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Li Z, Guo H, Yuan Y, Liu X. The effect of moderate and vigorous aerobic exercise training on the cognitive and walking ability among stroke patients during different periods: A systematic review and meta-analysis. PLoS One 2024; 19:e0298339. [PMID: 38394189 PMCID: PMC10889575 DOI: 10.1371/journal.pone.0298339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVE The study examined whether rehabilitation using aerobic exercise is more appropriate for patients less than 3 months post-stroke or more appropriate for patients more than 3 months post-stroke. METHOD PubMed, Embase, Web of Science, Scopus and CNKI databases were searched from inception to September 2023. All studies included must be written in English and grey literature was excluded. The quality of the study was evaluated using the PEDro scale. Standard mean difference (SMD) and 95% confidence interval (CI) were calculated. The primary outcomes are cognitive ability and walking ability. The intervention of the experimental group must be or include high-intensity aerobic training or moderate-intensity aerobic training. In addition, we required low intensity routine exercises in control group. RESULT Only 15 studies were included in this meta-analysis. The results showed that aerobic exercise has a positive rehabilitation effect on cognitive and walking ability of stroke patients. Global Cognitive Function (SMD = 0.81 95%CI 0.49-1.12), Walking Capacity (SMD = 1.19, 95%CI 0.75-1.62), VO2peak (SMD = 0.97, 95%CI 0.66-1.28), and brain-derived neurotrophic factor (SMD = 2.73, 95%CI 2.03-3.43). We further observed that patients who suffered a stroke within the past three months exhibited superior rehabilitation outcomes compared to patients who suffered a stroke more than three months ago, specifically in terms of cognitive ability, walking tests, and cardiopulmonary function. CONCLUSIONS It is recommended to carry out treatment for patients in the initial stage of stroke, and it is required to pay attention to exercise intensity in the process of treatment to ensure patient safety.
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Affiliation(s)
- Zecheng Li
- College of Sports Science, Harbin Normal University, Harbin, China
| | - Hongpeng Guo
- College of Sports Science, Harbin Normal University, Harbin, China
| | - Yuan Yuan
- College of Medical Information Engineering, Shandong First Medical University, Tai'an, China
| | - Xuebin Liu
- College of Sports Science, Harbin Normal University, Harbin, China
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2
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Guan X, Zheng W, Fan K, Han X, Hu B, Li X, Yan Z, Lu Z, Gong J. Structural and functional changes following brain surgery in pediatric patients with intracranial space-occupying lesions. Brain Imaging Behav 2024:10.1007/s11682-023-00799-x. [PMID: 38376714 DOI: 10.1007/s11682-023-00799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 02/21/2024]
Abstract
We explored the structural and functional changes of the healthy hemisphere of the brain after surgery in children with intracranial space-occupying lesions. We enrolled 32 patients with unilateral intracranial space-occupying lesions for brain imaging and cognitive assessment. Voxel-based morphometry and surface-based morphometry analyses were used to investigate the structural images of the healthy hemisphere. Functional images were analyzed using regional homogeneity, amplitude of low-frequency fluctuations, and fractional-amplitude of low-frequency fluctuations. Voxel-based morphometry and surface-based morphometry analysis used the statistical model built into the CAT 12 toolbox. Paired t-tests were used for functional image and cognitive test scores. For structural image analysis, we used family-wise error correction of peak level (p < 0.05), and for functional image analysis, we use Gaussian random-field theory correction (voxel p < 0.001, cluster p < 0.05). We found an increase in gray matter volume in the healthy hemisphere within six months postoperatively, mainly in the frontal lobe. Regional homogeneity and fractional-amplitude of low-frequency fluctuations also showed greater functional activity in the frontal lobe. The results of cognitive tests showed that psychomotor speed and motor speed decreased significantly after surgery, and reasoning increased significantly after surgery. We concluded that in children with intracranial space-occupying lesions, the healthy hemisphere exhibits compensatory structural and functional effects within six months after surgery. This effect occurs mainly in the frontal lobe and is responsible for some higher cognitive compensation. This may provide some guidance for the rehabilitation of children after brain surgery.
