did not show any changes over time. The changes in muscle activity in patients with stroke differed between the paretic and nonparetic sides, muscle type, and gait phase; walking performance was maintained despite being affected by neuromuscular fatigue.
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6
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Takahashi R, Fujita K, Kobayashi Y, Ogawa T, Teranishi M, Kawamura M. Effect of muscle fatigue on brain activity in healthy individuals. Brain Res 2021; 1764:147469. [PMID: 33838129 DOI: 10.1016/j.brainres.2021.147469] [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: 02/22/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 11/20/2022]
Abstract
Fatigue is affected by both peripheral and central factors. However, the interrelationship between muscle fatigue and brain activity has not yet been clarified. This study aimed to clarify the effect of muscle fatigue due to sustained pinch movement on brain activity in healthy individuals using functional near-infrared spectroscopy (fNIRS). Ten healthy adults participated in the study. Pinch movement of isometric contraction was the task to be performed, and electromyogram of the first dorsal interosseous muscle and brain activity by fNIRS were measured in this period. The median power frequency (MdPF) was calculated as an index of muscle fatigue and the oxygen-Hb value in the bilateral premotor and motor areas was calculated as an index of brain activity. As a result, MdPF showed a significant decrease in the middle and later phases compared with that in the early phase (p < 0.05, p < 0.001, respectively) and a significant decrease in the later phase compared with that in the middle phase (p < 0.05). The oxygen-Hb values in the motor cortex were not significantly different between the analysis sections. The oxygen-Hb values in the premotor cortex was significantly increased in the later phase (p < 0.05) compared with that in the early phase. The premotor cortex was found to be specifically activated during muscle fatigue.
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Affiliation(s)
- Ryo Takahashi
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan.
| | - Kazuki Fujita
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Fukui-city, Fukui, Japan
| | - Yasutaka Kobayashi
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Fukui-city, Fukui, Japan
| | - Tomoki Ogawa
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan
| | - Masanobu Teranishi
- Department of Physical Therapy Rehabilitation, Fukui General Hospital, Fukui-city, Fukui, Japan
| | - Mimpei Kawamura
- Department of Medical and Social, Faculty of Health Science, Kyoto Koka Women's University, Japan
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7
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PhysIOpathology of NEuromuscular function rElated to fatigue in chronic Renal disease in the elderly (PIONEER): study protocol. BMC Nephrol 2020; 21:305. [PMID: 32711479 PMCID: PMC7382847 DOI: 10.1186/s12882-020-01976-6] [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: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is associated with reduced muscular strength resulting in profound fatigue. The physiopathology of these changes, their prevalence and evolution are still debated. Moreover, we have little data on elderly CKD patients. The present study protocol aims to 1) quantify the prevalence of low muscle strength (dynapenia) in a cohort of elderly patients with advanced CKD and to 2) characterize their force production coupled with electromyographic features and the symptoms of fatigue compared to a matched control group. METHODS This is a case-control, prospective, interventional study. INCLUSION CRITERIA age ≥ 60 years; CKD Stage 3b-5; clinical stability (i.e. no hospitalization and ≤ 25% in creatinine increase in the previous 3 months). Controls with normal kidney function will be matched in terms of age, gender and diabetes mellitus (requisite: estimated glomerular filtration rate ≥ 60 ml/min/1.73m2 available in the last 6 months). Exclusion criteria for cases and controls: neuromuscular disease, life expectancy < 3 months. The handgrip strength protocol is an intermittent test consisting in 6 series of 9 repetitions of 3-s sub-maximum contractions at 40% of the maximum voluntary contraction (MVC) and 2 s of resting time between contractions. Each series is separated by one fast sub-maximum contraction and one MVC. Strength is assessed with a high-frequency handgrip dynamometer paired with surface electromyography. Symptoms of fatigue are assessed using MFI-20 and FACIT-F questionnaires. In order to reach a statistical power of 96%, we plan to enroll 110 subjects in each group. DISCUSSION The novelty of this study resides in the application of an already validated set of tests in a population in which this combination (dynamometer, electromyography and questionnaires) has not previously been explored. We expect a high prevalence of dynapenia and a higher fatigability in CKD patients. A positive correlation is expected between reported fatigue and fatigability. Better appreciation of the prevalence and the relationship between fatigability and a sensation of fatigue can help us target interventions in CKD patients to improve quality of life and survival. TRIAL REGISTRATION The study was approved by Ethical Committee EST III n°20.03.01 and was recorded as a Clinical Trial (NCT04330807) on April 2, 2020.
