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Liu M, Meng Y, Ouyang S, Zhai M, Yang L, Yang Y, Wang Y. Neuromodulation technologies improve functional recovery after brain injury: From bench to bedside. Neural Regen Res 2026; 21:506-520. [PMID: 39851132 DOI: 10.4103/nrr.nrr-d-24-00652] [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: 06/12/2024] [Accepted: 11/05/2024] [Indexed: 01/26/2025] Open
Abstract
Spontaneous recovery frequently proves maladaptive or insufficient because the plasticity of the injured adult mammalian central nervous system is limited. This limited plasticity serves as a primary barrier to functional recovery after brain injury. Neuromodulation technologies represent one of the fastest-growing fields in medicine. These techniques utilize electricity, magnetism, sound, and light to restore or optimize brain functions by promoting reorganization or long-term changes that support functional recovery in patients with brain injury. Therefore, this review aims to provide a comprehensive overview of the effects and underlying mechanisms of neuromodulation technologies in supporting motor function recovery after brain injury. Many of these technologies are widely used in clinical practice and show significant improvements in motor function across various types of brain injury. However, studies report negative findings, potentially due to variations in stimulation protocols, differences in observation periods, and the severity of functional impairments among participants across different clinical trials. Additionally, we observed that different neuromodulation techniques share remarkably similar mechanisms, including promoting neuroplasticity, enhancing neurotrophic factor release, improving cerebral blood flow, suppressing neuroinflammation, and providing neuroprotection. Finally, considering the advantages and disadvantages of various neuromodulation techniques, we propose that future development should focus on closed-loop neural circuit stimulation, personalized treatment, interdisciplinary collaboration, and precision stimulation.
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Affiliation(s)
- Mei Liu
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University (The 904 Hospital of PLA), Wuxi, Jiangsu Province, China
| | - Yijing Meng
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University (The 904 Hospital of PLA), Wuxi, Jiangsu Province, China
| | - Siguang Ouyang
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University (The 904 Hospital of PLA), Wuxi, Jiangsu Province, China
| | - Meng'ai Zhai
- Department of Neurosurgery, The 904 Hospital of PLA, Jiangnan University, Wuxi, Jiangsu Province, China
| | - Likun Yang
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University (The 904 Hospital of PLA), Wuxi, Jiangsu Province, China
| | - Yang Yang
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University (The 904 Hospital of PLA), Wuxi, Jiangsu Province, China
| | - Yuhai Wang
- Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University (The 904 Hospital of PLA), Wuxi, Jiangsu Province, China
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Cheng C, Liu T, Zhang B, Wu X, Song Z, Zhao Z, Ren X, Zhao M, Su Y, Wang J. Effects of robot-assisted hand function therapy on brain functional mechanisms: a synchronized study using fNIRS and sEMG. Front Med (Lausanne) 2024; 11:1411616. [PMID: 39544380 PMCID: PMC11560759 DOI: 10.3389/fmed.2024.1411616] [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: 04/03/2024] [Accepted: 10/17/2024] [Indexed: 11/17/2024] Open
Abstract
Background Robot-assisted hand function therapy is pivotal in the rehabilitation of patients with stroke; however, its therapeutic mechanism remains elusive. Currently, research examining the impact of robot-assisted hand function therapy on brain function in patients with stroke is scarce, and there is a lack of studies investigating the correlation between muscle activity and alterations in brain function. Objective This study aimed to investigate the correlation between forearm muscle movement and brain functional activation by employing the synchronized use of functional near-infrared spectroscopy and surface electromyography methods. Moreover, it sought to compare neural activity patterns during different rehabilitation tasks and refine the mechanism of robot-assisted hand function therapy for post-stroke hand function impairments. Methods Stroke patients with hand dysfunction underwent three sessions of robot-assisted hand function therapy within 2 weeks to 3 months of onset. The fNIRS-sEMG synchronous technique was used to observe brain function and forearm muscle activation. Ten participants were randomly assigned to receive mirror, resistance, or passive rehabilitation training. During the intervention, cortical and muscle activation information was obtained using fNIRS and electromyographic signals. The primary outcomes included changes in oxyhemoglobin concentration and root mean square of surface electromyography. Results Compared to the resting state, the Oxy-Hb concentration in the brain regions involved in three rehabilitation tasks with robot-assisted hand function therapy significantly increased (p < 0.05). Mirror therapy significantly enhanced the prefrontal cortex and the superior frontal cortex activation levels. In contrast, resistance therapy significantly promoted the activation of the supplementary motor area and the premotor cortex. Passive rehabilitation tasks showed some activation in the target brain area premotor cortex region. Robot-assisted hand function therapy has shown that forearm muscle movement is closely related to oxygenated hemoglobin concentration activity in specific brain regions during different rehabilitation tasks. Conclusion The simultaneous sEMG-fNIRS study found a significant correlation between muscle movement and brain activity after stroke, which provides an important basis for understanding the treatment mechanism of hand function impairment.