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Affiliation(s)
- Xueyi Guan
- Department of Pediatric Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Wenjian Zheng
- Department of Pediatric Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Kaiyu Fan
- Department of Pediatric Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xu Han
- Department of Pediatric Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Bohan Hu
- Department of Pediatric Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiang Li
- Department of Pediatric Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zihan Yan
- Department of Pediatric Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zheng Lu
- Department of Pediatric Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Jian Gong
- Department of Pediatric Neurosurgery Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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3
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Lassi M, Dalise S, Bandini A, Spina V, Azzollini V, Vissani M, Micera S, Mazzoni A, Chisari C. Neurophysiological underpinnings of an intensive protocol for upper limb motor recovery in subacute and chronic stroke patients. Eur J Phys Rehabil Med 2024; 60:13-26. [PMID: 37987741 DOI: 10.23736/s1973-9087.23.07922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND Upper limb (UL) motor impairment following stroke is a leading cause of functional limitations in activities of daily living. Robot-assisted therapy supports rehabilitation, but how its efficacy and the underlying neural mechanisms depend on the time after stroke is yet to be assessed. AIM We investigated the response to an intensive protocol of robot-assisted rehabilitation in sub-acute and chronic stroke patients, by analyzing the underlying changes in clinical scores, electroencephalography (EEG) and end-effector kinematics. We aimed at identifying neural correlates of the participants' upper limb motor function recovery, following an intensive 2-week rehabilitation protocol. DESIGN Prospective cohort study. SETTING Inpatients and outpatients from the Neurorehabilitation Unit of Pisa University Hospital, Italy. POPULATION Sub-acute and chronic stroke survivors. METHODS Thirty-one stroke survivors (14 sub-acute, 17 chronic) with mild-to-moderate UL paresis were enrolled. All participants underwent ten rehabilitative sessions of task-oriented exercises with a planar end-effector robotic device. All patients were evaluated with the Fugl-Meyer Assessment Scale and the Wolf Motor Function Test, at recruitment (T0), end-of-treatment (T1), and one-month follow-up (T2). Along with clinical scales, kinematic parameters and quantitative EEG were collected for each patient. Kinematics metrics were related to velocity, acceleration and smoothness of the movement. Relative power in four frequency bands was extracted from the EEG signals. The evolution over time of kinematic and EEG features was analyzed, in correlation with motor recovery. RESULTS Both groups displayed significant gains in motility after treatment. Sub-acute patients displayed more pronounced clinical improvements, significant changes in kinematic parameters, and a larger increase in Beta-band in the motor area of the affected hemisphere. In both groups these improvements were associated to a decrease in the Delta-band of both hemispheres. Improvements were retained at T2. CONCLUSIONS The intensive two-week rehabilitation protocol was effective in both chronic and sub-acute patients, and improvements in the two groups shared similar dynamics. However, stronger cortical and behavioral changes were observed in sub-acute patients suggesting different reorganizational patterns. CLINICAL REHABILITATION IMPACT This study paves the way to personalized approaches to UL motor rehabilitation after stroke, as highlighted by different neurophysiological modifications following recovery in subacute and chronic stroke patients.
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Affiliation(s)
- Michael Lassi
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Stefania Dalise
- Neurorehabilitation Unit, Pisa University Hospital, Pisa, Italy
| | - Andrea Bandini
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Health Science Interdisciplinary Research Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vincenzo Spina
- Neurorehabilitation Unit, Pisa University Hospital, Pisa, Italy
| | | | - Matteo Vissani
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Silvestro Micera
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
- Bertarelli Foundation Chair in Translational Neural Engineering, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fèdèrale de Lausanne, Lausanne, Switzerland
| | - Alberto Mazzoni
- The Biorobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Carmelo Chisari
- Neurorehabilitation Unit, Pisa University Hospital, Pisa, Italy -
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Papageorgiou G, Kasselimis D, Laskaris N, Potagas C. Unraveling the Thread of Aphasia Rehabilitation: A Translational Cognitive Perspective. Biomedicines 2023; 11:2856. [PMID: 37893229 PMCID: PMC10604624 DOI: 10.3390/biomedicines11102856] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Translational neuroscience is a multidisciplinary field that aims to bridge the gap between basic science and clinical practice. Regarding aphasia rehabilitation, there are still several unresolved issues related to the neural mechanisms that optimize language treatment. Although there are studies providing indications toward a translational approach to the remediation of acquired language disorders, the incorporation of fundamental neuroplasticity principles into this field is still in progress. From that aspect, in this narrative review, we discuss some key neuroplasticity principles, which have been elucidated through animal studies and which could eventually be applied in the context of aphasia treatment. This translational approach could be further strengthened by the implementation of intervention strategies that incorporate the idea that language is supported by domain-general mechanisms, which highlights the impact of non-linguistic factors in post-stroke language recovery. Here, we highlight that translational research in aphasia has the potential to advance our knowledge of brain-language relationships. We further argue that advances in this field could lead to improvement in the remediation of acquired language disturbances by remodeling the rationale of aphasia-therapy approaches. Arguably, the complex anatomy and phenomenology of aphasia dictate the need for a multidisciplinary approach with one of its main pillars being translational research.