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8
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Pearcey GEP, Zehr EP. Repeated and patterned stimulation of cutaneous reflex pathways amplifies spinal cord excitability. J Neurophysiol 2020; 124:342-351. [PMID: 32579412 DOI: 10.1152/jn.00072.2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Priming with patterned stimulation of antagonist muscle afferents induces modulation of spinal cord excitability as evidenced by changes in group Ia reciprocal inhibition. When assessed transiently with a condition-test pulse paradigm, stimulating cutaneous afferents innervating the foot reduces Ia presynaptic inhibition and facilitates soleus Hoffmann (H)-reflex amplitudes. Modulatory effects (i.e., priming) of longer lasting sensory stimulation of cutaneous afferents innervating the foot have yet to be examined. As a first step, we examined how priming with 20 min of patterned and alternating stimulation between the left and right foot affects spinal cord excitability. During priming, stimulus trains (550 ms; consisting of twenty-eight 1-ms pulses at 51 Hz, 1.2 times the radiating threshold) were applied simultaneously to the sural and plantar nerves of the ankle. Stimulation to the left and right ankle was out of phase by 500 ms. We evoked soleus H-reflexes and muscle compound action potentials (M waves) before and following priming stimulation to provide a proxy measure of spinal cord excitability. H-reflex and M-wave recruitment curves were recorded at rest, during brief (<2 min) arm cycling, and with sural conditioning [train of five 1-ms pulses at 2 times the radiating threshold (RT) with a condition-test interval (C-T) = 80 ms]. Data indicate an increase in H-reflex excitability following priming via patterned sensory stimulation. Transient sural conditioning was less effective following priming, indicating that the increased excitability of the H-reflex is partially attributable to reductions in group Ia presynaptic inhibition. Sensory stimulation to cutaneous afferents, which enhances spinal cord excitability, may prove useful in both rehabilitation and performance settings.NEW & NOTEWORTHY Priming via patterned stimulation of the nervous system induces neuroplasticity. Yet, accessing previously known cutaneous reflex pathways to alter muscle reflex excitability has not yet been examined. Here, we show that sensory stimulation of the cutaneous afferents that innervate the foot sole can amplify spinal cord excitability, which, in this case, is attributed to reductions in presynaptic inhibition.
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Affiliation(s)
- Gregory E P Pearcey
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, British Columbia, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, British Columbia, Canada
| | - E Paul Zehr
- Rehabilitation Neuroscience Laboratory, University of Victoria, Victoria, British Columbia, Canada.,Human Discovery Science, International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada.,Centre for Biomedical Research, University of Victoria, Victoria, British Columbia, Canada.,Division of Medical Sciences, University of Victoria, Victoria, British Columbia, Canada
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Rohner A, Gutbrod K, Kohler B, Lidzba K, Fischer U, Goeggel-Simonetti B, Regenyi M, Steinlin M, Bigi S. Health-Related Quality of Life in Young Adults Following Pediatric Arterial Ischemic Stroke. Stroke 2020; 51:952-957. [DOI: 10.1161/strokeaha.119.027622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Purpose—
Pediatric arterial ischemic stroke (AIS) is a rare disease leading to long-lasting neurological sequelae. Little is known about the long-term health-related quality of life (HRQoL) of these patients. The study aims to compare HRQoL in young adults who have had pediatric AIS with a healthy control group.
