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Seusing N, Strauss S, Fleischmann R, Nafz C, Groppa S, Muthuraman M, Ding H, Byblow WD, Lotze M, Grothe M. The excitability of ipsilateral motor evoked potentials is not task-specific and spatially distinct from the contralateral motor hotspot. Exp Brain Res 2024:10.1007/s00221-024-06851-6. [PMID: 38842754 DOI: 10.1007/s00221-024-06851-6] [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: 02/04/2023] [Accepted: 05/10/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE The role of ipsilateral descending motor pathways in voluntary movement of humans is still a matter of debate, with partly contradictory results. The aim of our study therefore was to examine the excitability of ipsilateral motor evoked potentials (iMEPs) regarding site and the specificity for unilateral and bilateral elbow flexion extension tasks. METHODS MR-navigated transcranial magnetic stimulation mapping of the dominant hemisphere was performed in twenty healthy participants during tonic unilateral (iBB), bilateral homologous (bBB) or bilateral antagonistic elbow flexion-extension (iBB-cAE), the map center of gravity (CoG) and iMEP area from BB were obtained. RESULTS The map CoG of the ipsilateral BB was located more anterior-laterally than the hotspot of the contralateral BB within the primary motor cortex, with a significant difference in CoG in iBB and iBB-cAE, but not bBB compared to the hotspot for the contralateral BB (each p < 0.05). However, different tasks had no effect on the size of the iMEPs. CONCLUSION Our data demonstrated that excitability of ipsilateral and contralateral MEP differ spatially in a task-specific manner suggesting the involvement of different motor networks within the motor cortex.
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Affiliation(s)
- Nelly Seusing
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Sebastian Strauss
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Robert Fleischmann
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Christina Nafz
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Sergiu Groppa
- Imaging and Neurostimulation, Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Muthuraman Muthuraman
- Imaging and Neurostimulation, Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Neural Engineering with Signal Analytics and Artificial Intelligence (NESA-AI), Department of Neurology, University Medicine of Würzburg, Würzburg, Germany
| | - Hao Ding
- Imaging and Neurostimulation, Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Neural Engineering with Signal Analytics and Artificial Intelligence (NESA-AI), Department of Neurology, University Medicine of Würzburg, Würzburg, Germany
| | - Winston D Byblow
- Movement Neuroscience Laboratory, Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, University of Auckland, Auckland, New Zealand
| | - Martin Lotze
- Functional Imaging Unit, Center for Diagnostic Radiology, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany.
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Lowenthal-Raz J, Liebermann DG, Friedman J, Soroker N. Kinematic descriptors of arm reaching movement are sensitive to hemisphere-specific immediate neuromodulatory effects of transcranial direct current stimulation post stroke. Sci Rep 2024; 14:11971. [PMID: 38796610 PMCID: PMC11127956 DOI: 10.1038/s41598-024-62889-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 05/22/2024] [Indexed: 05/28/2024] Open
Abstract
Transcranial direct current stimulation (tDCS) exerts beneficial effects on motor recovery after stroke, presumably by enhancement of adaptive neural plasticity. However, patients with extensive damage may experience null or deleterious effects with the predominant application mode of anodal (excitatory) stimulation of the damaged hemisphere. In such cases, excitatory stimulation of the non-damaged hemisphere might be considered. Here we asked whether tDCS exerts a measurable effect on movement quality of the hemiparetic upper limb, following just a single treatment session. Such effect may inform on the hemisphere that should be excited. Using a single-blinded crossover experimental design, stroke patients and healthy control subjects were assessed before and after anodal, cathodal and sham tDCS, each provided during a single session of reaching training (repeated point-to-point hand movement on an electronic tablet). Group comparisons of endpoint kinematics at baseline-number of peaks in the speed profile (NoP; smoothness), hand-path deviations from the straight line (SLD; accuracy) and movement time (MT; speed)-disclosed greater NoP, larger SLD and longer MT in the stroke group. NoP and MT revealed an advantage for anodal compared to sham stimulation of the lesioned hemisphere. NoP and MT improvements under anodal stimulation of the non-lesioned hemisphere correlated positively with the severity of hemiparesis. Damage to specific cortical regions and white-matter tracts was associated with lower kinematic gains from tDCS. The study shows that simple descriptors of movement kinematics of the hemiparetic upper limb are sensitive enough to demonstrate gain from neuromodulation by tDCS, following just a single session of reaching training. Moreover, the results show that tDCS-related gain is affected by the severity of baseline motor impairment, and by lesion topography.
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Affiliation(s)
- Justine Lowenthal-Raz
- Physical Therapy Department, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
- Neurological Rehabilitation Department, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel
| | - Dario G Liebermann
- Physical Therapy Department, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jason Friedman
- Physical Therapy Department, Stanley Steyer School of Health Professions, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Soroker
- Neurological Rehabilitation Department, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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Zhang K, Ding L, Wang X, Zhuang J, Tong S, Jia J, Guo X. Evidence of mirror therapy for recruitment of ipsilateral motor pathways in stroke recovery: A resting fMRI study. Neurotherapeutics 2024; 21:e00320. [PMID: 38262102 DOI: 10.1016/j.neurot.2024.e00320] [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: 11/21/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
Mirror therapy (MT) has been proposed to promote motor recovery post-stroke through activation of mirror neuron system, recruitment of ipsilateral motor pathways, or/and increasing attention toward the affected limb. However, neuroimaging evidence for these mechanisms is still lacking. To uncover the underlying mechanisms, we designed a randomized controlled study and used a voxel-based whole-brain analysis of resting-state fMRI to explore the brain reorganizations induced by MT. Thirty-five stroke patients were randomized to an MT group (n = 16) and a conventional therapy (CT) group (n = 19) for a 4-week intervention. Before and after the intervention, the Fugl-Meyer Assessment Upper Limb subscale (FMA-UL) and resting-state fMRI were collected. A healthy cohort (n = 16) was established for fMRI comparison. The changes in fractional amplitude of low-frequency fluctuation (fALFF) and seed-based functional connectivity were analyzed to investigate the impact of intervention. Results showed that greater FMA-UL improvement in the MT group was associated with the compensatory increase of fALFF in the contralesional precentral gyrus (M1) region and the re-establishment of functional connectivity between the bilateral M1 regions, which facilitate motor signals transmission via the ipsilateral motor pathways from the ipsilesional M1, contralesional M1, to the affected limb. A step-wise linear regression model revealed these two brain reorganization patterns collaboratively contributed to FMA-UL improvement. In conclusion, MT achieved motor rehabilitation primarily by recruitment of the ipsilateral motor pathways. Trial Registration Information: http://www.chictr.org.cn. Unique Identifier. ChiCTR-INR-17013644, submitted on December 2, 2017.
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Affiliation(s)
- Kexu Zhang
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Li Ding
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Xu Wang
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Jinyang Zhuang
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China
| | - Shanbao Tong
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China
| | - Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital Fudan University, Shanghai, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China.
| | - Xiaoli Guo
- School of Biomedical Engineering, Shanghai Jiaotong University, Shanghai, China.
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Peng X, Srivastava S, Sutton F, Zhang Y, Badran BW, Kautz SA. Compensatory increase in ipsilesional supplementary motor area and premotor connectivity is associated with greater gait impairments: a personalized fMRI analysis in chronic stroke. Front Hum Neurosci 2024; 18:1340374. [PMID: 38487103 PMCID: PMC10937543 DOI: 10.3389/fnhum.2024.1340374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024] Open
Abstract
Background Balance and mobility impairments are prevalent post-stroke and a large number of survivors require walking assistance at 6 months post-stroke which diminishes their overall quality of life. Personalized interventions for gait and balance rehabilitation are crucial. Recent evidence indicates that stroke lesions in primary motor pathways, such as corticoreticular pathways (CRP) and corticospinal tract (CST), may lead to reliance on alternate motor pathways as compensation, but the current evidence lacks comprehensive knowledge about the underlying neural mechanisms. Methods In this study, we investigate the functional connectivity (FC) changes within the motor network derived from an individualized cortical parcellation approach in 33 participants with chronic stroke compared to 17 healthy controls. The correlations between altered motor FC and gait deficits (i.e., walking speed and walking balance) were then estimated in the stroke population to understand the compensation mechanism of the motor network in motor function rehabilitation post-stroke. Results Our results demonstrated significant FC increases between ipsilesional medial supplementary motor area (SMA) and premotor in stroke compared to healthy controls. Furthermore, we also revealed a negative correlation between ipsilesional SMA-premotor FC and self-selected walking speed, as well as the Functional Gait Assessment (FGA) scores. Conclusion The increased FC between the ipsilesional SMA and premotor regions could be a compensatory mechanism within the motor network following a stroke when the individual can presumably no longer rely on the more precise CST modulation of movements to produce a healthy walking pattern. These findings enhance our understanding of individualized motor network FC changes and their connection to gait and walking balance impairments post-stroke, improving stroke rehabilitation interventions.
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Affiliation(s)
- Xiaolong Peng
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Shraddha Srivastava
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Falon Sutton
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Yongkuan Zhang
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Bashar W. Badran
- Department of Psychiatry and Behavioral Sciences, Neuro-X Lab, Medical University of South Carolina, Charleston, SC, United States
| | - Steven A. Kautz
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
- Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
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5
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Yang F, Wang F, Ma X, Zhou M, Jiang S, Xu W. Longitudinal optogenetic mapping reveals enhanced motor control by the contralesional cortex after traumatic brain injury in mice. Exp Neurol 2023; 369:114546. [PMID: 37751813 DOI: 10.1016/j.expneurol.2023.114546] [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: 04/11/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 09/28/2023]
Abstract
Traumatic brain injury (TBI) is a significant cause of human disability, and understanding its spontaneous recovery pattern after injury is critical for potential treatments. However, studies on the function of the contralesional cortex after TBI have mostly focused on acute-phase changes, and long-term dynamic changes in the control of the affected limb by the contralesional cortex are less understood. To unravel long-term adaptations in the contralesional cortex, we developed a mouse model of TBI and used longitudinal optogenetic motor mapping to observe the function of contralesional corticospinal neurons (CSNs) projecting to the unilateral seventh cervical (C7) segment of the spinal cord. We injected a retrograde adeno-associated virus (AAV) expressing channelrhodopsin-2 to optogenetically stimulate and map the functional connections of the motor-sensory cortex. We validated the effectiveness of transcranial optogenetic stimulation for functional mapping and observed a general increase in the control of the affected limb by the contralesional cortex over time. Using retrograde labeling techniques, we showed that TBI does not affect the distribution of C7-CSNs but alters their function, and the labeled CSNs are concentrated in the caudal and rostral forelimb areas. Our findings provide new insights into harnessing contralesional cortical plasticity to improve treatment for affected limbs. This study sheds light on the long-term adaptations in the contralesional cortex after TBI, paving the way for potential clinical applications of optogenetic stimulation to improve motor control and rehabilitation outcomes.
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Affiliation(s)
- Fangjing Yang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Fei Wang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; The National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China
| | - Xingyi Ma
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Mingjie Zhou
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Su Jiang
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China; The National Clinical Research Center for Aging and Medicine, Fudan University, Shanghai, China; Department of Hand and Upper Extremity Surgery, Jing'an District Central Hospital, Fudan University, Shanghai, China; Institutes of Brain Science, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Collaborative Innovation Center of Brain Science, Fudan University, Shanghai, China; Co-innovation Center of Neuroregeneration, Nantong University,226000 Nantong, China; Research Unit of Synergistic Reconstruction of Upper and Lower Limbs After Brain Injury, Chinese Academy of Medical Sciences, Beijing, China.
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6
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Altermatt M, Jordan H, Ho K, Byblow WD. Modulation of ipsilateral motor evoked potentials during bimanual coordination tasks. Front Hum Neurosci 2023; 17:1219112. [PMID: 37736146 PMCID: PMC10509758 DOI: 10.3389/fnhum.2023.1219112] [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: 05/08/2023] [Accepted: 08/08/2023] [Indexed: 09/23/2023] Open
Abstract
Introduction Ipsilateral motor evoked potentials (iMEPs) are difficult to obtain in distal upper limb muscles of healthy participants but give a direct insight into the role of ipsilateral motor control. Methods We tested a new high-intensity double pulse transcranial magnetic stimulation (TMS) protocol to elicit iMEPs in wrist extensor and flexor muscles during four different bimanual movements (cooperative-asymmetric, cooperative-symmetric, non-cooperative-asymmetric and non-cooperative-symmetric) in 16 participants. Results Nine participants showed an iMEP in the wrist extensor in at least 20% of the trials in each of the conditions and were classified as iMEP+ participants. iMEP persistence was greater for cooperative (50.5 ± 28.8%) compared to non-cooperative (31.6 ± 22.1%) tasks but did not differ between asymmetric and symmetric tasks. Area and amplitude of iMEPs were also increased during cooperative (area = 5.41 ± 3.4 mV × ms; amplitude = 1.60 ± 1.09 mV) compared to non-cooperative (area = 3.89 ± 2.0 mV × ms; amplitude = 1.12 ± 0.56 mV) tasks and unaffected by task-symmetry. Discussion The upregulation of iMEPs during common-goal cooperative tasks shows a functional relevance of ipsilateral motor control in bimanual movements. The paired-pulse TMS protocol is a reliable method to elicit iMEPs in healthy participants and can give new information about neural control of upper limb movements. With this work we contribute to the research field in two main aspects. First, we describe a reliable method to elicit ipsilateral motor evoked potentials in healthy participants which will be useful in further advancing research in the area of upper limb movements. Second, we add new insight into the motor control of bimanual movements. We were able to show an upregulation of bilateral control represented by increased ipsilateral motor evoked potentials in cooperative, object-oriented movements compared to separate bimanual tasks. This result might also have an impact on neurorehabilitation after stroke.