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Affiliation(s)
- Changfeng Cheng
- Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tiantian Liu
- Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Beibei Zhang
- The first affiliated hospital of Anhui University of Traditional Chinese Medicine, Anhui, China
| | - Xubo Wu
- Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhenwang Song
- Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhongzhi Zhao
- Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xue Ren
- Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Minjun Zhao
- Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yajuan Su
- Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiening Wang
- Shanghai Seventh People’s Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Ruan H, Mahmoud SS, Sang Choy C, Fang Q. An Investigation of Changes in Hemispheric Functional Connectivity after Stroke Based on fNIRS. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2024; 2024:1-4. [PMID: 40039949 DOI: 10.1109/embc53108.2024.10781619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2025]
Abstract
Stroke is a severe cerebrovascular disease. The understanding of the process of post-stroke brain recovery is crucial for prescribing rehabilitation plan. The resting-state functional connectivity (rsFC) has been used to analyze the brain functional networks with the aim to understand the post-stroke neuroplasticity. In this investigation, the rsFC data has been collected from 7 stroke patients and 7 healthy control subjects using functional Near-Infrared Spectroscopy (fNIRS) to explore the possible changes in hemispheric functional connectivity (FC) in stroke patients in comparison with the healthy subjects. The fNIRS signals were captured while the participants were asked to do the upper and lower limb motor imagery. A reduced FC was found between the damaged hemisphere and other regions in stroke patients. For patients with right hemiplegia, the FC strength between the right primary motor cortex (RPMC) and the Prefrontal Cortex (PFC) regions decreased by 0.18 (p<0.05). The change in functional connectivity indicates the existence of the post-stroke brain's plasticity as a compensatory mechanism. Hence the FC study could be used to guide and improve the effectiveness of the stroke rehabilitation.
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Parhizi B, Barss TS, Dineros AM, Sivadasan G, Mann D, Mushahwar VK. Bimanual coordination and spinal cord neuromodulation: how neural substrates of bimanual movements are altered by transcutaneous spinal cord stimulation. J Neuroeng Rehabil 2024; 21:103. [PMID: 38890742 PMCID: PMC11184732 DOI: 10.1186/s12984-024-01395-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 05/30/2024] [Indexed: 06/20/2024] Open
Abstract
Humans use their arms in complex ways that often demand two-handed coordination. Neurological conditions limit this impressive feature of the human motor system. Understanding how neuromodulatory techniques may alter neural mechanisms of bimanual coordination is a vital step towards designing efficient rehabilitation interventions. By non-invasively activating the spinal cord, transcutaneous spinal cord stimulation (tSCS) promotes recovery of motor function after spinal cord injury. A multitude of research studies have attempted to capture the underlying neural mechanisms of these effects using a variety of electrophysiological tools, but the influence of tSCS on cortical rhythms recorded via electroencephalography remains poorly understood, especially during bimanual actions. We recruited 12 neurologically intact participants to investigate the effect of cervical tSCS on sensorimotor cortical oscillations. We examined changes in the movement kinematics during the application of tSCS as well as the cortical activation level and interhemispheric connectivity during the execution of unimanual and bimanual arm reaching movements that represent activities of daily life. Behavioral assessment of the movements showed improvement of movement time and error during a bimanual common-goal movement when tSCS was delivered, but no difference was found in the performance of unimanual and bimanual dual-goal movements with the application of tSCS. In the alpha band, spectral power was modulated with tSCS in the direction of synchronization in the primary motor cortex during unimanual and bimanual dual-goal movements and in the somatosensory cortex during unimanual movements. In the beta band, tSCS significantly increased spectral power in the primary motor and somatosensory cortices during the performance of bimanual common-goal and unimanual movements. A significant increase in interhemispheric connectivity in the primary motor cortex in the alpha band was only observed during unimanual tasks in the presence of tSCS. Our observations provide, for the first time, information regarding the supra-spinal effects of tSCS as a neuromodulatory technique applied to the spinal cord during the execution of bi- and unimanual arm movements. They also corroborate the suppressive effect of tSCS at the cortical level reported in previous studies. These findings may guide the design of improved rehabilitation interventions using tSCS for the recovery of upper-limb function in the future.