Methods—
A cross-sectional study compared self-rated HRQoL, depression, fatigability, and behavior in pediatric stroke survivors to healthy controls. Patients with a confirmed diagnosis of pediatric AIS who were ≥18 years at the time of recruitment and ≥2 years after acute AIS, as well as healthy controls ≥18 years matched for age, sex, and socioeconomic status were included. Primary outcome was HRQoL measured with the Short Form Health Survey.
Results—
Thirty-three patients (median [interquartile range] aged 22 years [20–26]; 22 males, 67%) and 71 controls (median [interquartile range] aged 23 years [21–25]; 41 males, 58%) were included. Overall, HRQoL, depression, or fatigability did not differ between the patients and the control group. Patients rated themselves lower on the disinhibition scale (
P
=0.049) and tended to rate themselves lower on the executive dysfunction scale (
P
=0.076). Patients with a poor outcome 24 months after AIS showed a clear trend toward impairment of executive functioning (
P
=0.056) and work/productivity in the stroke-specific QoL (
P
=0.05).
Conclusions—
Self-rated HRQoL, depression, and fatigability in adult pediatric stroke survivors are comparable to healthy adult peers. A poor outcome 24 months after acute stroke might affect work performance and executive functioning in adulthood.
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Affiliation(s)
- Aline Rohner
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Klemens Gutbrod
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (K.G., U.F., B.G.-S.)
| | - Barbara Kohler
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Karen Lidzba
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (K.G., U.F., B.G.-S.)
| | - Barbara Goeggel-Simonetti
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Switzerland (K.G., U.F., B.G.-S.)
- Division of Child Neurology, Istituto Pediatrico della Svizzera Italiana, Bellinzona, Switzerland (B.G.-S.)
| | - Maria Regenyi
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Maja Steinlin
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
| | - Sandra Bigi
- From the Division of Child Neurology, Department of Pediatrics, University Children’s Hospital Bern, Bern University Hospital, and University of Bern, Switzerland on behalf of the Swiss Neuropaediatric Stroke Registry (A.R., B.K., K.L., M.R., M.S., S.B.)
- Swiss Epilepsy Clinic, Klinik Lengg, Zürich, Switzerland (S.B.)
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10
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Pin-Barre C, Pellegrino C, Laurin F, Laurin J. Cerebral Ischemia Changed the Effect of Metabosensitive Muscle Afferents on Somatic Reflex Without Affecting Thalamic Activity. Front Physiol 2018; 9:638. [PMID: 29896119 PMCID: PMC5986926 DOI: 10.3389/fphys.2018.00638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022] Open
Abstract
The purpose of the present study was to examine the contribution of group III and IV metabosensitive afferents at spinal and supraspinal levels in rats subjected to middle cerebral artery occlusion (MCAO) with reperfusion during the acute phase. Animals were randomized in Control (n = 23), SHAM (n = 18), MCAO-D1 (n = 10), and MCAO-D7 (n = 20) groups. Rats performed the Electrical Von Frey and the Adhesive removal tests before the surgery and at day 1 (D1), D3, and D7 after MCAO. Animals were subjected to electrophysiological recordings including the responses of group III/IV metabosensitive afferents to combinations of chemical activators and the triceps brachii somatic reflex activity at D1 or D7. The response of ventral posterolateral (VPL) thalamic nuclei was also recorded after group III/IV afferent activation. Histological measurements were performed to assess the infarct size and to confirm the location of the recording electrodes into the VPL. Behavioral results indicated that MCAO induced disorders of both mechanical sensibility and motor coordination of paretic forepaw during 7 days. Moreover, injured animals exhibited an absence of somatic reflex inhibition from the group III/IV afferents at D1, without affecting the response of both these afferents and the VPL. Finally, the regulation of the central motor drive by group III/IV afferents was modified at spinal level during the acute phase of cerebral ischemia and it might contribute to the observed behavioral disturbances.