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Affiliation(s)
- Miriam Altermatt
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Movement Neuroscience Laboratory, Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
| | - Harry Jordan
- Clinical Neuroscience Laboratory, Department of Medicine, The University of Auckland, Auckland, New Zealand
| | - Kelly Ho
- Movement Neuroscience Laboratory, Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
| | - Winston D. Byblow
- Movement Neuroscience Laboratory, Department of Exercise Sciences, The University of Auckland, Auckland, New Zealand
- Centre for Brain Research, The University of Auckland, Auckland, New Zealand
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Lim H, Madhavan S. Non-paretic leg movements can facilitate cortical drive to the paretic leg in individuals post stroke with severe motor impairment: Implications for motor priming. Eur J Neurosci 2023; 58:2853-2867. [PMID: 37354080 PMCID: PMC10530620 DOI: 10.1111/ejn.16069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/26/2023]
Abstract
Cross-education, a phenomenon where unilateral strength (or skill) training enhances strength (or skill) in the contralateral untrained limb, has been well studied in able-bodied individuals. Cross-education effect accompanies bilateral changes of corticomotor activity in the motor cortex (M1). Recent reports demonstrated greater cross-education effect in stroke survivors compared to healthy individuals, however, corticomotor responses to cross-education in stroke remains unclear. This study aimed to determine the effects of non-paretic leg movements on corticomotor excitability (CME) and reaction time of the paretic leg in severely impaired stroke survivors. Seventeen post stroke individuals with severe leg motor impairment (Fugl-Meyer lower extremity score less than 21 and absence of motor evoked potential in the paretic leg) performed three 20-min motor trainings using their non-paretic ankle: skill (targeted dynamic movements), strength (isometric resistance) and sham (sub-threshold electrical nerve stimulation). During training, verbal instructions were given to the participants to limit their movement to the non-paretic leg and this was confirmed with visual observation of the paretic leg. Transcranial magnetic stimulation measured CME of the contralateral pathways from the non-lesioned M1 to the non-paretic tibialis anterior (TA) muscle, ipsilateral pathways to the paretic TA and transcallosal inhibition (TCI) from the non-lesioned to lesioned M1. Paretic ankle reaction time was measured using a reaction time paradigm. All outcomes were measured before, immediately post, 30-min post and 60-min post priming. CME of the non-paretic TA increased after skill (.08 ± .10 mV) and strength (.06 ± .05 mV) training (p < .01). Ipsilateral CME of the paretic TA (.02 ± .01 mV) and TCI (.01 ± .01 s, ipsilateral silent period; more inhibition to the lesioned M1) increased after skill (p < .05) but not strength training. Reaction time of the paretic ankle improved after skill and strength training (-.11 ± .2 and -.13 ± .20 s, respectively; p < .05) and was sustained at 60 min. No changes were observed during the sham condition. Our findings may inform future studies for using non-paretic leg movements as a priming modality, especially for those who are contraindicated to other priming paradigms (e.g., brain stimulation) or unable to perform paretic leg movements. Conclusion: Non-paretic leg movements can be used as a priming modality, especially for those who are contraindicated to other priming paradigms (e.g., brain stimulation) or unable to perform paretic leg movements.
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Affiliation(s)
- Hyosok Lim
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
- Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
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Delatorre RG, Sutter EN, Nemanich ST, Krach LE, Meekins G, Feyma T, Gillick BT. Anodal Contralesional tDCS Enhances CST Excitability Bilaterally in an Adolescent with Hemiparetic Cerebral Palsy: A Brief Report. Dev Neurorehabil 2023; 26:216-221. [PMID: 36967533 PMCID: PMC10228174 DOI: 10.1080/17518423.2023.2193626] [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: 07/25/2022] [Revised: 01/08/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023]
Abstract
Hemiparetic cerebral palsy (HCP), weakness on one side of the body typically caused by perinatal stroke, is characterized by lifelong motor impairments related to alterations in the corticospinal tract (CST). CST reorganization could be a useful biomarker to guide applications of neuromodulatory interventions, such as transcranial direct current stimulation (tDCS), to improve the effectiveness of rehabilitation therapies. We evaluated an adolescent with HCP and CST reorganization who demonstrated persistent heightened CST excitability in both upper limbs following anodal contralesional tDCS. The results support further investigation of targeted tDCS as an adjuvant therapy to traditional neurorehabilitation for upper limb function.
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Affiliation(s)
| | - Ellen N. Sutter
- Waisman Center, University of Wisconsin-Madison, Madison, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Samuel T. Nemanich
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Occupational Therapy, Marquette University, Milwaukee, WI, USA
| | - Linda E. Krach
- Department of Neurology, Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | - Gregg Meekins
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Timothy Feyma
- Department of Neurology, Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | - Bernadette T. Gillick
- Waisman Center, University of Wisconsin-Madison, Madison, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
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9
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Restoring After Central Nervous System Injuries: Neural Mechanisms and Translational Applications of Motor Recovery. Neurosci Bull 2022; 38:1569-1587. [DOI: 10.1007/s12264-022-00959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/29/2022] [Indexed: 11/06/2022] Open
Abstract
AbstractCentral nervous system (CNS) injuries, including stroke, traumatic brain injury, and spinal cord injury, are leading causes of long-term disability. It is estimated that more than half of the survivors of severe unilateral injury are unable to use the denervated limb. Previous studies have focused on neuroprotective interventions in the affected hemisphere to limit brain lesions and neurorepair measures to promote recovery. However, the ability to increase plasticity in the injured brain is restricted and difficult to improve. Therefore, over several decades, researchers have been prompted to enhance the compensation by the unaffected hemisphere. Animal experiments have revealed that regrowth of ipsilateral descending fibers from the unaffected hemisphere to denervated motor neurons plays a significant role in the restoration of motor function. In addition, several clinical treatments have been designed to restore ipsilateral motor control, including brain stimulation, nerve transfer surgery, and brain–computer interface systems. Here, we comprehensively review the neural mechanisms as well as translational applications of ipsilateral motor control upon rehabilitation after CNS injuries.
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10
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Srivastava S, Seamon BA, Marebwa BK, Wilmskoetter J, Bowden MG, Gregory CM, Seo NJ, Hanlon CA, Bonilha L, Brown TR, Neptune RR, Kautz SA. The relationship between motor pathway damage and flexion-extension patterns of muscle co-excitation during walking. Front Neurol 2022; 13:968385. [PMID: 36388195 PMCID: PMC9650203 DOI: 10.3389/fneur.2022.968385] [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: 06/13/2022] [Accepted: 10/12/2022] [Indexed: 01/16/2023] Open
Abstract
Background Mass flexion-extension co-excitation patterns during walking are often seen as a consequence of stroke, but there is limited understanding of the specific contributions of different descending motor pathways toward their control. The corticospinal tract is a major descending motor pathway influencing the production of normal sequential muscle coactivation patterns for skilled movements. However, control of walking is also influenced by non-corticospinal pathways such as the corticoreticulospinal pathway that possibly contribute toward mass flexion-extension co-excitation patterns during walking. The current study sought to investigate the associations between damage to corticospinal (CST) and corticoreticular (CRP) motor pathways following stroke and the presence of mass flexion-extension patterns during walking as evaluated using module analysis. Methods Seventeen healthy controls and 44 stroke survivors were included in the study. We used non-negative matrix factorization for module analysis of paretic leg electromyographic activity. We typically have observed four modules during walking in healthy individuals. Stroke survivors often have less independently timed modules, for example two-modules presented as mass flexion-extension pattern. We used diffusion tensor imaging-based analysis where streamlines connecting regions of interest between the cortex and brainstem were computed to evaluate CST and CRP integrity. We also used a coarse classification tree analysis to evaluate the relative CST and CRP contribution toward module control. Results Interhemispheric CST asymmetry was associated with worse lower extremity Fugl-Meyer score (p = 0.023), propulsion symmetry (p = 0.016), and fewer modules (p = 0.028). Interhemispheric CRP asymmetry was associated with worse lower extremity Fugl-Meyer score (p = 0.009), Dynamic gait index (p = 0.035), Six-minute walk test (p = 0.020), Berg balance scale (p = 0.048), self-selected walking speed (p = 0.041), and propulsion symmetry (p = 0.001). The classification tree model reveled that substantial ipsilesional CRP or CST damage leads to a two-module pattern and poor walking ability with a trend toward increased compensatory contralesional CRP based control. Conclusion Both CST and CRP are involved with control of modules during walking and damage to both may lead to greater reliance on the contralesional CRP, which may contribute to a two-module pattern and be associated with worse walking performance.
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Affiliation(s)
- Shraddha Srivastava
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,*Correspondence: Shraddha Srivastava
| | - Bryant A. Seamon
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Barbara K. Marebwa
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Janina Wilmskoetter
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Mark G. Bowden
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Chris M. Gregory
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Na Jin Seo
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Colleen A. Hanlon
- Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Leonardo Bonilha
- Department of Neurology, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Truman R. Brown
- Department of Radiology and Radiological Science, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Richard R. Neptune
- Walker Department of Mechanical Engineering, The University of Texas at Austin, Austin, TX, United States
| | - Steven A. Kautz
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States,Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States,Division of Physical Therapy, Department of Rehabilitation Sciences, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
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11
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Lim H, Madhavan S. Effects of Cross-Education on Neural Adaptations Following Non-Paretic Limb Training in Stroke: A Scoping Review with Implications for Neurorehabilitation. J Mot Behav 2022; 55:111-124. [PMID: 35940590 DOI: 10.1080/00222895.2022.2106935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Current stroke rehabilitation interventions focus on intensive task specific training of the paretic limb, which may not be feasible for individuals with higher levels of impairment or in the early phase of stroke. Cross-education, a mechanism that improves strength or skill of the untrained limb following unilateral motor training, has high clinical relevance for stroke rehabilitation. Despite its potential benefits, our knowledge on the application and efficacy of cross-education in stroke is limited. We performed a scoping review to synthesize the current evidence regarding neurophysiological and motor effects of cross-education training in stroke. Low to strong evidence from five studies demonstrated strength gains ranging from 31-200% in the untrained paretic limb following non-paretic muscle training. Neurophysiological mechanisms underlying cross-education were unclear as the three studies that used transcranial magnetic stimulation to probe functional connectivity demonstrated mixed results in low sample size. Our review suggests that cross-education is a promising clinical approach in stroke, however high quality studies focusing on neurophysiological mechanisms are required to establish the efficacy and underlying mechanisms of cross-education in stroke. Recommendations regarding future directions and clinical utility are provided.
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Affiliation(s)
- Hyosok Lim
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA.,Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
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12
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Atkinson E, Škarabot J, Ansdell P, Goodall S, Howatson G, Thomas K. Does the reticulospinal tract mediate adaptation to resistance training in humans? J Appl Physiol (1985) 2022; 133:689-696. [PMID: 35834623 PMCID: PMC9467470 DOI: 10.1152/japplphysiol.00264.2021] [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] [Indexed: 11/30/2022] Open
Abstract
Resistance training increases volitional force-producing capacity, and it is widely accepted that such an increase is partly underpinned by adaptations in the central nervous system, particularly in the early phases of training. Despite this, the neural substrate(s) responsible for mediating adaptation remains largely unknown. Most studies have focused on the corticospinal tract, the main descending pathway controlling movement in humans, with equivocal findings. It is possible that neural adaptation to resistance training is mediated by other structures; one such candidate is the reticulospinal tract. The aim of this narrative mini-review is to articulate the potential of the reticulospinal tract to underpin adaptations in muscle strength. Specifically, we 1) discuss why the structure and function of the reticulospinal tract implicate it as a potential site for adaptation; 2) review the animal and human literature that supports the idea of the reticulospinal tract as an important neural substrate underpinning adaptation to resistance training; and 3) examine the potential methodological options to assess the reticulospinal tract in humans.