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Affiliation(s)
- Georgios Papageorgiou
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Dimitrios Kasselimis
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Psychology, Panteion University of Social and Political Sciences, 17671 Athens, Greece
| | - Nikolaos Laskaris
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
- Department of Industrial Design and Production Engineering, School of Engineering, University of West Attica, 12241 Athens, Greece
| | - Constantin Potagas
- Neuropsychology and Language Disorders Unit, 1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece
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Krishnagopal S, Lohse K, Braun R. Stroke recovery phenotyping through network trajectory approaches and graph neural networks. Brain Inform 2022; 9:13. [PMID: 35717640 PMCID: PMC9206968 DOI: 10.1186/s40708-022-00160-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/23/2022] [Indexed: 11/23/2022] Open
Abstract
Stroke is a leading cause of neurological injury characterized by impairments in multiple neurological domains including cognition, language, sensory and motor functions. Clinical recovery in these domains is tracked using a wide range of measures that may be continuous, ordinal, interval or categorical in nature, which can present challenges for multivariate regression approaches. This has hindered stroke researchers’ ability to achieve an integrated picture of the complex time-evolving interactions among symptoms. Here, we use tools from network science and machine learning that are particularly well-suited to extracting underlying patterns in such data, and may assist in prediction of recovery patterns. To demonstrate the utility of this approach, we analyzed data from the NINDS tPA trial using the Trajectory Profile Clustering (TPC) method to identify distinct stroke recovery patterns for 11 different neurological domains at 5 discrete time points. Our analysis identified 3 distinct stroke trajectory profiles that align with clinically relevant stroke syndromes, characterized both by distinct clusters of symptoms, as well as differing degrees of symptom severity. We then validated our approach using graph neural networks to determine how well our model performed predictively for stratifying patients into these trajectory profiles at early vs. later time points post-stroke. We demonstrate that trajectory profile clustering is an effective method for identifying clinically relevant recovery subtypes in multidimensional longitudinal datasets, and for early prediction of symptom progression subtypes in individual patients. This paper is the first work introducing network trajectory approaches for stroke recovery phenotyping, and is aimed at enhancing the translation of such novel computational approaches for practical clinical application.
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Affiliation(s)
- Sanjukta Krishnagopal
- Gatsby Computational Neuroscience Unit, University College London, London, W1T 4JG, UK.
| | - Keith Lohse
- Physical Therapy and Neurology, Washington University School of Medicine, 4444 Forest Park Ave., Suite 1101, St. Louis, MO, 63108-2212, USA
| | - Robynne Braun
- Department of Neurology, University of Maryland School of Medicine, 655 W. Baltimore Street, Bressler Research Building, 12th Floor, Baltimore, MD, 21201, USA, on behalf of the GPAS Collaboration, Phenotyping Core
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6
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Savitz SI. Is There a Time-Sensitive Window in Patients With Stroke to Enhance Arm Recovery With Higher Intensity Motor Therapy? Stroke 2022; 53:1823-1825. [PMID: 35467996 DOI: 10.1161/strokeaha.121.037402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sean I Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center, Houston
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7
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Critical Period After Stroke Study (CPASS): A phase II clinical trial testing an optimal time for motor recovery after stroke in humans. Proc Natl Acad Sci U S A 2021; 118:2026676118. [PMID: 34544853 PMCID: PMC8488696 DOI: 10.1073/pnas.2026676118] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 02/06/2023] Open
Abstract
Restoration of postinjury brain function is a signal neuroscience challenge. Animal models of stroke recovery demonstrate time-limited windows of heightened motor recovery, similar to developmental neuroplasticity. However, no equivalent windows have been demonstrated in humans. We report a randomized controlled trial applying essential elements of animal motor training paradigms to humans, to determine the existence of an analogous sensitive period in adults. We found a similar sensitive or optimal period 60 to 90 d after stroke, with lesser effects ≤30 d and no effect 6 mo or later after stroke. These findings prospectively demonstrated the existence of a sensitive period in adult humans. We urge the provision of more intensive motor rehabilitation within 60 to 90 d after stroke onset. Restoration of human brain function after injury is a signal challenge for translational neuroscience. Rodent stroke recovery studies identify an optimal or sensitive period for intensive motor training after stroke: near-full recovery is attained if task-specific motor training occurs during this sensitive window. We extended these findings to adult humans with stroke in a randomized controlled trial applying the essential elements of rodent motor training paradigms to humans. Stroke patients were adaptively randomized to begin 20 extra hours of self-selected, task-specific motor therapy at ≤30 d (acute), 2 to 3 mo (subacute), or ≥6 mo (chronic) after stroke, compared with controls receiving standard motor rehabilitation. Upper extremity (UE) impairment assessed by the Action Research Arm Test (ARAT) was measured at up to five time points. The primary outcome measure was ARAT recovery over 1 y after stroke. By 1 y we found significantly increased UE motor function in the subacute group compared with controls (ARAT difference = +6.87 ± 2.63, P = 0.009). The acute group compared with controls showed smaller but significant improvement (ARAT difference = +5.25 ± 2.59 points, P = 0.043). The chronic group showed no significant improvement compared with controls (ARAT = +2.41 ± 2.25, P = 0.29). Thus task-specific motor intervention was most effective within the first 2 to 3 mo after stroke. The similarity to rodent model treatment outcomes suggests that other rodent findings may be translatable to human brain recovery. These results provide empirical evidence of a sensitive period for motor recovery in humans.