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Hyngstrom AS, Murphy SA, Nguyen J, Schmit BD, Negro F, Gutterman DD, Durand MJ. Ischemic conditioning increases strength and volitional activation of paretic muscle in chronic stroke: a pilot study. J Appl Physiol (1985) 2018; 124:1140-1147. [PMID: 29420152 PMCID: PMC6050199 DOI: 10.1152/japplphysiol.01072.2017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Ischemic conditioning (IC) on the arm or leg has emerged as an intervention to improve strength and performance in healthy populations, but the effects on neurological populations are unknown. The purpose of this study was to quantify the effects of a single session of IC on knee extensor strength and muscle activation in chronic stroke survivors. Maximal knee extensor torque measurements and surface EMG were quantified in 10 chronic stroke survivors (>1 yr poststroke) with hemiparesis before and after a single session of IC or sham on the paretic leg. IC consisted of 5 min of compression with a proximal thigh cuff (inflation pressure = 225 mmHg for IC or 25 mmHg for sham) followed by 5 min of rest. This was repeated five times. Maximal knee extensor strength, EMG magnitude, and motor unit firing behavior were measured before and immediately after IC or sham. IC increased paretic leg strength by 10.6 ± 8.5 Nm, whereas no difference was observed in the sham group (change in sham = 1.3 ± 2.9 Nm, P = 0.001 IC vs. sham). IC-induced increases in strength were accompanied by a 31 ± 15% increase in the magnitude of muscle EMG during maximal contractions and a 5% decrease in motor unit recruitment thresholds during submaximal contractions. Individuals who had the most asymmetry in strength between their paretic and nonparetic legs had the largest increases in strength ( r2 = 0.54). This study provides evidence that a single session of IC can increase strength through improved muscle activation in chronic stroke survivors. NEW & NOTEWORTHY Present rehabilitation strategies for chronic stroke survivors do not optimally activate paretic muscle, and this limits potential strength gains. Ischemic conditioning of a limb has emerged as an effective strategy to improve muscle performance in healthy individuals but has never been tested in neurological populations. In this study, we show that ischemic conditioning on the paretic leg of chronic stroke survivors can increase leg strength and muscle activation while reducing motor unit recruitment thresholds.
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Affiliation(s)
| | - Spencer A Murphy
- Department of Biomedical Engineering, Marquette University, and the Medical College of Wisconsin Milwaukee, Wisconsin
| | - Jennifer Nguyen
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Brian D Schmit
- Department of Biomedical Engineering, Marquette University, and the Medical College of Wisconsin Milwaukee, Wisconsin
| | - Francesco Negro
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia , Brescia Italy
| | - David D Gutterman
- Department of Medicine, Medical College of Wisconsin , Milwaukee, Wisconsin
- Cardiovascular Center, Medical College of Wisconsin , Milwaukee, Wisconsin
| | - Matthew J Durand
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin , Milwaukee, Wisconsin
- Cardiovascular Center, Medical College of Wisconsin , Milwaukee, Wisconsin
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Kutlubaev MA, Akhmadeeva LR. [Pathological fatigue and fatigability after stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:43-47. [PMID: 27296801 DOI: 10.17116/jnevro20161163243-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To compare the phenomena of pathological fatigue and fatigability in patients after stroke. MATERIAL AND METHODS Forty-two patients were examined 6-24 months after stroke onset. Fatigue and fatigability were assessed by Russian versions of the Fatigue Assessment Scale and the Dutch Exertional Fatigue Scale, respectively. RESULTS AND CONCLUSION The severity of both fatigue and fatigability was related to the levels of anxiety and depression. The degree of fatigability, but not fatigue, depended on the severity of cognitive and physical deficits. Thus, fatigue and fatigability after stroke represent different phenomena.