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Affiliation(s)
- Elliott Atkinson
- Department of Sport, Exercise and Rehabilitation, grid.42629.3bNorthumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Jakob Škarabot
- School of Sport, Exercise and Health Sciences, grid.6571.5Loughborough University, Loughborough, United Kingdom
| | - Paul Ansdell
- Department of Sport, Exercise and Rehabilitation, grid.42629.3bNorthumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Stuart Goodall
- Department of Sport, Exercise and Rehabilitation, grid.42629.3bNorthumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, grid.42629.3bNorthumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Kevin Thomas
- Department of Sport, Exercise and Rehabilitation, grid.42629.3bNorthumbria University, Newcastle-upon-Tyne, United Kingdom
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13
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Takasawa E, Abe M, Chikuda H, Hanakawa T. A computational model based on corticospinal functional MRI revealed asymmetrically organized motor corticospinal networks in humans. Commun Biol 2022; 5:664. [PMID: 35790815 PMCID: PMC9256686 DOI: 10.1038/s42003-022-03615-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/21/2022] [Indexed: 11/21/2022] Open
Abstract
Evolution of the direct, monosynaptic connection from the primary motor cortex to the spinal cord parallels acquisition of hand dexterity and lateralization of hand preference. In non-human mammals, the indirect, multi-synaptic connections between the bilateral primary motor cortices and the spinal cord also participates in controlling dexterous hand movement. However, it remains unknown how the direct and indirect corticospinal pathways work in concert to control unilateral hand movement with lateralized preference in humans. Here we demonstrated the asymmetric functional organization of the two corticospinal networks, by combining network modelling and simultaneous functional magnetic resonance imaging techniques of the brain and the spinal cord. Moreover, we also found that the degree of the involvement of the two corticospinal networks paralleled lateralization of hand preference. The present results pointed to the functionally lateralized motor nervous system that underlies the behavioral asymmetry of handedness in humans. MRI and network modelling reveal correlation between the degree of involvement of the two corticospinal networks and the lateralization of handedness in humans.
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Affiliation(s)
- Eiji Takasawa
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mitsunari Abe
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takashi Hanakawa
- Department of Advanced Neuroimaging, Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan. .,Department of Integrated Neuroanatomy & Neuroimaging, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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14
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Cleland BT, Madhavan S. Motor overflow in the lower limb after stroke: insights into mechanisms. Eur J Neurosci 2022; 56:4455-4468. [PMID: 35775788 PMCID: PMC9380181 DOI: 10.1111/ejn.15753] [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: 01/19/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Motor overflow (involuntary muscle activation) is common after stroke, particularly in the non-paretic upper limb. Two potential cortical mechanisms are: 1) the contralesional hemisphere controls both limbs, and 2) inhibition from the ipsilesional to the contralesional hemisphere is diminished. Few studies have differentiated between these hypotheses or investigated motor overflow in the lower limb after stroke. To investigate these potential mechanisms, individuals with chronic stroke performed unilateral isometric and dynamic dorsiflexion. Motor overflow was quantified in the contralateral, resting (non-target) ankle. Transcranial magnetic stimulation was applied, and responses were measured in both legs. Relations between motor overflow, excitability of ipsilateral motor pathways, and interhemispheric inhibition were assessed. Non-target muscle activity (motor overflow) was greater during isometric and dynamic conditions than rest in both legs (p≤0.001) and was higher in the non-paretic than the paretic leg (p=0.03). Some participants (25%) had motor overflow >4SD above the group mean in the non-paretic leg. Greater motor overflow in the non-paretic leg was associated with lesser inhibition from the ipsilesional to the contralesional hemisphere (p=0.04). In both legs, non-target TMS responses were greater during the isometric and dynamic than the rest condition (p≤0.01), but not when normalized to background muscle activity. Overall, motor overflow occurred in both legs after stroke, suggesting a common bilateral mechanism. Our correlational results suggest that alterations in interhemispheric inhibition may contribute to motor overflow. Furthermore, the lack of differences in non-target MEPs between rest, isometric, and dynamic conditions, suggests that subcortical and/or spinal pathways may contribute to motor overflow.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
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15
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Comparison of transcallosal inhibition between hemispheres and its relationship with motor behavior in patients with severe upper extremity impairment after subacute stroke. J Stroke Cerebrovasc Dis 2022; 31:106469. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/20/2022] [Indexed: 10/18/2022] Open
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16
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Trunk BH, Ziegler L, Gharabaghi A. Ipsilateral corticospinal maps correspond to severe poststroke motor impairment. Brain Stimul 2022; 15:758-760. [PMID: 35561962 DOI: 10.1016/j.brs.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- Bettina Hanna Trunk
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Otfried-Mueller-Str. 45, 72076, Tuebingen, Germany
| | - Lukas Ziegler
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Otfried-Mueller-Str. 45, 72076, Tuebingen, Germany
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Otfried-Mueller-Str. 45, 72076, Tuebingen, Germany.
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17
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Guggenberger R, Trunk BH, Canbolat S, Ziegler L, Gharabaghi A. Evaluation of signal analysis algorithms for ipsilateral motor-evoked potentials induced by transcranial magnetic stimulation. J Neural Eng 2022; 19. [PMID: 35525187 DOI: 10.1088/1741-2552/ac6dc4] [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: 12/02/2021] [Accepted: 05/07/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Evaluating ipsilateral motor-evoked potentials (iMEP) induced by transcranial magnetic stimulation (TMS) is challenging. In healthy adults, isometric contraction is necessary to facilitate iMEP induction; therefore, the signal may be masked by the concurrent muscle activity. Signal analysis algorithms for iMEP evaluation need to be benchmarked and evaluated. APPROACH An open analysis toolbox for iMEP evaluation was implemented on the basis of eleven previously reported algorithms, which were all threshold based, and a new template-based method based on data-driven signal decomposition. The reliability and validity of these algorithms were evaluated with a dataset of 4244 iMEP from 55 healthy adults. MAIN RESULTS iMEP estimation varies drastically between algorithms. Several algorithms exhibit high reliability, but some appear to be influenced by background activity of muscle preactivation. Especially in healthy subjects, template-based approaches might be more valid than threshold-based ones. Measurement of iMEP persistence requires algorithms that reject some trials as MEP negative. The stricter the algorithms reject trials, the less reliable they generally are. Our evaluation identifies an optimally strict and reliable algorithm. SIGNIFICANCE We show different benchmarks and propose application for different use cases.
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Affiliation(s)
- Robert Guggenberger
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Otfried-Müller-Straße 45, Tubingen, 72076, GERMANY
| | - Bettina Hanna Trunk
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Otfried-Müller-Straße 45, Tubingen, 72076, GERMANY
| | - Sine Canbolat
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Otfried-Müller-Straße 45, Tubingen, 72076, GERMANY
| | - Lukas Ziegler
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Tuebingen, Tubingen, Baden-Württemberg, 72076, GERMANY
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, Universitätsklinikum Tübingen, Tuebingen, Tubingen, Baden-Württemberg, 72076, GERMANY
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18
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Hannanu FF, Naegele B, Hommel M, Krainik A, Detante O, Jaillard A. White matter tract disruption is associated with ipsilateral hand impairment in subacute stroke: a diffusion MRI study. Neuroradiology 2022; 64:1605-1615. [PMID: 35344052 DOI: 10.1007/s00234-022-02927-8] [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: 01/04/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The ipsilateral hand (ILH) is impaired after unilateral stroke, but the underlying mechanisms remain unresolved. Based on the degeneracy theory of network connectivity that many connectivity patterns are functionally equivalent, we hypothesized that ILH impairment would result from the summation of microstructural white matter (WM) disruption in the motor network, with a task-related profile. We aimed to determine the WM disruption patterns associated with ILH impairment. METHODS This was a cross-sectional analysis of patients in the ISIS-HERMES Study with ILH and diffusion-MRI data collected 1 month post-stroke. Patients performed three tasks, the Purdue Pegboard Test (PPT), handgrip strength, and movement time. Fractional anisotropy (FA) derived from diffusion MRI was measured in 33 WM regions. We used linear regression models controlling for age, sex, and education to determine WM regions associated with ILH impairment. RESULTS PPT was impaired in 42%, grip in 59%, and movement time in 24% of 29 included patients (mean age, 51.9 ± 10.5 years; 21 men). PPT was predicted by ipsilesional corticospinal tract (i-CST) (B = 17.95; p = 0.002) and superior longitudinal Fasciculus (i-SLF) (B = 20.52; p = 0.008); handgrip by i-CST (B = 109.58; p = 0.016) and contralesional anterior corona radiata (B = 42.69; p = 0.039); and movement time by the corpus callosum (B = - 1810.03; p = 0.003) i-SLF (B = - 917.45; p = 0.015), contralesional pons-CST (B = 1744.31; p = 0.016), and i-corticoreticulospinal pathway (B = - 380.54; p = 0.037). CONCLUSION ILH impairment was associated with WM disruption to a combination of ipsilateral and contralesional tracts with a pattern influenced by task-related processes, supporting the degeneracy theory. We propose to integrate ILH assessment in rehabilitation programs and treatment interventions such as neuromodulation.
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Affiliation(s)
- Firdaus Fabrice Hannanu
- AGEIS, EA 7407 Université Grenoble Alpes, Grenoble, France.,Unité IRM 3T Recherche - IRMaGe, Inserm US 17 CNRS - UMS 3552 UGA, CHUGA, Grenoble, France.,Medical Faculty of Hasanuddin University, Makassar, Indonesia
| | - Bernadette Naegele
- Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Stroke Unit Neurology, Grenoble, France
| | - Marc Hommel
- AGEIS, EA 7407 Université Grenoble Alpes, Grenoble, France
| | - Alexandre Krainik
- Unité IRM 3T Recherche - IRMaGe, Inserm US 17 CNRS - UMS 3552 UGA, CHUGA, Grenoble, France.,Neuroradiologie, Pôle Imagerie, CHUGA, Grenoble, France
| | - Olivier Detante
- Medical Faculty of Hasanuddin University, Makassar, Indonesia
| | - Assia Jaillard
- AGEIS, EA 7407 Université Grenoble Alpes, Grenoble, France. .,Unité IRM 3T Recherche - IRMaGe, Inserm US 17 CNRS - UMS 3552 UGA, CHUGA, Grenoble, France. .,Pôle Recherche, CHUGA, Grenoble, France.
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19
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McInnes AN, Nguyen AT, Carroll TJ, Lipp OV, Marinovic W. Engagement of the contralateral limb can enhance the facilitation of motor output by loud acoustic stimuli. J Neurophysiol 2022; 127:840-855. [PMID: 35264005 DOI: 10.1152/jn.00235.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
When intense sound is presented during light muscle contraction, inhibition of the corticomotoneuronal pathway is observed. During action preparation, this effect is reversed, with sound resulting in excitation of the corticomotoneuronal pathway. We investigated how combined maintenance of a muscle contraction during preparation for a ballistic action impacts the magnitude of the facilitation of motor output by a loud acoustic stimulus (LAS) - a phenomenon known as the StartReact effect. Participants executed ballistic wrist flexion movements and a LAS was presented simultaneously with the imperative signal in a subset of trials. We examined whether the force level or muscle used to maintain a contraction during preparation for the ballistic response impacted reaction time and/or the force of movements triggered by the LAS. These contractions were sustained either ipsilaterally or contralaterally to the ballistic response. The magnitude of facilitation by the LAS was greatest when low force flexion contractions were maintained in the limb contralateral to the ballistic response during preparation. There was little change in facilitation when contractions recruited the contralateral extensor muscle, or when they were sustained in the same limb that executed the ballistic response. We conclude that a larger network of neurons which may be engaged by a contralateral sustained contraction prior to initiation may be recruited by the LAS, further contributing to the motor output of the response. These findings may be particularly applicable in stroke rehabilitation where engagement of the contralesional side may increase the benefits of a LAS to the functional recovery of movement.