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Abstract
Stroke is a debilitating disease. Current effective therapies for stroke recovery are limited to neurorehabilitation. Most stroke recovery occurs in a limited and early time window. Many of the mechanisms of spontaneous recovery after stroke parallel mechanisms of normal learning and memory. While various efforts are in place to identify potential drug targets, an emerging approach is to understand biological correlates between learning and stroke recovery. This review assesses parallels between biological changes at the molecular, structural, and functional levels during learning and recovery after stroke, with a focus on drug and cellular targets for therapeutics.
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Affiliation(s)
- Mary Teena Joy
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - S. Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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9
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Joy MT, Carmichael ST. Encouraging an excitable brain state: mechanisms of brain repair in stroke. Nat Rev Neurosci 2021; 22:38-53. [PMID: 33184469 PMCID: PMC10625167 DOI: 10.1038/s41583-020-00396-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 02/02/2023]
Abstract
Stroke induces a plastic state in the brain. This period of enhanced plasticity leads to the sprouting of new axons, the formation of new synapses and the remapping of sensory-motor functions, and is associated with motor recovery. This is a remarkable process in the adult brain, which is normally constrained in its levels of neuronal plasticity and connectional change. Recent evidence indicates that these changes are driven by molecular systems that underlie learning and memory, such as changes in cellular excitability during memory formation. This Review examines circuit changes after stroke, the shared mechanisms between memory formation and brain repair, the changes in neuronal excitability that underlie stroke recovery, and the molecular and pharmacological interventions that follow from these findings to promote motor recovery in animal models. From these findings, a framework emerges for understanding recovery after stroke, central to which is the concept of neuronal allocation to damaged circuits. The translation of the concepts discussed here to recovery in humans is underway in clinical trials for stroke recovery drugs.
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Affiliation(s)
- Mary T Joy
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - S Thomas Carmichael
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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10
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Guedan-Duran A, Jemni-Damer N, Orueta-Zenarruzabeitia I, Guinea GV, Perez-Rigueiro J, Gonzalez-Nieto D, Panetsos F. Biomimetic Approaches for Separated Regeneration of Sensory and Motor Fibers in Amputee People: Necessary Conditions for Functional Integration of Sensory-Motor Prostheses With the Peripheral Nerves. Front Bioeng Biotechnol 2020; 8:584823. [PMID: 33224936 PMCID: PMC7670549 DOI: 10.3389/fbioe.2020.584823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 09/25/2020] [Indexed: 12/22/2022] Open
Abstract
The regenerative capacity of the peripheral nervous system after an injury is limited, and a complete function is not recovered, mainly due to the loss of nerve tissue after the injury that causes a separation between the nerve ends and to the disorganized and intermingled growth of sensory and motor nerve fibers that cause erroneous reinnervations. Even though the development of biomaterials is a very promising field, today no significant results have been achieved. In this work, we study not only the characteristics that should have the support that will allow the growth of nerve fibers, but also the molecular profile necessary for a specific guidance. To do this, we carried out an exhaustive study of the molecular profile present during the regeneration of the sensory and motor fibers separately, as well as of the effect obtained by the administration and inhibition of different factors involved in the regeneration. In addition, we offer a complete design of the ideal characteristics of a biomaterial, which allows the growth of the sensory and motor neurons in a differentiated way, indicating (1) size and characteristics of the material; (2) necessity to act at the microlevel, on small groups of neurons; (3) combination of molecules and specific substrates; and (4) temporal profile of those molecules expression throughout the regeneration process. The importance of the design we offer is that it respects the complexity and characteristics of the regeneration process; it indicates the appropriate temporal conditions of molecular expression, in order to obtain a synergistic effect; it takes into account the importance of considering the process at the group of neuron level; and it gives an answer to the main limitations in the current studies.