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Affiliation(s)
- Behdad Parhizi
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
| | - Trevor S Barss
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Katz Group-Rexall Centre for Pharmacy and Health Research, University of Alberta, Edmonton, AB, T6G 2E1, Canada
| | - Alphonso Martin Dineros
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Gokul Sivadasan
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
- Department of Electrical and Computer Engineering, University of Alberta, Edmonton, AB, Canada
| | - Darren Mann
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Vivian K Mushahwar
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
- Institute for Smart Augmentative and Restorative Technologies and Health Innovation (iSMART), University of Alberta, Edmonton, AB, Canada.
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Katz Group-Rexall Centre for Pharmacy and Health Research, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
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Yuan R, Peng Y, Ji R, Zheng Y. Comparison of the activation level in the sensorimotor cortex between motor point and proximal nerve bundle electrical stimulation. J Neural Eng 2024; 21:026029. [PMID: 38537271 DOI: 10.1088/1741-2552/ad3850] [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: 11/07/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
Objective.Neuromuscular electrical stimulation (NMES) is widely used for motor function rehabilitation in stroke survivors. Compared with the conventional motor point (MP) stimulation, the stimulation at the proximal segment of the peripheral nerve (PN) bundles has been demonstrated to have multiple advantages. However, it is not known yet whether the PN stimulation can increase the cortical activation level, which is crucial for motor function rehabilitation.Approach.The current stimuli were delivered transcutaneously at the muscle belly of the finger flexors and the proximal segment of the median and ulnar nerves, respectively for the MP and PN stimulation. The stimulation intensity was determined to elicit the same contraction levels between the two stimulation methods in 18 healthy individuals and a stroke patient. The functional near-infrared spectroscopy and the electromyogram were recorded to compare the activation pattern of the sensorimotor regions and the target muscles.Main Results.For the healthy subjects, the PN stimulation induced significantly increased concentration of the oxygenated hemoglobin in the contralateral sensorimotor areas, and enhanced the functional connectivity between brain regions compared with the MP stimulation. Meanwhile, the compound action potentials had a smaller amplitude and the H-reflex became stronger under the PN stimulation, indicating that more sensory axons were activated in the PN stimulation. For the stroke patient, the PN stimulation can elicit finger forces and induce activation of both the contralateral and ipsilateral motor cortex.Conclusions. Compared with the MP stimulation, the PN stimulation can induce more cortical activation in the contralateral sensorimotor areas possibly via involving more activities in the central pathway.Significance.This study demonstrated the potential of the PN stimulation to facilitate functional recovery via increasing the cortical activation level, which may help to improve the outcome of the NMES-based rehabilitation for motor function recovery after stroke.
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Affiliation(s)
- Rui Yuan
- Institute of Engineering and Medicine Interdisciplinary Studies and the State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yu Peng
- Department of Rehabilitation, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Run Ji
- National Research Center for Rehabilitation Technical Aids and the Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, Beijing, People's Republic of China
| | - Yang Zheng
- Institute of Engineering and Medicine Interdisciplinary Studies and the State Key Laboratory for Manufacturing Systems Engineering, School of Mechanical Engineering, Xi'an Jiaotong University, Xi'an, People's Republic of China
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Lai MH, Yu XM, Lu Y, Wang HL, Fu W, Zhou HX, Li YL, Hu J, Xia J, Hu Z, Shan CL, Wang F, Wang C. Effectiveness and brain mechanism of multi-target transcranial alternating current stimulation (tACS) on motor learning in stroke patients: study protocol for a randomized controlled trial. Trials 2024; 25:97. [PMID: 38291500 PMCID: PMC10826150 DOI: 10.1186/s13063-024-07913-4] [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: 10/20/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Transcranial alternating current stimulation (tACS) has proven to be an effective treatment for improving cognition, a crucial factor in motor learning. However, current studies are predominantly focused on the motor cortex, and the potential brain mechanisms responsible for the therapeutic effects are still unclear. Given the interconnected nature of motor learning within the brain network, we have proposed a novel approach known as multi-target tACS. This study aims to ascertain whether multi-target tACS is more effective than single-target stimulation in stroke patients and to further explore the potential underlying brain mechanisms by using techniques such as transcranial magnetic stimulation (TMS) and magnetic resonance imaging (MRI). METHODS This