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Affiliation(s)
- Aaron N McInnes
- School of Population Health, Discipline of Psychology, Curtin University, Perth, Australia.,Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, United States
| | - An T Nguyen
- School of Population Health, Discipline of Psychology, Curtin University, Perth, Australia
| | - Timothy John Carroll
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Ottmar V Lipp
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Welber Marinovic
- School of Population Health, Discipline of Psychology, Curtin University, Perth, Australia
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20
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Rosenzopf H, Wiesen D, Basilakos A, Yourganov G, Bonilha L, Rorden C, Fridriksson J, Karnath HO, Sperber C. Mapping the human praxis network: an investigation of white matter disconnection in limb apraxia of gesture production. Brain Commun 2022; 4:fcac004. [PMID: 35169709 PMCID: PMC8833454 DOI: 10.1093/braincomms/fcac004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/19/2021] [Accepted: 01/07/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Left hemispheric cerebral stroke can cause apraxia, a motor-cognitive disorder characterised by deficits of higher-order motor skills such as the failure to accurately produce meaningful gestures. This disorder provides unique insights into the anatomical and cognitive architecture of the human praxis system. The present study aimed to map the structural brain network that is damaged in apraxia. We assessed the ability to perform meaningful gestures with the hand in 101 patients with chronic left hemisphere stroke. Structural white matter fibre damage was directly assessed by diffusion tensor imaging and fractional anisotropy mapping. We used multivariate topographical inference on tract-based fractional anisotropy topographies to identify white matter disconnection associated with apraxia. We found relevant pathological white matter alterations in a densely connected fronto-temporo-parietal network of short and long association fibres. Hence, the findings suggest that heterogeneous topographical results in previous lesion mapping studies might not only result from differences in study design, but also from the general methodological limitations of univariate topographical mapping in uncovering the structural praxis network. A striking role of middle and superior temporal lobe disconnection, including temporo-temporal short association fibres, was found, suggesting strong involvement of the temporal lobe in the praxis network. Further, the results stressed the importance of subcortical disconnections for the emergence of apractic symptoms. Our study provides a fine-grain view into the structural connectivity of the human praxis network and suggests a potential value of disconnection measures in the clinical prediction of behavioural post-stroke outcome.
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Affiliation(s)
- Hannah Rosenzopf
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Daniel Wiesen
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Grigori Yourganov
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Hans-Otto Karnath
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Christoph Sperber
- Centre of Neurology, Division of Neuropsychology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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21
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Li X, Lin YL, Cunningham DA, Wolf SL, Sakaie K, Conforto AB, Machado AG, Mohan A, O’Laughlin K, Wang X, Widina M, Plow EB. Repetitive Transcranial Magnetic Stimulation of the Contralesional Dorsal Premotor Cortex for Upper Extremity Motor Improvement in Severe Stroke: Study Protocol for a Pilot Randomized Clinical Trial. Cerebrovasc Dis 2022; 51:557-564. [PMID: 35051941 PMCID: PMC9296688 DOI: 10.1159/000521514] [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: 09/08/2021] [Accepted: 12/14/2021] [Indexed: 01/22/2023] Open
Abstract
Up to 50% of stroke survivors have persistent, severe upper extremity paresis even after receiving rehabilitation. Repetitive transcranial magnetic stimulation (rTMS) can augment the effects of rehabilitation by modulating corticomotor excitability, but the conventional approach of facilitating excitability of the ipsilesional primary motor cortex (iM1) fails to produce motor improvement in stroke survivors with severe loss of ipsilesional substrate. Instead, the undamaged, contralesional dorsal premotor cortex (cPMd) may be a more suitable target. CPMd can offer alternate, bi-hemispheric and ipsilateral connections in support of paretic limb movement. This pilot, randomized clinical trial seeks to investigate whether rTMS delivered to facilitate cPMd in conjunction with rehabilitation produces greater gains in motor function than conventional rTMS delivered to facilitate iM1 in conjunction with rehabilitation in severely impaired stroke survivors. Twenty-four chronic (≥6 months) stroke survivors with severe loss of ipsilesional substrate (defined by the absence of physiologic evidence of excitable residual pathways tested using TMS) will be included. Participants will be randomized to receive rTMS to facilitate cPMd or iM1 in conjunction with task-oriented upper limb rehabilitation given for 2 sessions/week for 6 weeks. Assessments of primary outcome related to motor impairment (upper extremity Fugl-Meyer [UEFM]), motor function, neurophysiology, and functional neuroimaging will be made at baseline and at 6-week end-of-treatment. An additional assessment of motor outcomes will be repeated at 3-month follow-up to evaluate retention. The primary endpoint is 6-week change in UEFM. This pilot trial will provide preliminary evidence on the effects and mechanisms associated with facilitating intact cPMd in chronic severe stroke survivors. The trial is registered on clinicaltrials.gov, NCT03868410.
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Affiliation(s)
- Xin Li
- Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yin-Liang Lin
- Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, OH, USA,Department of Physical Therapy and Assistive Technology,
National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - David A Cunningham
- Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, OH, USA,Department of Physical Medicine and Rehabilitation, Case
Western Reserve University, Cleveland, OH, USA,MetroHealth Rehabilitation Institute of Ohio, MetroHealth
Medical Center, Cleveland, OH, USA,Cleveland Functional Electrical Stimulation Center, Louis
Stokes Cleveland Department of Veteran’s Affairs, Cleveland, OH, USA
| | - Steven L Wolf
- Department of Rehabilitation Medicine, Division of Physical
Therapy, Emory University School of Medicine, Atlanta, GA, USA
| | - Ken Sakaie
- Department of Diagnostic Radiology, Imaging Institute,
Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Akhil Mohan
- Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kyle O’Laughlin
- Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Xiaofeng Wang
- Respiratory Institute Biostatistics Core, Quantitative
Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH,
USA
| | - Morgan Widina
- Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research
Institute, Cleveland Clinic, Cleveland, OH, USA,Department of Physical Medicine and Rehabilitation,
Neurological Institute, Cleveland Clinic, OH, USA
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22
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Effect of Object Texture and Weight on Ipsilateral Corticospinal Influences During Bimanual Holding in Humans. Motor Control 2021; 26:76-91. [PMID: 34920415 DOI: 10.1123/mc.2021-0096] [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: 08/11/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022]
Abstract
We tested the hypothesis that the ipsilateral corticospinal system, like the contralateral corticospinal system, controls the threshold muscle length at which wrist muscles and the stretch reflex begin to act during holding tasks. Transcranial magnetic stimulation was applied over the right primary motor cortex in 21 healthy subjects holding a smooth or coarse block between the hands. Regardless of the lifting force, motor evoked potentials in right wrist flexors were larger for the smooth block. This result was explained based on experimental evidence that motor actions are controlled by shifting spatial stretch reflex thresholds. Thus, the ipsilateral corticospinal system is involved in threshold position control by modulating facilitatory influences of hand skin afferents on motoneurons of wrist muscles during bimanual object manipulation.
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23
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Veldema J, Nowak DA, Gharabaghi A. Resting motor threshold in the course of hand motor recovery after stroke: a systematic review. J Neuroeng Rehabil 2021; 18:158. [PMID: 34732203 PMCID: PMC8564987 DOI: 10.1186/s12984-021-00947-8] [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: 06/24/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022] Open
Abstract
Background Resting motor threshold is an objective measure of cortical excitability. Numerous studies indicate that the success of motor recovery after stroke is significantly determined by the direction and extent of cortical excitability changes. A better understanding of this topic (particularly with regard to the level of motor impairment and the contribution of either cortical hemisphere) may contribute to the development of effective therapeutical strategies in this cohort. Objectives This systematic review collects and analyses the available evidence on resting motor threshold and hand motor recovery in stroke patients. Methods PubMed was searched from its inception through to 31/10/2020 on studies investigating resting motor threshold of the affected and/or the non-affected hemisphere and motor function of the affected hand in stroke cohorts. Results Overall, 92 appropriate studies (including 1978 stroke patients and 377 healthy controls) were identified. The analysis of the data indicates that severe hand impairment is associated with suppressed cortical excitability within both hemispheres and with great between-hemispheric imbalance of cortical excitability. Favorable motor recovery is associated with an increase of ipsilesional motor cortex excitability and reduction of between-hemispheric imbalance. The direction of change of contralesional motor cortex excitability depends on the amount of hand motor impairment. Severely disabled patients show an increase of contralesional motor cortex excitability during motor recovery. In contrast, recovery of moderate to mild hand motor impairment is associated with a decrease of contralesional motor cortex excitability. Conclusions This data encourages a differential use of rehabilitation strategies to modulate cortical excitability. Facilitation of the ipsilesional hemisphere may support recovery in general, whereas facilitation and inhibition of the contralesional hemisphere may enhance recovery in severe and less severely impaired patients, respectively.
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Affiliation(s)
- Jitka Veldema
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital and University of Tübingen, Otfried-Mueller-Str.45, 72076, Tübingen, Germany.
| | - Dennis Alexander Nowak
- Department of Neurology, VAMED Hospital Kipfenberg, Konrad-Regler-Straße 1, 85110, Kipfenberg, Germany
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University Hospital and University of Tübingen, Otfried-Mueller-Str.45, 72076, Tübingen, Germany
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Giulia L, Adolfo V, Julie C, Quentin D, Simon B, Fleury M, Leveque-Le Bars E, Bannier E, Lécuyer A, Barillot C, Bonan I. The impact of neurofeedback on effective connectivity networks in chronic stroke patients: an exploratory study. J Neural Eng 2021; 18. [PMID: 34551403 DOI: 10.1088/1741-2552/ac291e] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/22/2021] [Indexed: 11/12/2022]
Abstract
Objective.In this study, we assessed the impact of electroencephalography-functional magnetic resonance imaging (EEG-fMRI) neurofeedback (NF) on connectivity strength and direction in bilateral motor cortices in chronic stroke patients. Most of the studies using NF or brain computer interfaces for stroke rehabilitation have assessed treatment effects focusing on successful activation of targeted cortical regions. However, given the crucial role of brain network reorganization for stroke recovery, our broader aim was to assess connectivity changes after an NF training protocol targeting localized motor areas.Approach.We considered changes in fMRI connectivity after a multisession EEG-fMRI NF training targeting ipsilesional motor areas in nine stroke patients. We applied the dynamic causal modeling and parametric empirical Bayes frameworks for the estimation of effective connectivity changes. We considered a motor network including both ipsilesional and contralesional premotor, supplementary and primary motor areas.Main results.Our results indicate that NF upregulation of targeted areas (ipsilesional supplementary and primary motor areas) not only modulated activation patterns, but also had a more widespread impact on fMRI bilateral motor networks. In particular, inter-hemispheric connectivity between premotor and primary motor regions decreased, and ipsilesional self-inhibitory connections were reduced in strength, indicating an increase in activation during the NF motor task.Significance.To the best of our knowledge, this is the first work that investigates fMRI connectivity changes elicited by training of localized motor targets in stroke. Our results open new perspectives in the understanding of large-scale effects of NF training and the design of more effective NF strategies, based on the pathophysiology underlying stroke-induced deficits.
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Affiliation(s)
- Lioi Giulia
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France.,IMT Atlantique, Lab-STICC, UMR CNRS 6285, Brest, F-29238, France
| | - Veliz Adolfo
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
| | | | - Duché Quentin
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France.,Department of Physical and Rehabilitation Medicine, CHU Rennes, Rennes, France
| | - Butet Simon
- Department of Physical and Rehabilitation Medicine, CHU Rennes, Rennes, France
| | - Mathis Fleury
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
| | | | - Elise Bannier
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France.,Department of Radiology, CHU Rennes, Rennes, France
| | | | | | - Isabelle Bonan
- Department of Physical and Rehabilitation Medicine, CHU Rennes, Rennes, France
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25
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Interlimb Transfer of Reach Adaptation Does Not Require an Intact Corpus Callosum: Evidence from Patients with Callosal Lesions and Agenesis. eNeuro 2021; 8:ENEURO.0190-20.2021. [PMID: 33632816 PMCID: PMC8318344 DOI: 10.1523/eneuro.0190-20.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 11/26/2022] Open
Abstract
Generalization of sensorimotor adaptation across limbs, known as interlimb transfer, is a well-demonstrated phenomenon in humans, yet the underlying neural mechanisms remain unclear. Theoretical models suggest that interlimb transfer is mediated by interhemispheric transfer of information via the corpus callosum. We thus hypothesized that lesions of the corpus callosum, especially to its midbody connecting motor, supplementary motor, and premotor areas of the two cerebral hemispheres, would impair interlimb transfer of sensorimotor adaptation. To test this hypothesis, we recruited three patients: two rare stroke patients with recent, extensive callosal lesions including the midbody and one patient with complete agenesis. A prismatic adaptation paradigm involving unconstrained arm reaching movements was designed to assess interlimb transfer from the prism-exposed dominant arm (DA) to the unexposed non-dominant arm (NDA) for each participant. Baseline results showed that spatial performance of each patient did not significantly differ from controls, for both limbs. Further, each patient adapted to the prismatic perturbation, with no significant difference in error reduction compared with controls. Crucially, interlimb transfer was found in each patient. The absolute magnitude of each patient’s transfer did not significantly differ from controls. These findings show that sensorimotor adaptation can transfer across limbs despite extensive lesions or complete absence of the corpus callosum. Therefore, callosal pathways connecting homologous motor, premotor, and supplementary motor areas are not necessary for interlimb transfer of prismatic reach adaptation. Such interlimb transfer could be mediated by transcallosal splenium pathways (connecting parietal, temporal and visual areas), ipsilateral cortico-spinal pathways or subcortical structures such as the cerebellum.