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Affiliation(s)
- Atocha Guedan-Duran
- Neuro-computing and Neuro-robotics Research Group, Complutense University of Madrid, Madrid, Spain
- Innovation Group, Institute for Health Research San Carlos Clinical Hospital (IdISSC), Madrid, Spain
- Department of Biomedical Engineering, Tufts University, Medford, MA, United States
| | - Nahla Jemni-Damer
- Neuro-computing and Neuro-robotics Research Group, Complutense University of Madrid, Madrid, Spain
- Innovation Group, Institute for Health Research San Carlos Clinical Hospital (IdISSC), Madrid, Spain
| | - Irune Orueta-Zenarruzabeitia
- Neuro-computing and Neuro-robotics Research Group, Complutense University of Madrid, Madrid, Spain
- Innovation Group, Institute for Health Research San Carlos Clinical Hospital (IdISSC), Madrid, Spain
| | - Gustavo Víctor Guinea
- Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
- Department of Material Science, Civil Engineering Superior School, Universidad Politécnica de Madrid, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Silk Biomed SL, Madrid, Spain
| | - José Perez-Rigueiro
- Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
- Department of Material Science, Civil Engineering Superior School, Universidad Politécnica de Madrid, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Silk Biomed SL, Madrid, Spain
| | - Daniel Gonzalez-Nieto
- Center for Biomedical Technology, Universidad Politécnica de Madrid, Madrid, Spain
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
- Silk Biomed SL, Madrid, Spain
| | - Fivos Panetsos
- Neuro-computing and Neuro-robotics Research Group, Complutense University of Madrid, Madrid, Spain
- Innovation Group, Institute for Health Research San Carlos Clinical Hospital (IdISSC), Madrid, Spain
- Silk Biomed SL, Madrid, Spain
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11
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Liang WD, Xu Y, Schmidt J, Zhang LX, Ruddy KL. Upregulating excitability of corticospinal pathways in stroke patients using TMS neurofeedback; A pilot study. Neuroimage Clin 2020; 28:102465. [PMID: 33395961 PMCID: PMC7585154 DOI: 10.1016/j.nicl.2020.102465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/14/2020] [Accepted: 10/06/2020] [Indexed: 01/22/2023]
Abstract
Upper limb weakness following a stroke affects 80% of survivors and is a key factor in preventing their return to independence. State-of-the art approaches to rehabilitation often require that the patient can generate some activity in the paretic limb, which is not possible for many patients in the early period following stroke. Approaches that enable more patients to engage with upper limb therapy earlier are urgently needed. Motor imagery has shown promise as a potential means to maintain activity in the brain's motor network, when the patient is incapable of generating functional movement. However, as imagery is a hidden mental process, it is impossible for individuals to gauge what impact this is having upon their neural activity. Here we used a novel brain-computer interface (BCI) approach allowing patients to gain an insight into the effect of motor imagery on their brain-muscle pathways, in real-time. Seven patients 2-26 weeks post stroke were provided with neurofeedback (NF) of their corticospinal excitability measured by the size of motor evoked potentials (MEP) in response to transcranial magnetic stimulation (TMS). The aim was to train patients to use motor imagery to increase the size of MEPs, using the BCI with a computer game displaying neurofeedback. Patients training finger muscles learned to elevate MEP amplitudes above their resting baseline values for the first dorsal interosseous (FDI) and abductor digiti minimi (ADM) muscles. By day 3 for ADM and day 4 for FDI, MEP amplitudes were sustained above baseline in all three NF blocks. Here we have described the first clinical implementation of TMS NF in a population of sub-acute stroke patients. The results show that in the context of severe upper limb paralysis, patients are capable of using neurofeedback to elevate corticospinal excitability in the affected muscles. This may provide a new training modality for early intervention following stroke.
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Affiliation(s)
- W D Liang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Y Xu
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - J Schmidt
- Institute of Neuroscience and School of Psychology, Trinity College Dublin, Ireland
| | - L X Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - K L Ruddy
- Institute of Neuroscience and School of Psychology, Trinity College Dublin, Ireland.