study employs a double-blind, sham-controlled, randomized controlled trial design with a 2-week intervention period. Both participants and outcome assessors will remain unaware of treatment allocation throughout the study. Thirty-nine stroke patients will be recruited and randomized into three distinct groups, including the sham tACS group (SS group), the single-target tACS group (ST group), and the multi-target tACS group (MT group), at a 1:1:1 ratio. The primary outcomes are series reaction time tests (SRTTs) combined with electroencephalograms (EEGs). The secondary outcomes include motor evoked potential (MEP), central motor conduction time (CMCT), short interval intracortical inhibition (SICI), intracortical facilitation (ICF), magnetic resonance imaging (MRI), Box and Block Test (BBT), and blood sample RNA sequencing. The tACS interventions for all three groups will be administered over a 2-week period, with outcome assessments conducted at baseline (T0) and 1 day (T1), 7 days (T2), and 14 days (T3) of the intervention phase. DISCUSSION The study's findings will determine the potential of 40-Hz tACS to improve motor learning in stroke patients. Additionally, it will compare the effectiveness of multi-target and single-target approaches, shedding light on their respective improvement effects. Through the utilization of techniques such as TMS and MRI, the study aims to uncover the underlying brain mechanisms responsible for the therapeutic impact. Furthermore, the intervention has the potential to facilitate motor learning efficiency, thereby contributing to the advancement of future stroke rehabilitation treatment. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300073465. Registered on 11 July 2023.
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Affiliation(s)
- Ming-Hui Lai
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Xiao-Ming Yu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Yan Lu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Hong-Lin Wang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Wang Fu
- Department of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Huan-Xia Zhou
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
| | - Yuan-Li Li
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jun Hu
- The Second Rehabilitation Hospital of Shanghai, Shanghai, 200435, China
| | - Jiayi Xia
- The Second Rehabilitation Hospital of Shanghai, Shanghai, 200435, China
| | - Zekai Hu
- The Second Rehabilitation Hospital of Shanghai, Shanghai, 200435, China
| | - Chun-Lei Shan
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, 201203, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Feng Wang
- Department of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Cong Wang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Datong Rd. 358, Shanghai, 200137, China.
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai, 201203, China.
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
- The Second Rehabilitation Hospital of Shanghai, Shanghai, 200435, China.
- Queensland Brain Institute, the University of Queensland, Brisbane, 4072, Australia.
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Wang L, Gao F, Dai Y, Wang Z, Liang F, Wu J, Wang M, Wang L. Transcutaneous auricular vagus nerve stimulation on upper limb motor function with stroke: a functional near-infrared spectroscopy pilot study. Front Neurosci 2023; 17:1297887. [PMID: 38075278 PMCID: PMC10702495 DOI: 10.3389/fnins.2023.1297887] [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: 09/20/2023] [Accepted: 11/06/2023] [Indexed: 02/02/2025] Open
Abstract
BACKGROUND Transcutaneous auricular vagus nerve stimulation (taVNS) emerges as a promising neuromodulatory technique. However, taVNS uses left ear stimulation in stroke survivors with either left or right hemiparesis. Understanding its influence on the cortical responses is pivotal for optimizing post-stroke rehabilitation protocols. OBJECTIVE The primary objective of this study was to elucidate the influence of taVNS on cortical responses in stroke patients presenting with either left or right hemiparesis and to discern its potential ramifications for upper limb rehabilitative processes. METHODS We employed functional near-infrared spectroscopy (fNIRS) to ascertain patterns of cerebral activation in stroke patients as they engaged in a "block transfer" task. Additionally, the Lateralization Index (LI) was utilized to quantify the lateralization dynamics of cerebral functions. RESULTS In patients exhibiting left-side hemiplegia, there was a notable increase in activation within the pre-motor and supplementary motor cortex (PMC-SMC) of the unaffected hemisphere as well as in the left Broca area. Conversely, those with right-side hemiplegia displayed heightened activation in the affected primary somatosensory cortex (PSC) region following treatment.Significantly, taVNS markedly amplified cerebral activation, with a pronounced impact on the left motor cortical network across both cohorts. Intriguingly, the LI showcased consistency, suggesting a harmonized enhancement across both compromised and uncompromised cerebral regions. CONCLUSION TaVNS can significantly bolster the activation within compromised cerebral territories, particularly within the left motor cortical domain, without destabilizing cerebral lateralization. TaVNS could play a pivotal role in enhancing upper limb functional restoration post-stroke through precise neuromodulatory and neuroplastic interventions.