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26
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Hammerbeck U, Tyson SF, Samraj P, Hollands K, Krakauer JW, Rothwell J. The Strength of the Corticospinal Tract Not the Reticulospinal Tract Determines Upper-Limb Impairment Level and Capacity for Skill-Acquisition in the Sub-Acute Post-Stroke Period. Neurorehabil Neural Repair 2021; 35:812-822. [PMID: 34219510 PMCID: PMC8414832 DOI: 10.1177/15459683211028243] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Upper-limb impairment in patients with
chronic stroke appears to be partly attributable to an
upregulated reticulospinal tract (RST). Here, we assessed whether the impact of
corticospinal (CST) and RST connectivity on motor impairment and
skill-acquisition differs in sub-acute stroke, using
transcranial magnetic stimulation (TMS)–based proxy measures.
Methods. Thirty-eight stroke survivors were randomized to
either reach training 3-6 weeks post-stroke (plus usual care) or usual care
only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and
contralesional cortical connectivity (surrogates for CST and RST connectivity,
respectively) to weak pre-activated triceps and deltoid muscles with single
pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity
Index) and synergies (Fugl-Meyer upper-limb score). Results.
Strength and presence of synergies were associated with ipsilesional (CST)
connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar
reaching skill beyond that expected from spontaneous recovery and occurred for
both weak and strong ipsilesional tract integrity. Reaching ability, presence of
synergies, skill-acquisition and strength were not affected by either the
presence or absence of contralesional (RST) connectivity.
Conclusion. The degree of ipsilesional CST connectivity is
the main determinant of proximal dexterity, upper-limb strength and synergy
expression in sub-acute stroke. In contrast, there is no evidence for enhanced
contralesional RST connectivity contributing to any of these components of
impairment. In the sub-acute post-stroke period, the balance of activity between
CST and RST may matter more for the paretic phenotype than RST upregulation per
se.
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Affiliation(s)
- Ulrike Hammerbeck
- Geoffrey Jefferson Brain Research Centre, 158986Manchester Academic Health Science Centre, Faculty of Biology, Medicine and Healthy, 5292University of Manchester, Manchester, UK.,Department of Health Professions, Faculty of Health, Psychology and Social Care, 5289Manchester Metropolitan University, Manchester, UK
| | - Sarah F Tyson
- Department of Health Professions, Faculty of Health, Psychology and Social Care, 5289Manchester Metropolitan University, Manchester, UK
| | - Prawin Samraj
- Department of Medical Physics, Northern Care Alliance NHS Trust, Salford, UK
| | - Kristen Hollands
- Department of Health Sciences, 105168University of Salford, Salford, UK
| | - John W Krakauer
- Departments of Neurology, Neuroscience and Physical Medicine & Rehabilitation, 1500The John Hopkins University School of Medicine, Baltimore, MD, USA.,The Santa Fe Institute, Santa Fe, NM, USA
| | - John Rothwell
- Institute of Neurology, University College London, London, UK
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Cleland BT, Sisel E, Madhavan S. Motor evoked potential latency and duration from tibialis anterior in individuals with chronic stroke. Exp Brain Res 2021; 239:2251-2260. [PMID: 34059935 DOI: 10.1007/s00221-021-06144-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
Ipsilateral motor pathways from the contralesional hemisphere to the paretic limbs may be upregulated to compensate for impaired function after stroke. Onset latency and duration of motor evoked potentials (MEPs) evoked by transcranial magnetic stimulation (TMS) provide insight into compensatory pathways but have been understudied in the lower limb. This study assessed MEP onset latency and duration in the lower limb after stroke, and compared ipsilateral and contralateral MEPs in the paretic and non-paretic limb. We hypothesized that: (1) onset latency would be longer for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb, and (2) duration would be shorter for ipsilateral than contralateral MEPs and longer for the paretic than the non-paretic limb. Data were collected as a part of a pre-test of a randomized controlled trial. TMS was applied to the ipsilateral and contralateral hemisphere of the paretic and non-paretic limb. MEP onset latency and duration were calculated from the tibialis anterior. Thirty-five participants with chronic stroke were included in the final analysis. Onset latency was longer in the paretic than the non-paretic limb (~ 6.0 ms) and longer after ipsilateral than contralateral stimulation (~ 1.8 ms). Duration was longer in the paretic than the non-paretic limb (~ 9.2 ms) and longer after contralateral than ipsilateral stimulation (~ 5.2 ms). Ipsilateral MEPs may be elicited through ipsilateral pathways with fewer fibers with a higher activation threshold and/or greater spinal branching. MEPs from the paretic limb may reflect slower central motor conduction, peripheral changes, or changes in motor pathway.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA
| | - Emily Sisel
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA.
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28
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Chen JL, Schipani A, Schuch CP, Lam H, Swardfager W, Thiel A, Edwards JD. Does Cathodal vs. Sham Transcranial Direct Current Stimulation Over Contralesional Motor Cortex Enhance Upper Limb Motor Recovery Post-stroke? A Systematic Review and Meta-analysis. Front Neurol 2021; 12:626021. [PMID: 33935936 PMCID: PMC8083132 DOI: 10.3389/fneur.2021.626021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/03/2021] [Indexed: 11/17/2022] Open
Abstract
Background: During recovery from stroke, the contralesional motor cortex (M1) may undergo maladaptive changes that contribute to impaired interhemispheric inhibition (IHI). Transcranial direct current stimulation (tDCS) with the cathode over contralesional M1 may inhibit this maladaptive plasticity, normalize IHI, and enhance motor recovery. Objective: The objective of this systematic review and meta-analysis was to evaluate available evidence to determine whether cathodal tDCS on contralesional M1 enhances motor re-learning or recovery post-stroke more than sham tDCS. Methods: We searched OVID Medline, Embase, and the Cochrane Central Register of Controlled Trials for participants with stroke (>1 week post-onset) with motor impairment and who received cathodal or sham tDCS to contralesional M1 for one or more sessions. The outcomes included a change in any clinically validated assessment of physical function, activity, or participation, or a change in a movement performance variable (e.g., time, accuracy). A meta-analysis was performed by pooling five randomized controlled trials (RCTs) and comparing the change in Fugl–Meyer upper extremity scores between cathodal and sham tDCS groups. Results: Eleven studies met the inclusion criteria. Qualitatively, four out of five cross-over design studies and three out of six RCTs reported a significant effect of cathodal vs. sham tDCS. In the quantitative synthesis, cathodal tDCS (n = 65) did not significantly reduce motor impairment compared to sham tDCS (n = 67; standardized mean difference = 0.33, z = 1.79, p = 0.07) with a little observed heterogeneity (I2 = 5%). Conclusions: The effects of cathodal tDCS to contralesional M1 on motor recovery are small and consistent. There may be sub-populations that may respond to this approach; however, further research with larger cohorts is required.
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Affiliation(s)
- Joyce L Chen
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Ashley Schipani
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
| | | | - Henry Lam
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Walter Swardfager
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada.,Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Alexander Thiel
- Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Jodi D Edwards
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada
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ZHANG LEIGANG, GUO SHUAI, SUN QING. DEVELOPMENT AND ANALYSIS OF A BILATERAL END-EFFECTER UPPER LIMB REHABILITATION ROBOT. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Studies have shown that rehabilitation training with the unaffected side guiding affected side is more consistent with the natural movement pattern of human upper limb compared with unilateral rehabilitation training, which is conducive to improve rehabilitation effect of the affected limb motor function. In this paper, a bilateral end-effector upper limb rehabilitation robot (BEULRR) based on two modern commercial manipulators is developed first, then the kinematics, reachability, and dexterity analysis of BEULRR are performed, respectively. Finally, a bilateral symmetric training protocol with the unaffected side guiding the affected side is proposed and evaluated through healthy human subject experiment testing based on BEULRR. The simulation results show that the developed BEULRR could perform spatial rehabilitation training and its rehabilitation training workspace can fully cover the physiological workspace of human upper limb. The preliminary experiment results from the healthy human subject show that the BEULRR system could provide reliable bilateral symmetric training protocol. These simulation and experiment results demonstrated that the developed BEULRR system could be used in bilateral rehabilitation training application, and also show that the BEULRR system has the potential to be applied to clinical rehabilitation training in the further step. In the close future, the proposed BEULRR and bilateral symmetric training protocol are planned to be applied in elderly volunteers and patients with upper limb motor dysfunction for further evaluating.
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Affiliation(s)
- LEIGANG ZHANG
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
| | - SHUAI GUO
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
| | - QING SUN
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, P. R. China
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30
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Cleland BT, Madhavan S. Ipsilateral Motor Pathways and Transcallosal Inhibition During Lower Limb Movement After Stroke. Neurorehabil Neural Repair 2021; 35:367-378. [PMID: 33703951 DOI: 10.1177/1545968321999049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stroke rehabilitation may be improved with a better understanding of the contribution of ipsilateral motor pathways to the paretic limb and alterations in transcallosal inhibition. Few studies have evaluated these factors during dynamic, bilateral lower limb movements, and it is unclear whether they relate to functional outcomes. OBJECTIVE Determine if lower limb ipsilateral excitability and transcallosal inhibition after stroke depend on target limb, task, or number of limbs involved, and whether these factors are related to clinical measures. METHODS In 29 individuals with stroke, ipsilateral and contralateral responses to transcranial magnetic stimulation were measured in the paretic and nonparetic tibialis anterior during dynamic (unilateral or bilateral ankle dorsiflexion/plantarflexion) and isometric (unilateral dorsiflexion) conditions. Relative ipsilateral excitability and transcallosal inhibition were assessed. Fugl-Meyer, ankle movement accuracy, and walking characteristics were assessed. RESULTS Relative ipsilateral excitability was greater during dynamic than isometric conditions in the paretic limb (P ≤ .02) and greater in the paretic than the nonparetic limb during dynamic conditions (P ≤ .004). Transcallosal inhibition was greater in the ipsilesional than contralesional hemisphere (P = .002) and during dynamic than isometric conditions (P = .03). Greater ipsilesional transcallosal inhibition was correlated with better ankle movement accuracy (R2 = 0.18, P = .04). Greater contralateral excitability to the nonparetic limb was correlated with improved walking symmetry (R2 = 0.19, P = .03). CONCLUSIONS Ipsilateral pathways have increased excitability to the paretic limb, particularly during dynamic tasks. Transcallosal inhibition is greater in the ipsilesional than contralesional hemisphere and during dynamic than isometric tasks. Ipsilateral pathways and transcallosal inhibition may influence walking asymmetry and ankle movement accuracy.
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31
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Cleland BT, Madhavan S. Ipsilateral motor pathways to the lower limb after stroke: Insights and opportunities. J Neurosci Res 2021; 99:1565-1578. [PMID: 33665910 DOI: 10.1002/jnr.24822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/17/2021] [Indexed: 01/04/2023]
Abstract
Stroke-related damage to the crossed lateral corticospinal tract causes motor deficits in the contralateral (paretic) limb. To restore functional movement in the paretic limb, the nervous system may increase its reliance on ipsilaterally descending motor pathways, including the uncrossed lateral corticospinal tract, the reticulospinal tract, the rubrospinal tract, and the vestibulospinal tract. Our knowledge about the role of these pathways for upper limb motor recovery is incomplete, and even less is known about the role of these pathways for lower limb motor recovery. Understanding the role of ipsilateral motor pathways to paretic lower limb movement and recovery after stroke may help improve our rehabilitative efforts and provide alternate solutions to address stroke-related impairments. These advances are important because walking and mobility impairments are major contributors to long-term disability after stroke, and improving walking is a high priority for individuals with stroke. This perspective highlights evidence regarding the contributions of ipsilateral motor pathways from the contralesional hemisphere and spinal interneuronal pathways for paretic lower limb movement and recovery. This perspective also identifies opportunities for future research to expand our knowledge about ipsilateral motor pathways and provides insights into how this information may be used to guide rehabilitation.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
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Kang JH, Kim YH, Choi YA. Montreal Cognitive Assessment and Frontal Assessment Battery test as a predictor of performance of unaffected hand function after subcortical stroke. Int J Rehabil Res 2021; 44:45-50. [PMID: 33234844 DOI: 10.1097/mrr.0000000000000445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to elucidate the association between unaffected hand function and cognitive impairment and to determine whether the cognitive screening test can be a predictor of unaffected upper limb function in patients with unilateral subcortical strokes. A retrospective study of 37 patients with unilateral first-ever subcortical stroke was conducted through a review of medical records. The unaffected hand function and cognitive screening tests were measured upon admission to the neurorehabilitation unit and then 4 weeks later at discharge. The relationship between unaffected hand function and cognitive function was investigated with multiple linear regression analysis. Comparing the initial evaluation of unaffected hand function and cognitive function with the evaluation at discharge, cognitive function improved significantly at discharge; however, grip strength and dexterity of the unaffected hand were stationary except for three-point pinch strength, tip pinch strength, and finger tapping speed. The Montreal cognitive assessment (MoCA) score was found to be a significant predictor of unaffected grip strength (R2 = 0.33, P = 0.004) and three-point pinch strength (R2 = 0.16, P = 0.04) at discharge and the Frontal Assessment Battery (FAB) score to be a predictive value of the unaffected finger tapping test (R2 = 0.46, P < 0.001) at discharge. In subcortical stroke patients with low MoCA and FAB scores, clinicians must ensure that patients participate in rehabilitation therapy including bimanual activity with careful attention to the patient's unaffected hand function.