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Affiliation(s)
- M A Kutlubaev
- Kuvatov Republican Clinical Hospital, Ufa; Bashkir State Medical University, Ufa
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Cunningham DA, Janini D, Wyant A, Bonnett C, Varnerin N, Sankarasubramanian V, Potter-Baker KA, Roelle S, Wang X, Siemionow V, Yue GH, Plow EB. Post-exercise depression following submaximal and maximal isometric voluntary contraction. Neuroscience 2016; 326:95-104. [PMID: 27058145 DOI: 10.1016/j.neuroscience.2016.03.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/25/2016] [Accepted: 03/28/2016] [Indexed: 11/29/2022]
Abstract
It is well known that corticomotor excitability is altered during the post-exercise depression following fatigue within the primary motor cortex (M1). However, it is currently unknown whether corticomotor reorganization following muscle fatigue differs between magnitudes of force and whether corticomotor reorganization occurs measured with transcranial magnetic stimulation (TMS). Fifteen young healthy adults (age 23.8±1.4, 8 females) participated in a within-subjects, repeated measures design study, where they underwent three testing sessions separated by one-week each. Subjects performed separate sessions of each: low-force isometric contraction (30% maximal voluntary contraction [MVC]), high-force isometric contraction (95% MVC) of the first dorsal interosseous (FDI) muscle until self-perceived exhaustion, as well as one session of a 30-min rest as a control. We examined changes in corticomotor map area, excitability and location of the FDI representation in and around M1 using TMS. The main finding was that following low-force, but not high-force fatigue (HFF) corticomotor map area and excitability reduced [by 3cm(2) (t(14)=-2.94, p=0.01) and 56% respectively t(14)=-4.01, p<0.001)]. Additionally, the region of corticomotor excitability shifted posteriorly (6.4±2.5mm) (t(14)=-6.33, p=.019). Corticomotor output became less excitable particularly in regions adjoining M1. Overall, post-exercise depression is present in low-force, but not for HFF. Further, low-force fatigue (LFF) results in a posterior shift in corticomotor output. These changes may be indicative of increased sensory feedback from the somatosensory cortex during the recovery phase of fatigue.
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Affiliation(s)
- David A Cunningham
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; School of Biomedical Sciences, Kent State University, Kent, OH, United States
| | - Daniel Janini
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Alexandria Wyant
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Corin Bonnett
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Nicole Varnerin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | | | - Kelsey A Potter-Baker
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Sarah Roelle
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, United States
| | - Vlodek Siemionow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Guang H Yue
- Human Performance & Engineering Research, Kessler Foundation, West Orange, NJ, United States; Department of Physical Medicine & Rehab, Rutgers New Jersey Medical School, Rutgers University, Newark, NJ, United States.
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States; Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States; Department of Physical Medicine & Rehab, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
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Boudarham J, Roche N, Pradon D, Delouf E, Bensmail D, Zory R. Effects of quadriceps muscle fatigue on stiff-knee gait in patients with hemiparesis. PLoS One 2014; 9:e94138. [PMID: 24718087 PMCID: PMC3981762 DOI: 10.1371/journal.pone.0094138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/14/2014] [Indexed: 11/18/2022] Open
Abstract
The relationship between neuromuscular fatigue and locomotion has never been investigated in hemiparetic patients despite the fact that, in the clinical context, patients report to be more spastic or stiffer after walking a long distance or after a rehabilitation session. The aim of this study was to evaluate the effects of quadriceps muscle fatigue on the biomechanical gait parameters of patients with a stiff-knee gait (SKG). Thirteen patients and eleven healthy controls performed one gait analysis before a protocol of isokinetic quadriceps fatigue and two after (immediately after and after 10 minutes of rest). Spatiotemporal parameters, sagittal knee and hip kinematics, rectus femoris (RF) and vastus lateralis (VL) kinematics and electromyographic (EMG) activity were analyzed. The results showed that quadriceps muscle weakness, produced by repetitive concentric contractions of the knee extensors, induced an improvement of spatiotemporal parameters for patients and healthy subjects. For the patient group, the increase in gait velocity and step length was associated with i) an increase of sagittal hip and knee flexion during the swing phase, ii) an increase of the maximal normalized length of the RF and VL and of the maximal VL lengthening velocity during the pre-swing and swing phases, and iii) a decrease in EMG activity of the RF muscle during the initial pre-swing phase and during the latter 2/3 of the initial swing phase. These results suggest that quadriceps fatigue did not alter the gait of patients with hemiparesis walking with a SKG and that neuromuscular fatigue may play the same functional role as an anti-spastic treatment such as botulinum toxin-A injection. Strength training of knee extensors, although commonly performed in rehabilitation, does not seem to be a priority to improve gait of these patients.