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Affiliation(s)
- Likai Wang
- Department of Rehabilitation Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Fei Gao
- Department of Rehabilitation Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yongli Dai
- Department of Rehabilitation Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Zhan Wang
- Department of Rehabilitation Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Feng Liang
- First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Jingyi Wu
- Department of Rehabilitation Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Mengchun Wang
- Department of Rehabilitation Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Litong Wang
- Department of Rehabilitation Medicine, The Second Hospital of Dalian Medical University, Dalian, China
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Kong Y, Peng W, Li J, Zhu C, Zhang C, Fan Y. Alteration in brain functional connectivity in patients with post-stroke cognitive impairment during memory task: A fNIRS study. J Stroke Cerebrovasc Dis 2023; 32:107280. [PMID: 37517137 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107280] [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: 03/25/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023] Open
Abstract
OBJECTIVE This study attempted to evaluate the functional connectivity (FC) in relevant cortex areas during three memory tasks using the functional near-infrared spectroscopy (fNIRS) method to expound the neural mechanisms in individuals with post-stroke cognitive impairment (PSCI). METHODS Short-term memory and visuospatial abilities were assessed using the clock drawing test, digit span test, and Corsi Block-tapping tests with simultaneous fNIRS. The oxygenated hemoglobin concentration signals were recorded from the bilateral motor sense cortex (LMS/RMS) and prefrontal lobe (LPFT/PFT/RPFT) of 19 subjects with cognitive impairment (PSCI group), 27 stroke subjects (STR group) and 26 healthy subjects (HC group). RESULTS MMSE scores were positively correlated with the clock drawing test and digit span test scores but not with Corsi Block-tapping scores. During each test, functional connectivity between the bilateral MS (LMS/RMS) was highest within each group, but the functional connectivity between motor sense cortex and frontal lobe was lowest. PSCI group showed decreased FC between bilateral motor sense cortex (P < 0.05) and between motor sense cortex and frontal lobe (P > 0.05) during clock drawing test and Corsi Block-tapping test while decreased FC between each region of interest during digit span test with no significant difference. Functional connectivity levels were closely related to MMSE scores. CONCLUSIONS Decreased functional connectivity level may be a marker of impaired cognitive function in post-stroke cognitive impairment. The fNIRS-based functional connectivity provides a non-invasive method to recognize cognitive impairment post-stroke. Functional connectivity changes may help to further understand the neural mechanisms of cognitive impairment post stroke.
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Affiliation(s)
- Ying Kong
- Department of Rehabilitation, the Second Xiangya Hospital, Central South University, No. 139, Renmin Rd. Furong District, Changsha 410011, Hunan China
| | - Wenna Peng
- Department of Rehabilitation, the Second Xiangya Hospital, Central South University, No. 139, Renmin Rd. Furong District, Changsha 410011, Hunan China
| | - Jing Li
- Department of Rehabilitation, the Second Xiangya Hospital, Central South University, No. 139, Renmin Rd. Furong District, Changsha 410011, Hunan China
| | - Chunjiao Zhu
- Department of Rehabilitation, the Second Xiangya Hospital, Central South University, No. 139, Renmin Rd. Furong District, Changsha 410011, Hunan China
| | - Changjie Zhang
- Department of Rehabilitation, the Second Xiangya Hospital, Central South University, No. 139, Renmin Rd. Furong District, Changsha 410011, Hunan China
| | - Yongmei Fan
- Department of Rehabilitation, the Second Xiangya Hospital, Central South University, No. 139, Renmin Rd. Furong District, Changsha 410011, Hunan China.