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Affiliation(s)
- Ji Hye Kang
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Ah Choi
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital
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33
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Castle-Kirszbaum M, Goldschlager T. Pyramidal weakness: Is it time to retire the term? Clin Anat 2020; 34:478-482. [PMID: 33347647 DOI: 10.1002/ca.23715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
Pyramidal weakness, that is, the weakness that preferentially spares the antigravity muscles, is considered an integral part of the upper motor neuron syndrome. Despite its name, pyramidal weakness has very little to do with the pyramidal tract, and preeminent texts on neurology, neuroanatomy, and clinical examination differ considerably in their descriptions and localization of this enigmatic finding. Evidence from human and nonhuman primate studies demonstrates that lesions confined only to the corticospinal (pyramidal) tract cause significant deficits in fine motor control of the hand, but do not cause posturing or patterned weakness of the extremities. Lesioning of the corticofugal fibers, particularly the corticoreticular and corticopontine tracts, leads to dysbalanced output from reticulospinal, and vestibulospinal systems, which along with changes in rubrospinal tract output balance, probably accounts for the pyramidal weakness pattern. Importantly, this would delineate that pyramidal weakness could only be incited by lesions above the brainstem. It has also been suggested that the inherently greater strength of the antigravity musculature is the substrate for pyramidal weakness, independent of any preferential motor innervation. These hypotheses require further testing in myometric studies with carefully selected participants.
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Affiliation(s)
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
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Zhang L, Duval L, Hasanbarani F, Zhu Y, Zhang X, Barthelemy D, Dancause N, Feldman AG. Participation of ipsilateral cortical descending influences in bimanual wrist movements in humans. Exp Brain Res 2020; 238:2359-2372. [PMID: 32766959 DOI: 10.1007/s00221-020-05899-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 07/29/2020] [Indexed: 01/09/2023]
Abstract
There are contralateral and less studied ipsilateral (i), indirect cortical descending projections to motoneurons (MNs). We compared ipsilateral cortical descending influences on MNs of wrist flexors by applying transcranial magnetic stimulation (TMS) over the right primary motor cortex at actively maintained flexion and extension wrist positions in uni- and bimanual tasks in right-handed participants (n = 23). The iTMS response includes a short latency (~ 25 ms) motor evoked potential (iMEP), a silent period (iSP) and a long latency (~ 60 ms) facilitation called rebound (iRB). We also investigated whether the interaction between the two hands while holding an object in a bimanual task involves ipsilateral cortical descending influences. In the unimanual task, iTMS responses in the right wrist flexors were unaffected by changes in wrist position. In the bimanual task with an object, iMEPs in the right wrist flexors were larger when the ipsilateral wrist was in flexion compared to extension. Without the object, only iRB were larger when the ipsilateral wrist was extended. Thus, ipsilateral cortical descending influences on MNs were modulated only in bimanual tasks and depended on how the two hands interacted. It is concluded that the left and right cortices cooperate in bimanual tasks involving holding an object with both hands, with possible involvement of oligo- and poly-synaptic, as well as transcallosal projections to MNs. The possible involvement of spinal and transcortical stretch and cutaneous reflexes in bimanual tasks when holding an object is discussed in the context of the well-established notion that indirect, referent control underlies motor actions.
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Affiliation(s)
- L Zhang
- Institut für Neuroinformatik, Ruhr-Universität Bochum, Bochum, Germany
| | - L Duval
- Department of Neuroscience, University of Montreal, Montreal, Canada
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), IRGLM, Institut de Readaptation Gingras-Lindsay de Montreal, 6300 Darlington, Montreal, Canada
| | - F Hasanbarani
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), IRGLM, Institut de Readaptation Gingras-Lindsay de Montreal, 6300 Darlington, Montreal, Canada
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Y Zhu
- Faculty of Medicine, University of Montreal, Montreal, Canada
| | - X Zhang
- Faculty of Medicine, University of Montreal, Montreal, Canada
| | - D Barthelemy
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), IRGLM, Institut de Readaptation Gingras-Lindsay de Montreal, 6300 Darlington, Montreal, Canada
- Ecole de Readaptation, University of Montreal, Montreal, Canada
| | - N Dancause
- Department of Neuroscience, University of Montreal, Montreal, Canada
| | - A G Feldman
- Department of Neuroscience, University of Montreal, Montreal, Canada.
- Centre for Interdisciplinary Research in Rehabilitation (CRIR), IRGLM, Institut de Readaptation Gingras-Lindsay de Montreal, 6300 Darlington, Montreal, Canada.
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McCambridge AB, Hay K, Levin K, Philpott K, Wood K, Bradnam LV. Neck rotation modulates motor-evoked potential duration of proximal muscle cortical representations in healthy adults. Exp Brain Res 2020; 238:2531-2538. [PMID: 32862278 DOI: 10.1007/s00221-020-05887-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
Transcranial magnetic stimulation (TMS) produces motor-evoked potentials (MEP) used to infer changes in corticomotor excitability. In humans, neck rotation can probe reticulospinal input on corticomotor output. This study investigated the effect of neck rotation on MEP duration in a proximal and distal upper limb muscle and compared responses between rest and preactivation. Single-pulse TMS to motor cortex was used to evoke MEPs at two stimulus intensities in 18 healthy adults (20-40 years). Surface electromyography recorded MEPs from the non-dominant biceps brachii (BB) and first dorsal interosseous (FDI). Participants were seated with the target muscle at rest or 10% preactivated, and head rotated ipsilateral, contralateral, or in neutral position. The primary outcome was MEP tail, defined as the mean difference in MEP duration between active and rest trials. Secondary outcomes were MEP duration and amplitude. MEP tail was modulated by neck rotation in the proximal BB (P = 0.03) but not distal FDI (P > 0.19), with shorter duration during ipsilateral or contralateral rotation relative to neutral. In a neutral neck position, MEP duration was prolonged by muscle preactivation and higher TMS intensities in the FDI and BB (P < 0.03). Neck rotation attenuated the prolongation of MEP duration during preactivation in the BB, but not the FDI. Neck rotation had no effect on MEP amplitude for either muscle (P > 0.05). Modulation of the late portion of the MEP by rotation of the neck could indicate subcortical projections to alpha-motoneuron pools are stronger in proximal than distal upper limb muscles. These findings may have relevance for using MEP duration as a neural biomarker in neurological diseases.
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Affiliation(s)
- Alana B McCambridge
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia.
| | - Kayla Hay
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Kumbelin Levin
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Kirsty Philpott
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Kunal Wood
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Lynley V Bradnam
- Department of Exercise Sciences, University of Auckland, Auckland, New Zealand.,Centre for Brain Research, University of Auckland, Auckland, New Zealand
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Latchoumane CFV, Barany DA, Karumbaiah L, Singh T. Neurostimulation and Reach-to-Grasp Function Recovery Following Acquired Brain Injury: Insight From Pre-clinical Rodent Models and Human Applications. Front Neurol 2020; 11:835. [PMID: 32849253 PMCID: PMC7396659 DOI: 10.3389/fneur.2020.00835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 07/06/2020] [Indexed: 12/26/2022] Open
Abstract
Reach-to-grasp is an evolutionarily conserved motor function that is adversely impacted following stroke and traumatic brain injury (TBI). Non-invasive brain stimulation (NIBS) methods, such as transcranial magnetic stimulation and transcranial direct current stimulation, are promising tools that could enhance functional recovery of reach-to-grasp post-brain injury. Though the rodent literature provides a causal understanding of post-injury recovery mechanisms, it has had a limited impact on NIBS protocols in human research. The high degree of homology in reach-to-grasp circuitry between humans and rodents further implies that the application of NIBS to brain injury could be better informed by findings from pre-clinical rodent models and neurorehabilitation research. Here, we provide an overview of the advantages and limitations of using rodent models to advance our current understanding of human reach-to-grasp function, cortical circuitry, and reorganization. We propose that a cross-species comparison of reach-to-grasp recovery could provide a mechanistic framework for clinically efficacious NIBS treatments that could elicit better functional outcomes for patients.
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Affiliation(s)
- Charles-Francois V. Latchoumane
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, United States
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States
| | - Deborah A. Barany
- Department of Kinesiology, University of Georgia, Athens, GA, United States
| | - Lohitash Karumbaiah
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, United States
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States
| | - Tarkeshwar Singh
- Regenerative Bioscience Center, University of Georgia, Athens, GA, United States
- Department of Kinesiology, University of Georgia, Athens, GA, United States
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Frenkel-Toledo S, Ofir-Geva S, Soroker N. Lesion Topography Impact on Shoulder Abduction and Finger Extension Following Left and Right Hemispheric Stroke. Front Hum Neurosci 2020; 14:282. [PMID: 32765245 PMCID: PMC7379861 DOI: 10.3389/fnhum.2020.00282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/23/2020] [Indexed: 11/13/2022] Open
Abstract
The existence of shoulder abduction and finger extension movement capacity shortly after stroke onset is an important prognostic factor, indicating favorable functional outcomes for the hemiparetic upper limb (HUL). Here, we asked whether variation in lesion topography affects these two movements similarly or distinctly and whether lesion impact is similar or distinct for left and right hemisphere damage. Shoulder abduction and finger extension movements were examined in 77 chronic post-stroke patients using relevant items of the Fugl-Meyer test. Lesion effects were analyzed separately for left and right hemispheric damage patient groups, using voxel-based lesion-symptom mapping. In the left hemispheric damage group, shoulder abduction and finger extension were affected only by damage to the corticospinal tract in its passage through the corona radiata. In contrast, following the right hemispheric damage, these two movements were affected not only by corticospinal tract damage but also by damage to white matter association tracts, the putamen, and the insular cortex. In both groups, voxel clusters have been found where damage affected shoulder abduction and also finger extension, along with voxels where damage affected only one of the two movements. The capacity to execute shoulder abduction and finger extension movements following stroke is affected significantly by damage to shared and distinct voxels in the corticospinal tract in left-hemispheric damage patients and by damage to shared and distinct voxels in a larger array of cortical and subcortical regions in right hemispheric damage patients.
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Affiliation(s)
- Silvi Frenkel-Toledo
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel.,Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
| | - Shay Ofir-Geva
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nachum Soroker
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lim H, Madhavan S. Differential corticomotor mechanisms of ankle motor control in post stroke individuals with and without motor evoked potentials. Brain Res 2020; 1739:146833. [PMID: 32298662 DOI: 10.1016/j.brainres.2020.146833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/05/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Deficits in ankle motor control has been identified as a significant contributor to impaired walking after stroke. Corticomotor excitability has been related to impaired upper limb motor control and poor recovery in stroke, however contributions to lower limb function are still unclear. This study used transcranial magnetic stimulation (TMS) to determine the influence of corticomotor characteristics on lower limb motor control in chronic stroke survivors. METHODS This retrospective study assessed 28 individuals with post stroke hemiparesis. Motor evoked potentials (MEP) measured from the paretic and non-paretic tibialis anterior (TA) muscles were used to calculate corticomotor excitability symmetry (CMEsym) and relative ipsilateral corticomotor excitability (ICE). Participants were assigned to MEP+ and MEP- groups depending on the presence (+) or absence (-) of MEPs. Ankle motor control was quantified by the ability of participants to track a sinusoidal target using dorsiflexion-plantarflexion movements of the paretic ankle and tracking error was calculated using root mean square error (RMSE). RESULTS Multiple linear regression model for all participants revealed only CMEsym and FMLE (p < 0.01) to significantly predict RMSE. In the MEP+ group, CMEsym significantly predicted RMSE (p = 0.03) while FMLE (p = 0.02) was a significant predictor for the MEP-. CONCLUSION Our results indicate that CMEsym between the ipsilesional and contralesional hemispheres does not necessarily translate to better paretic ankle motor control in chronic stroke. Presence or absence of a MEP in the TA muscle did not affect the ankle tracking performance, however, it was noted that different strategies maybe used by those with and without a MEP.