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12
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Hayward KS, Jolliffe L, Churilov L, Herrmann A, Cloud GC, Lannin NA. In search of Kipling’s six honest serving men in upper limb rehabilitation: within participant case-crossover experiment nested within a web-based questionnaire. Disabil Rehabil 2020; 44:1959-1967. [DOI: 10.1080/09638288.2020.1815873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- K. S. Hayward
- Melbourne School of Health Sciences, Florey Institute of Neuroscience and Mental Health and NHMRC CRE in Stroke Rehabilitation and Brain Recovery, University of Melbourne, Melbourne, Australia
| | - L. Jolliffe
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Occupational Therapy Department, Alfred Health, Prahran, Australia
| | - L. Churilov
- Melbourne Medical School and NHMRC CRE in Stroke Rehabilitation and Brain Recovery, University of Melbourne, Heidelberg, Australia
| | - A. Herrmann
- Occupational Therapy Department, Alfred Health, Prahran, Australia
| | - G. C. Cloud
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Department of Neurology, Alfred Health, Prahran, Australia
| | - N. A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Occupational Therapy Department, Alfred Health, Prahran, Australia
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13
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Frenkel-Toledo S, Einat M, Kozol Z. The Effects of Instruction Manipulation on Motor Performance Following Action Observation. Front Hum Neurosci 2020; 14:33. [PMID: 32210778 PMCID: PMC7073404 DOI: 10.3389/fnhum.2020.00033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/23/2020] [Indexed: 11/13/2022] Open
Abstract
The effects of action observation (AO) on motor performance can be modulated by instruction. The effects of two top-down aspects of the instruction on motor performance have not been fully resolved: those related to attention to the observed task and the incorporation of motor imagery (MI) during AO. In addition, the immediate vs. 24-h retention test effects of those instruction’s aspects are yet to be elucidated. Forty-eight healthy subjects were randomly instructed to: (1) observe reaching movement (RM) sequences toward five lighted units with the intention of reproducing the same sequence as fast and as accurate as possible (Intentional + Attentional group; AO+At); (2) observe the RMs sequence with the intention of reproducing the same sequence as fast and as accurate as possible and simultaneously to the observation to imagine performing the RMs (Intentional + attentional + MI group; AO+At+MI); and (3) observe the RMs sequence (Passive AO group). Subjects’ performance was tested before and immediately after the AO and retested after 24 h. During each of the pretest, posttest, and retest, the subject performed RMs toward the units that were activated in the same order as the observed sequence. Occasionally, the sequence order was changed by beginning the sequence with a different activated unit. The outcome measures were: averaged response time of the RMs during the sequences, difference between the response time of the unexpected and expected RMs and percent of failures to reach the target within 1 s. The averaged response time and the difference between the response time of the unexpected and expected RMs were improved in all groups at posttest compared to pretest, regardless of instruction. Averaged response time was improved in the retest compared to the posttest only in the Passive AO group. The percent of failures across groups was higher in pretest compared to retest. Our findings suggest that manipulating top-down aspects of instruction by adding attention and MI to AO in an RM sequence task does not improve subsequent performance more than passive observation. Off-line learning of the sequence in the retention test was improved in comparison to posttest following passive observation only.
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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 Hospital, Raanana, Israel
| | - Moshe Einat
- Department of Electrical and Electronic Engineering, Ariel University, Ariel, Israel
| | - Zvi Kozol
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
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14
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Indorewalla KK, McArdle M, Tomlinson E, Piryatinsky I. Neuropsychological profile associated with Moyamoya disease: A case report. NeuroRehabilitation 2019; 46:603-611. [PMID: 31868692 DOI: 10.3233/nre-192903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Moyamoya disease (MMD) is a rare cardiovascular condition characterized by stenosis and gradual occlusion of the internal carotid arteries near the Circle of Willis. Current research on the disease has primarily been restricted to its medical implications, without adequate appreciation for its neurocognitive and/or neuropsychiatric implications. OBJECTIVES The current study presents the neurocognitive profile of a 31-year-old woman diagnosed with MMD, further complicated by cerebral vascular accidents (CVAs) and history of bilateral craniotomy aimed at providing maximal revascularization. METHODS Although speech and motor disturbances experienced by Ms. Doe around the time of her craniotomy and CVA were resolved at the time of current evaluation, she reported experiencing continued difficulties in processing speed, concentration, memory, word-retrieval, and planning. The patient underwent comprehensive neuropsychological evaluation assessing multiple cognitive domains. RESULTS Neurocognitive evaluation revealed the presence of a lateralized profile as well as impairments in simple auditory attention, processing speed, working memory, verbal learning, verbal fluency, and speeded fine-motor dexterity. CONCLUSIONS MMD significantly impacts cognition and daily functioning in affected individuals. This is often further exacerbated by additional CVAs requiring surgical intervention. While there is a clear growth of research on MMD, limited information is available on the neurocognitive and neuropsychiatric outcomes of the disease process. Neuropsychological data from the current case study is closely examined to provide a unique example of the lateralized neuropsychological profile and deficit pattern in a historically high functioning individual diagnosed with MMD following a stroke.