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Cui Y, Cong F, Huang F, Zeng M, Yan R. Cortical activation of neuromuscular electrical stimulation synchronized mirror neuron rehabilitation strategies: an fNIRS study. Front Neurol 2023; 14:1232436. [PMID: 37602262 PMCID: PMC10437114 DOI: 10.3389/fneur.2023.1232436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background The mirror neuron system (MNS) plays a key role in the neural mechanism underlying motor learning and neural plasticity. Action observation (AO), action execution (AE), and a combination of both, known as action imitation (AI), are the most commonly used rehabilitation strategies based on MNS. It is possible to enhance the cortical activation area and amplitude by combining traditional neuromuscular electrical stimulation (NMES) with other top-down and active rehabilitation strategies based on the MNS theory. Objective This study aimed to explore the cortical activation patterns induced by NMES synchronized with rehabilitation strategies based on MNS, namely NMES+AO, NMES+AE, and NMES+AI. In addition, the study aimed to assess the feasibility of these three novel rehabilitative treatments in order to provide insights and evidence for the design, implementation, and application of brain-computer interfaces. Methods A total of 70 healthy adults were recruited from July 2022 to February 2023, and 66 of them were finally included in the analysis. The cortical activation patterns during NMES+AO, NMES+AE, and NMES+AI were detected using the functional Near-Infrared Spectroscopy (fNIRS) technique. The action to be observed, executed, or imitated was right wrist and hand extension, and two square-shaped NMES electrodes were placed on the right extensor digitorum communis. A block design was adopted to evaluate the activation intensity of the left MNS brain regions. Results General linear model results showed that compared with the control condition, the number of channels significantly activated (PFDR < 0.05) in the NMES+AO, NMES+AE, and NMES+AI conditions were 3, 9, and 9, respectively. Region of interest (ROI) analysis showed that 2 ROIs were significantly activated (PFDR < 0.05) in the NMES+AO condition, including BA6 and BA44; 5 ROIs were significantly activated in the NMES+AE condition, including BA6, BA40, BA44, BA45, and BA46; and 6 ROIs were significantly activated in the NMES+AI condition, including BA6, BA7, BA40, BA44, BA45, and BA46. Conclusion The MNS was activated during neuromuscular electrical stimulation combined with an AO, AE, and AI intervention. The synchronous application of NMES and mirror neuron rehabilitation strategies is feasible in clinical rehabilitation. The fNIRS signal patterns observed in this study could be used to develop brain-computer interface and neurofeedback therapy rehabilitation devices.
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Affiliation(s)
- Yao Cui
- Department of Physical Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Fang Cong
- Department of Physical Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
| | - Fubiao Huang
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Occupational Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Ming Zeng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Jiaxing University, The Second Hospital of Jiaxing City, Jiaxing, Zhejiang, China
| | - Ruxiu Yan
- School of Rehabilitation Medicine, Capital Medical University, Beijing, China
- Department of Occupational Therapy, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing, China
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Zou J, Yin Y, Lin Z, Gong Y. The analysis of brain functional connectivity of post-stroke cognitive impairment patients: an fNIRS study. Front Neurosci 2023; 17:1168773. [PMID: 37214384 PMCID: PMC10196111 DOI: 10.3389/fnins.2023.1168773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Background Post-stroke cognitive impairment (PSCI) is a considerable risk factor for developing dementia and reoccurrence of stroke. Understanding the neural mechanisms of cognitive impairment after stroke can facilitate early identification and intervention. Objectives Using functional near-infrared spectroscopy (fNRIS), the present study aimed to examine whether resting-state functional connectivity (FC) of brain networks differs in patients with PSCI, patients with Non-PSCI (NPSCI), and healthy controls (HCs), and whether these features could be used for clinical diagnosis of PSCI. Methods The present study recruited 16 HCs and 32 post-stroke patients. Based on the diagnostic criteria of PSCI, post-stroke patients were divided to the PSCI or NPSCI group. All participants underwent a 6-min resting-state fNRIS test to measure the hemodynamic responses from regions of interests (ROIs) that were primarily distributed in the prefrontal, somatosensory, and motor cortices. Results The results showed that, when compared to the HC group, the PSCI group exhibited significantly decreased interhemispheric FC and intra-right hemispheric FC. ROI analyses showed significantly decreased FC among the regions of somatosensory cortex, dorsolateral prefrontal cortex, and medial prefrontal cortex for the PSCI group than for the HC group. However, no significant difference was found in the FC between the PSCI and the NPSCI groups. Conclusion Our findings provide evidence for compromised interhemispheric and intra-right hemispheric functional connectivity in patients with PSCI, suggesting that fNIRS is a promising approach to investigate the effects of stroke on functional connectivity of brain networks.
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Affiliation(s)
- Jiahuan Zou
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu,Sichuan, China
| | - Yongyan Yin
- School of Medical and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu,Sichuan, China
| | - Zhenfang Lin
- Department of Neurology, Sichuan Bayi Rehabilitation Center (Sichuan Provincial Rehabilitation Hospital), Chengdu, Sichuan, China
| | - Yulai Gong
- Department of Neurology, Sichuan Bayi Rehabilitation Center (Sichuan Provincial Rehabilitation Hospital), Chengdu, Sichuan, China
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