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Affiliation(s)
- Hyosok Lim
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA; Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA.
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Höller Y, Versace V, Trinka E, Nardone R. Functional connectivity after hemispherectomy. Quant Imaging Med Surg 2020; 10:1174-1178. [PMID: 32489942 DOI: 10.21037/qims.2020.03.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Yvonne Höller
- Faculty of Psychology, University of Akureyri, Akureyri, Iceland
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno, Vipiteno, Italy.,Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Eugen Trinka
- Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria.,Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria.,University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
| | - Raffaele Nardone
- Franz Tappeiner Hospital, Merano, Italy.,Spinal Cord Injury and Tissue Regeneration Center Salzburg, Salzburg, Austria.,Department of Neurology, Paracelsus Medical University Salzburg, Salzburg, Austria
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Berenguer-Rocha M, Baltar A, Rocha S, Shirahige L, Brito R, Monte-Silva K. Interhemispheric asymmetry of the motor cortex excitability in stroke: relationship with sensory-motor impairment and injury chronicity. Neurol Sci 2020; 41:2591-2598. [PMID: 32253636 DOI: 10.1007/s10072-020-04350-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 03/16/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the interhemispheric asymmetry of the motor cortex excitability of chronic stroke patients with healthy and to observe if the magnitude of this asymmetry is associated to sensory-motor impairment and stroke chronicity. METHODS This cross-sectional study was performed with chronic stroke and aged and sex-matched healthy individuals. The interhemispheric asymmetry index was calculated by the difference of rest motor threshold (rMT) of the brain hemispheres. The rMT was assessed by transcranial magnetic stimulation over the cortical representation of the first dorsal interosseous muscle. To investigate the relationship of the asymmetry with sensory-motor impairment and injury chronicity, the stroke patients were grouped according to the level of sensory-motor impairment (mild/moderate, moderate/severe, and severe) and different chronicity stages (> 3-12, 13-24, 25-60, and > 60 months since stroke). RESULTS Fifty-six chronic stroke and twenty-six healthy were included. We found higher interhemispheric asymmetry in stroke patients (mean, 27.1 ± 20.9) compared to healthy (mean, 4.9 ± 4.7). The asymmetry was higher in patients with moderate/severe (mean, 35.4 ± 20.4) and severe (mean, 32.9 ± 22.7) impairment. No difference was found between patients with mild/moderate impairment (mean, 15.5 ± 12.5) and healthy. There were no differences of the interhemispheric asymmetry between patients with different times since stroke (> 3-12, mean, 32 ± 18.1; > 13-24, mean, 20.7 ± 16.2; > 25-60, mean, 29.6 ± 18.1; > 60 months, mean, 25.9 ± 17.5). CONCLUSION Stroke patients showed higher interhemispheric asymmetry of the motor cortex excitability when compared to healthy, and the magnitude of this asymmetry seems to be correlated with the severity of sensory-motor impairment, but not with stroke chronicity. SIGNIFICANCE Higher interhemispheric asymmetry was found in stroke patients with greatest sensory-motor impairment.
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Affiliation(s)
- Marina Berenguer-Rocha
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Adriana Baltar
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Sérgio Rocha
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Rodrigo Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
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41
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Possible Contributions of Ipsilateral Pathways From the Contralesional Motor Cortex to the Voluntary Contraction of the Spastic Elbow Flexors in Stroke Survivors: A TMS Study. Am J Phys Med Rehabil 2020; 98:558-565. [PMID: 30672773 DOI: 10.1097/phm.0000000000001147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The contribution of the contralesional motor cortex to the impaired limbs is still controversial. The aim of this study was to investigate the role of descending projections from the contralesional hemisphere during voluntary elbow flexion on the paretic side. DESIGN Eleven healthy and 10 stroke subjects performed unilateral isometric elbow flexion tasks at various submaximal levels. Transcranial magnetic stimulation was delivered to the hotspot of biceps muscles ipsilateral to the target side (paretic side in stroke subjects or right side in controls) at rest and during elbow flexion tasks. Motor-evoked potential amplitudes of the contralateral resting biceps muscles, transcranial magnetic stimulation-induced ipsilateral force increment, and reflex torque and weakness of spastic elbow flexors were quantified. RESULTS The normalized motor-evoked potential amplitude increased with force level in both healthy and stroke subjects. However, stroke subjects exhibited significantly higher force increment compared with healthy subjects only at low level of elbow flexion but similar at moderate to high levels. The greater force increment significantly correlated with reflex torque of the spastic elbow flexors, but not weakness. CONCLUSIONS These results provide novel evidence that ipsilateral projections are not likely to contribute to strength but are correlated to spasticity of spastic-paretic elbow flexors after stroke.
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Lioi G, Butet S, Fleury M, Bannier E, Lécuyer A, Bonan I, Barillot C. A Multi-Target Motor Imagery Training Using Bimodal EEG-fMRI Neurofeedback: A Pilot Study in Chronic Stroke Patients. Front Hum Neurosci 2020; 14:37. [PMID: 32132910 PMCID: PMC7040168 DOI: 10.3389/fnhum.2020.00037] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/27/2020] [Indexed: 01/08/2023] Open
Abstract
Traditional rehabilitation techniques present limitations and the majority of patients show poor 1-year post-stroke recovery. Thus, Neurofeedback (NF) or Brain-Computer-Interface applications for stroke rehabilitation purposes are gaining increased attention. Indeed, NF has the potential to enhance volitional control of targeted cortical areas and thus impact on motor function recovery. However, current implementations are limited by temporal, spatial or practical constraints of the specific imaging modality used. In this pilot work and for the first time in literature, we applied bimodal EEG-fMRI NF for upper limb stroke recovery on four stroke-patients with different stroke characteristics and motor impairment severity. We also propose a novel, multi-target training approach that guides the training towards the activation of the ipsilesional primary motor cortex. In addition to fMRI and EEG outcomes, we assess the integrity of the corticospinal tract (CST) with tractography. Preliminary results suggest the feasibility of our approach and show its potential to induce an augmented activation of ipsilesional motor areas, depending on the severity of the stroke deficit. Only the two patients with a preserved CST and subcortical lesions succeeded in upregulating the ipsilesional primary motor cortex and exhibited a functional improvement of upper limb motricity. These findings highlight the importance of taking into account the variability of the stroke patients' population and enabled to identify inclusion criteria for the design of future clinical studies.
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Affiliation(s)
- Giulia Lioi
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
| | - Simon Butet
- Departement of Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) Rennes, Rennes, France
| | - Mathis Fleury
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
| | - Elise Bannier
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
- Departement of Radiology, CHU Rennes, Rennes, France
| | | | - Isabelle Bonan
- Univ Rennes, Inria, CNRS, Inserm, IRISA, Rennes, France
- Departement of Physical and Rehabilitation Medicine, Centre Hospitalier Universitaire (CHU) Rennes, Rennes, France
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Rech F, Herbet G, Gaudeau Y, Mézières S, Moureau JM, Moritz-Gasser S, Duffau H. A probabilistic map of negative motor areas of the upper limb and face: a brain stimulation study. Brain 2019; 142:952-965. [PMID: 30753319 DOI: 10.1093/brain/awz021] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 12/02/2018] [Accepted: 12/14/2018] [Indexed: 11/13/2022] Open
Abstract
Negative motor responses (NMRs) are defined as movement arrests induced by direct electrical stimulation of the brain. The NMRs manifest themselves after the disruption of a corticosubcortical network involved in motor control, referred to as the 'negative motor network'. At present, the spatial topography of the negative motor areas (NMAs) is poorly known. Hence, the objectives of the present study were to establish the first probabilistic map of the NMAs of the upper limbs and face, identify potential subareas, and investigate the NMAs' relationships with the primary motor cortex. A total of 117 patients with low grade glioma underwent awake surgery with direct electrostimulation. The Montreal Neurological Institute coordinates of sites eliciting NMRs (face and upper limbs) were registered. A probabilistic map was created, and subareas were identified in a cluster analysis. Each cluster was then plotted on the Glasser atlas and the 1200 Subjects Group Average Data from the Human Connectome Project, in order to study connectivity and compare the results with recent parcellation data. We elicited 386 NMRs (mean ± standard deviation current intensity: 2.26 ± 0.5 mA) distributed throughout the precentral gyrus in both hemispheres. In each hemisphere, we found two clusters for facial NMRs. For upper limb NMRs, we found two clusters in the right hemisphere; and three in the left. Each cluster overlapped with parcellations from the Glasser atlas. For the face, the NMAs were associated with areas 55b and 6v. For the upper limbs, the NMAs were linked to areas 6v, 6d, and 55b. Each NMA cluster showed a specific pattern of functionally connected areas, such as the inferior frontal gyrus, supplementary motor area, parietal areas, and posterior superior temporal gyrus. The white matter pathways projecting to these subareas involved the frontal aslant tract and the frontostriatal tract-both of which are well known to be associated with NMRs. This study constitutes the largest series to date of NMRs mapped to the lateral surface of both hemispheres. Rather than being randomly distributed, the NMAs appeared to be well structured and corresponded to parcellations identified by functional neuroimaging. Moreover, the white matter pathways known to drive NMRs are also connected to regions encompassing NMAs. Taken as a whole, our results suggest that NMAs belong to a large-scale modulatory motor network. Our new probabilistic map might constitute a valuable tool for use in further clinical and fundamental studies of motor control.
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Affiliation(s)
- Fabien Rech
- Department of Neurosurgery, Central Hospital, CHRU Nancy, 29 avenue du Maréchal de Lattre de Tassigny, F-54000 Nancy, France.,'Plasticity of Central Nervous System, Stem Cells and Glial Tumours' group, INSERM U1051, Institute for Neurosciences of Montpellier, F-34295 Montpellier, France
| | - Guillaume Herbet
- 'Plasticity of Central Nervous System, Stem Cells and Glial Tumours' group, INSERM U1051, Institute for Neurosciences of Montpellier, F-34295 Montpellier, France.,Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 avenue Augustin Fliche, F-34295 Montpellier, France
| | - Yann Gaudeau
- Centre de Recherche en Automatique de Nancy, UMR 7039, Faculté de médecine, Université de Lorraine, F-54000 Nancy, France.,Université de Strasbourg, 30 rue Maire Andre Traband, F-67500 Haguenau, France
| | - Sophie Mézières
- Université de Lorraine, I.E.C.L., INRIA-BIGS, CNRS UMR 7502, F-54506 Vandoeuvre-les-Nancy, France
| | - Jean-Marie Moureau
- Centre de Recherche en Automatique de Nancy, UMR 7039, Faculté de médecine, Université de Lorraine, F-54000 Nancy, France.,Centre de Recherche en Automatique de Nancy, UMR 7039, CNRS, Université de Lorraine, F-54000 Nancy, France
| | - Sylvie Moritz-Gasser
- 'Plasticity of Central Nervous System, Stem Cells and Glial Tumours' group, INSERM U1051, Institute for Neurosciences of Montpellier, F-34295 Montpellier, France.,Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 avenue Augustin Fliche, F-34295 Montpellier, France
| | - Hugues Duffau
- 'Plasticity of Central Nervous System, Stem Cells and Glial Tumours' group, INSERM U1051, Institute for Neurosciences of Montpellier, F-34295 Montpellier, France.,Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, 80 avenue Augustin Fliche, F-34295 Montpellier, France
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Zangrandi A, Mioli A, D'Alonzo M, Formica D, Pellegrino G, Di Pino G. Conditioning transcranial magnetic stimulation of ventral premotor cortex shortens simple reaction time. Cortex 2019; 121:322-331. [PMID: 31670027 DOI: 10.1016/j.cortex.2019.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/23/2019] [Accepted: 09/04/2019] [Indexed: 12/13/2022]
Abstract
The ventral premotor cortex (PMv) is a key area of the sensorimotor control loop, it subtends complex motor sequences, especially when the hand is involved. However, its specific contribution to simple motor response to sensory cue is still not completely clear. To investigate the role of PMv, we used transcranial magnetic stimulation (TMS) to interfere with its function during a simple reaction time (SRT) task. We ran two experiments where participants were required to respond as fast as possible to a median nerve stimulation (go-signal), while sub-M1-threshold single pulse TMS was delivered either on left (contralateral) PMv or right (ipsilateral to sensory stimulus and motor response) PMv, 5-65 ms after the go-signal. TMS delivered on either PMv up to 25 ms after the go-signal shortened reaction time. This is the time window compatible with the arrive of sensory afferences, as if conditioning before sensory afferences arrive lower the threshold needed to release the pre-planned motor program to the primary motor cortex. This is in line with a putative PMv function of buffer of pre-planned motor program not strictly lateralized in one hemisphere.