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15
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Talhada D, Feiteiro J, Costa AR, Talhada T, Cairrão E, Wieloch T, Englund E, Santos CR, Gonçalves I, Ruscher K. Triiodothyronine modulates neuronal plasticity mechanisms to enhance functional outcome after stroke. Acta Neuropathol Commun 2019; 7:216. [PMID: 31864415 PMCID: PMC6925884 DOI: 10.1186/s40478-019-0866-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/08/2019] [Indexed: 02/07/2023] Open
Abstract
The development of new therapeutic approaches for stroke patients requires a detailed understanding of the mechanisms that enhance recovery of lost neurological functions. The efficacy to enhance homeostatic mechanisms during the first weeks after stroke will influence functional outcome. Thyroid hormones (TH) are essential regulators of neuronal plasticity, however, their role in recovery related mechanisms of neuronal plasticity after stroke remains unknown. This study addresses important findings of 3,5,3′-triiodo-L-thyronine (T3) in the regulation of homeostatic mechanisms that adjust excitability – inhibition ratio in the post-ischemic brain. This is valid during the first 2 weeks after experimental stroke induced by photothrombosis (PT) and in cultured neurons subjected to an in vitro model of acute cerebral ischemia. In the human post-stroke brain, we assessed the expression pattern of TH receptors (TR) protein levels, important for mediating T3 actions. Our results show that T3 modulates several plasticity mechanisms that may operate on different temporal and spatial scales as compensatory mechanisms to assure appropriate synaptic neurotransmission. We have shown in vivo that long-term administration of T3 after PT significantly (1) enhances lost sensorimotor function; (2) increases levels of synaptotagmin 1&2 and levels of the post-synaptic GluR2 subunit in AMPA receptors in the peri-infarct area; (3) increases dendritic spine density in the peri-infarct and contralateral region and (4) decreases tonic GABAergic signaling in the peri-infarct area by a reduced number of parvalbumin+ / c-fos+ neurons and glutamic acid decarboxylase 65/67 levels. In addition, we have shown that T3 modulates in vitro neuron membrane properties with the balance of inward glutamate ligand-gated channels currents and decreases synaptotagmin levels in conditions of deprived oxygen and glucose. Interestingly, we found increased levels of TRβ1 in the infarct core of post-mortem human stroke patients, which mediate T3 actions. Summarizing, our data identify T3 as a potential key therapeutic agent to enhance recovery of lost neurological functions after ischemic stroke.
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16
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Bogolepova AN. [Possibilities of neurotrophic therapy in early recovery after stroke]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:84-89. [PMID: 31825367 DOI: 10.17116/jnevro201911908284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The high prevalence and disability of patients with ischemic stroke make the further development of the rehabilitation system relevant. The implementation of neuroplasticity mechanisms is largely provided by neurotrophic factors. One of the most well-known neurotrophic drugs is cerebrolysin, the efficacy of which in patients with stroke has been confirmed in many clinical studies. A recent meta-analysis included 9 randomized, double-blind, placebo-controlled clinical studies of using cerebrolysin in 1879 patients with hemispheric ischemic stroke, where it was administered at a dose of 30-50 ml for at least 1 week (10-21 days) and therapy was started during 72 hours after stroke. Cerebrolysin has been shown to give patients a 60% chance of better outcomes after a stroke, improves early recovery and increases the likelihood of better recovery.