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Affiliation(s)
- Julien Boudarham
- GRCTH, EA4497, CIC-IT 805, CHU Raymond Poincaré, Garches, France
- * E-mail:
| | - Nicolas Roche
- GRCTH, EA4497, CIC-IT 805, CHU Raymond Poincaré, Garches, France
| | - Didier Pradon
- GRCTH, EA4497, CIC-IT 805, CHU Raymond Poincaré, Garches, France
| | - Eric Delouf
- GRCTH, EA4497, CIC-IT 805, CHU Raymond Poincaré, Garches, France
| | - Djamel Bensmail
- GRCTH, EA4497, CIC-IT 805, CHU Raymond Poincaré, Garches, France
| | - Raphael Zory
- GRCTH, EA4497, CIC-IT 805, CHU Raymond Poincaré, Garches, France
- LAMHESS, EA 6309, University of Nice Sophia Antipolis, Nice, France
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Boudarham J, Roche N, Teixeira M, Hameau S, Robertson J, Bensmail D, Zory R. Relationship between neuromuscular fatigue and spasticity in chronic stroke patients: A pilot study. J Electromyogr Kinesiol 2014; 24:292-9. [DOI: 10.1016/j.jelekin.2013.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 10/10/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022] Open
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Abstract
OBJECTIVES Although fatigue is experienced by everyone, its definition and classification remains under debate. METHODS A review of the previously published data on fatigue. RESULTS Fatigue is influenced by age, gender, physical condition, type of food, latency to last meal, mental status, psychological conditions, personality type, life experience, and the health status of an individual. Fatigue may not only be a symptom but also a measurable and quantifiable dimension, also known as fatigability. Additionally, it may be classified as a condition occurring at rest or under exercise or stress, as physiologic reaction or pathologic condition, as spontaneous phenomenon or triggerable state, as resistant or irresistant to preconditioning, training, or attitude, as prominent or collateral experience, and as accessible or inaccessible to any type of treatment or intervention. Fatigue may be the sole symptom of a disease or one among others. It may be also classified as acute or chronic. Quantification of fatigability is achievable by fatigue scores, force measurement, electromyography, or other means. Fatigue and fatigability need to be delineated from conditions such as sleepiness, apathy, exhaustion, exercise intolerance, lack of vigor, weakness, inertia, or tiredness. Among neurological disorders, the prevalence of fatigue is particularly increased in multiple sclerosis, amyotrophic lateral sclerosis, Parkinson disease, traumatic brain injury, stroke, and bleeding and also in neuromuscular disorders. Fatigue may be influenced by training, mental preconditioning, or drugs. CONCLUSIONS Fatigue needs to be recognized as an important condition that is not only a symptom but may also be quantified and can be modified by various measures depending on the underlying cause.
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Affiliation(s)
| | - Sinda Zarrouk Mahjoub
- Laboratory of Biochemistry, UR "Human Nutrition and Metabolic Disorders" Faculty of Medicine Monastir, Monastir, Tunisie
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