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Affiliation(s)
- Andrea Zangrandi
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy
| | - Alessandro Mioli
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy
| | - Marco D'Alonzo
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy
| | - Domenico Formica
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy
| | - Giovanni Pellegrino
- San Camillo Hospital IRCCS, Venice, Italy; Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Giovanni Di Pino
- Research Unit of Neurophysiology and Neuroengineering of Human-Technology Interaction, Università Campus Bio-Medico, Rome, Italy.
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Constraint induced movement therapy promotes contralesional-oriented structural and bihemispheric functional neuroplasticity after stroke. Brain Res Bull 2019; 150:201-206. [PMID: 31181321 DOI: 10.1016/j.brainresbull.2019.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 05/10/2019] [Accepted: 06/05/2019] [Indexed: 12/19/2022]
Abstract
The mechanism behind constraint-induced movement therapy (CIMT) in promoting motor recovery after stroke remains unclear. We explored the bilateral structural and functional reorganization of the brain induced by CIMT after left middle cerebral artery occlusion (MCAO) in rats. CIMT started on the 8th day (D8) after MCAO surgery and lasted for 3 weeks. Skilled walking was assessed by Foot-Fault tests. The efferent neuron network innervating the paralyzed forelimb was labeled by pseudorabies virus (PRV) to explore neuron recruitment. Synapsin Ⅰ was used as an indicator of the number of synapses. Additionally, C-fos expression 1 h after walking was detected to explore the activation of the brain. As a result, CIMT significantly improved skilled walking and elicited more neuron recruitment into the innervating network of a paralyzed forelimb in the contralesional rather than the ipsilesional motor cortex and red nucleus. CIMT also increased the synapse number in the contralesional cortex but there was no corresponding effect in the intact ipsilesional cortex. Furthermore, MCAO decreased ipsilesional motor cortex activation, but CIMT partially compensated for this by increasing the number of activated neurons (c-fos+) in both the left and right motor cortex. In conclusion, the contralesional motor cortex and red nucleus might play more important roles than corresponding ipsilesional regions in structural reorganization during CIMT-induced motor recovery after stroke. However, CIMT promotes bilateral motor cortex activity without a side preference.
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Schambra HM, Xu J, Branscheidt M, Lindquist M, Uddin J, Steiner L, Hertler B, Kim N, Berard J, Harran MD, Cortes JC, Kitago T, Luft A, Krakauer JW, Celnik PA. Differential Poststroke Motor Recovery in an Arm Versus Hand Muscle in the Absence of Motor Evoked Potentials. Neurorehabil Neural Repair 2019; 33:568-580. [PMID: 31170880 DOI: 10.1177/1545968319850138] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background. After stroke, recovery of movement in proximal and distal upper extremity (UE) muscles appears to follow different time courses, suggesting differences in their neural substrates. Objective. We sought to determine if presence or absence of motor evoked potentials (MEPs) differentially influences recovery of volitional contraction and strength in an arm muscle versus an intrinsic hand muscle. We also related MEP status to recovery of proximal and distal interjoint coordination and movement fractionation, as measured by the Fugl-Meyer Assessment (FMA). Methods. In 45 subjects in the year following ischemic stroke, we tracked the relationship between corticospinal tract (CST) integrity and behavioral recovery in the biceps (BIC) and first dorsal interosseous (FDI) muscle. We used transcranial magnetic stimulation to probe CST integrity, indicated by MEPs, in BIC and FDI. We used electromyography, dynamometry, and UE FMA subscores to assess muscle-specific contraction, strength, and inter-joint coordination, respectively. Results. Presence of MEPs resulted in higher likelihood of muscle contraction, greater strength, and higher FMA scores. Without MEPs, BICs could more often volitionally contract, were less weak, and had steeper strength recovery curves than FDIs; in contrast, FMA recovery curves plateaued below normal levels for both the arm and hand. Conclusions. There are shared and separate substrates for paretic UE recovery. CST integrity is necessary for interjoint coordination in both segments and for overall recovery. In its absence, alternative pathways may assist recovery of volitional contraction and strength, particularly in BIC. These findings suggest that more targeted approaches might be needed to optimize UE recovery.
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Affiliation(s)
- Heidi M Schambra
- 1 New York University School of Medicine, New York, NY, USA.,2 Columbia University, New York, NY, USA
| | - Jing Xu
- 3 Johns Hopkins University, Baltimore, MD, USA
| | - Meret Branscheidt
- 3 Johns Hopkins University, Baltimore, MD, USA.,4 University Hospital of Zurich, Zurich, Switzerland
| | | | | | - Levke Steiner
- 4 University Hospital of Zurich, Zurich, Switzerland
| | | | - Nathan Kim
- 3 Johns Hopkins University, Baltimore, MD, USA
| | | | - Michelle D Harran
- 2 Columbia University, New York, NY, USA.,3 Johns Hopkins University, Baltimore, MD, USA
| | - Juan C Cortes
- 2 Columbia University, New York, NY, USA.,3 Johns Hopkins University, Baltimore, MD, USA
| | | | - Andreas Luft
- 4 University Hospital of Zurich, Zurich, Switzerland.,5 cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
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47
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Li S, Chen YT, Francisco GE, Zhou P, Rymer WZ. A Unifying Pathophysiological Account for Post-stroke Spasticity and Disordered Motor Control. Front Neurol 2019; 10:468. [PMID: 31133971 PMCID: PMC6524557 DOI: 10.3389/fneur.2019.00468] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/17/2019] [Indexed: 11/18/2022] Open
Abstract
Cortical and subcortical plastic reorganization occurs in the course of motor recovery after stroke. It is largely accepted that plasticity of ipsilesional motor cortex primarily contributes to recovery of motor function, while the contributions of contralesional motor cortex are not completely understood. As a result of damages to motor cortex and its descending pathways and subsequent unmasking of inhibition, there is evidence of upregulation of reticulospinal tract (RST) excitability in the contralesional side. Both animal studies and human studies with stroke survivors suggest and support the role of RST hyperexcitability in post-stroke spasticity. Findings from animal studies demonstrate the compensatory role of RST hyperexcitability in recovery of motor function. In contrast, RST hyperexcitability appears to be related more to abnormal motor synergy and disordered motor control in stroke survivors. It does not contribute to recovery of normal motor function. Recent animal studies highlight laterality dominance of corticoreticular projections. In particular, there exists upregulation of ipsilateral corticoreticular projections from contralesional premotor cortex (PM) and supplementary motor area (SMA) to medial reticular nuclei. We revisit and revise the previous theoretical framework and propose a unifying account. This account highlights the importance of ipsilateral PM/SMA-cortico-reticulospinal tract hyperexcitability from the contralesional motor cortex as a result of disinhibition after stroke. This account provides a pathophysiological basis for post-stroke spasticity and related movement impairments, such as abnormal motor synergy and disordered motor control. However, further research is needed to examine this pathway in stroke survivors to better understand its potential roles, especially in muscle strength and motor recovery. This account could provide a pathophysiological target for developing neuromodulatory interventions to manage spasticity and thus possibly to facilitate motor recovery.
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Affiliation(s)
- Sheng Li
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center – Houston and TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Yen-Ting Chen
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center – Houston and TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Gerard E. Francisco
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center – Houston and TIRR Memorial Hermann Hospital, Houston, TX, United States
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, University of Texas Health Science Center – Houston and TIRR Memorial Hermann Hospital, Houston, TX, United States
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48
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The unsolved role of heightened connectivity from the unaffected hemisphere to paretic arm muscles in chronic stroke. Clin Neurophysiol 2019; 130:781-788. [PMID: 30925310 DOI: 10.1016/j.clinph.2019.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 02/06/2019] [Accepted: 02/27/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Ipsilateral connectivity from the non-stroke hemisphere to paretic arm muscles appears to play little role in functional recovery, which instead depends on contralateral connectivity from the stroke hemisphere. Yet the incidence of ipsilateral projections in stroke survivors is often reported to be higher than normal. We tested this directly using a sensitive measure of connectivity to proximal arm muscles. METHOD TMS of the stroke and non-stroke motor cortex evoked responses in pre-activated triceps and deltoid muscles of 17 stroke survivors attending reaching training. Connectivity was defined as a clear MEP or a short-latency silent period in ongoing EMG in ≥ 50% of stimulations. We measured reaching accuracy at baseline, improvement after training and upper limb Fugl-Meyer (F-M) score. RESULTS Incidence of ipsilateral connections to triceps (47%) and deltoid (58%) was high, but unrelated to baseline reaching accuracy and F-M scores. Instead, these were related to contralateral connectivity from the stroke hemisphere. Absolute but not proportional improvement after training was greater in patients with ipsilateral responses. CONCLUSIONS Despite enhanced ipsilateral connectivity, arm function and learning was related most strongly to contralateral pathway integrity from the stroke hemisphere. SIGNIFICANCE Further work is needed to decipher the role of ipsilateral connections.
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49
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Chen YT, Li S, Zhou P, Li S. A startling acoustic stimulation (SAS)-TMS approach to assess the reticulospinal system in healthy and stroke subjects. J Neurol Sci 2019; 399:82-88. [PMID: 30782527 DOI: 10.1016/j.jns.2019.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/08/2019] [Accepted: 02/10/2019] [Indexed: 12/21/2022]
Abstract
Reticulospinal (RS) hyperexcitability is observed in stroke survivors with spastic hemiparesis. Habituated startle acoustic stimuli (SAS) can be used to stimulate the RS pathways non-reflexively. However, the role of RS pathways in motor function and its interactions with the corticospinal system after stroke still remain unclear. Therefore, the purpose of this study was to investigate the effects of conditioning SAS on the corticospinal system in healthy subjects and in stroke subjects with spastic hemiparesis. An established conditioning SAS- transcranial magnetic stimulation (TMS) paradigm was used to test the interactions between the RS pathways and the corticospinal system. TMS was delivered to the right hemisphere of eleven healthy subjects and the contralesional hemisphere of eleven stroke subjects during isometric elbow flexor contraction on the non-impaired (or left) side. Conditioning SAS had similar effects on the corticospinal motor system in both healthy and stroke subjects, including similar SAS-induced motor evoked potential (MEP) reduction at rest, but not during voluntary contraction tasks; similar magnitudes of TMS-induced MEP and force increment and shortening of the silent period during voluntary elbow flexor contraction. This study provides evidence that RS excitability on the contralesional side in stroke subjects with spastic hemiparesis is not abnormal, and suggests that RS projections are likely to be primarily unilateral in humans.
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Affiliation(s)
- Yen-Ting Chen
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, United States; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, United States
| | - Shengai Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, United States; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, United States.
| | - Ping Zhou
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, United States; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, United States
| | - Sheng Li
- Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center, Houston, United States; TIRR Memorial Hermann Research Center, TIRR Memorial Hermann Hospital, United States
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50
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McPherson LM, Dewald JPA. Differences between flexion and extension synergy-driven coupling at the elbow, wrist, and fingers of individuals with chronic hemiparetic stroke. Clin Neurophysiol 2019; 130:454-468. [PMID: 30771722 DOI: 10.1016/j.clinph.2019.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The flexion and extension synergies were quantified at the paretic elbow, forearm, wrist, and finger joints within the same group of participants for the first time. Differences in synergy expression at each of the four joints were examined, as were the ways these differences varied across the joints. METHODS Twelve post-stroke individuals with chronic moderate-to-severe hemiparesis and six age-matched controls participated. Participants generated isometric shoulder abduction (SABD) and shoulder adduction (SADD) at four submaximal levels to progressively elicit the flexion and extension synergies, respectively. Isometric joint torques and EMG were recorded from shoulder, elbow, forearm (radio-ulnar), wrist, and finger joints and muscles. RESULTS SABD elicited strong wrist and finger flexion torque that increased with shoulder torque level. SADD produced primarily wrist and finger flexion torque, but magnitudes at the wrist were less than during SABD. Findings contrasted with those at the elbow and forearm, where torques and EMG generated due to SABD and SADD were opposite in direction. CONCLUSIONS Flexion and extension synergy expression are more similar at the hand than at the shoulder and elbow. Specific bulbospinal pathways that may underlie flexion and extension synergy expression are discussed. SIGNIFICANCE Whole-limb behavior must be considered when examining paretic hand function in moderately-to-severely impaired individuals.
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Affiliation(s)
- Laura Miller McPherson
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA; Department of Physical Therapy, Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL, USA; Department of Biomedical Engineering, College of Engineering and Computing, Florida International University, Miami, FL, USA
| | - Julius P A Dewald
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL, USA; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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