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Affiliation(s)
- A N Bogolepova
- Pirogov Russian National Research Medical University, Moscow, Russia
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17
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Transcranial Direct Current Stimulation for Poststroke Motor Recovery: Challenges and Opportunities. PM R 2019; 10:S157-S164. [PMID: 30269802 DOI: 10.1016/j.pmrj.2018.04.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/15/2018] [Accepted: 04/30/2018] [Indexed: 11/21/2022]
Abstract
There has been a renewed research interest in transcranial direct current stimulation (tDCS) as an adjunctive tool for poststroke motor recovery as it has a neuro-modulatory effect on the human cortex. However, there are barriers towards its successful application in motor recovery as several scientific issues remain unresolved, including device-related issues (ie, dose-response relationship, safety and tolerability concerns, interhemispheric imbalance model, and choice of montage) and clinical trial-related issues (ie, patient selection, timing of study, and choice of outcomes). This narrative review examines and discusses the existing challenges in using tDCS as a brain modulation tool in facilitating recovery after stroke. Potential solutions pertinent to using tDCS with the goal of harnessing the brains plasticity are proposed.
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18
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Ballester BR, Maier M, Duff A, Cameirão M, Bermúdez S, Duarte E, Cuxart A, Rodríguez S, San Segundo Mozo RM, Verschure PFMJ. A critical time window for recovery extends beyond one-year post-stroke. J Neurophysiol 2019; 122:350-357. [PMID: 31141442 PMCID: PMC6689791 DOI: 10.1152/jn.00762.2018] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The impact of rehabilitation on post-stroke motor recovery and its dependency on the patient’s chronicity remain unclear. The field has widely accepted the notion of a proportional recovery rule with a “critical window for recovery” within the first 3–6 mo poststroke. This hypothesis justifies the general cessation of physical therapy at chronic stages. However, the limits of this critical window have, so far, been poorly defined. In this analysis, we address this question, and we further explore the temporal structure of motor recovery using individual patient data from a homogeneous sample of 219 individuals with mild to moderate upper-limb hemiparesis. We observed that improvement in body function and structure was possible even at late chronic stages. A bootstrapping analysis revealed a gradient of enhanced sensitivity to treatment that extended beyond 12 mo poststroke. Clinical guidelines for rehabilitation should be revised in the context of this temporal structure. NEW & NOTEWORTHY Previous studies in humans suggest that there is a 3- to 6-mo “critical window” of heightened neuroplasticity poststroke. We analyze the temporal structure of recovery in patients with hemiparesis and uncover a precise gradient of enhanced sensitivity to treatment that expands far beyond the limits of the so-called critical window. These findings highlight the need for providing therapy to patients at the chronic and late chronic stages.
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Affiliation(s)
- Belén Rubio Ballester
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia (IBEC) , Barcelona , Spain
| | - Martina Maier
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia (IBEC) , Barcelona , Spain
| | - Armin Duff
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia (IBEC) , Barcelona , Spain
| | - Mónica Cameirão
- Madeira Interactive Technologies Institute and Universidade da Madeira, Campus Universitário da Penteada, Funchal , Portugal
| | - Sergi Bermúdez
- Madeira Interactive Technologies Institute and Universidade da Madeira, Campus Universitário da Penteada, Funchal , Portugal
| | - Esther Duarte
- Servei de Medicina Física i Rehabilitació, Hospitals del Mar i l'Esperança, Institut Hospital del Mar d'Investigacions Mèdiques , Barcelona , Spain
| | - Ampar Cuxart
- Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | - Susana Rodríguez
- Servei de Medicina Física i Rehabilitació, Hospital Universitari Vall d'Hebron , Barcelona , Spain
| | | | - Paul F M J Verschure
- Laboratory of Synthetic Perceptive, Emotive and Cognitive Systems, Institute for Bioengineering of Catalonia (IBEC) , Barcelona , Spain.,ICREA, Institució Catalana de Recerca i Estudis Avançats, Passeig Lluís Companys, Barcelona , Spain
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19
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20
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Lewthwaite R, Winstein CJ, Lane CJ, Blanton S, Wagenheim BR, Nelsen MA, Dromerick AW, Wolf SL. Accelerating Stroke Recovery: Body Structures and Functions, Activities, Participation, and Quality of Life Outcomes From a Large Rehabilitation Trial. Neurorehabil Neural Repair 2019; 32:150-165. [PMID: 29554849 DOI: 10.1177/1545968318760726] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Task-oriented therapies have been developed to address significant upper extremity disability that persists after stroke. Yet, the extent of and approach to rehabilitation and recovery remains unsatisfactory to many. OBJECTIVE To compare a skill-directed investigational intervention with usual care treatment for body functions and structures, activities, participation, and quality of life outcomes. METHODS On average, 46 days poststroke, 361 patients were randomized to 1 of 3 outpatient therapy groups: a patient-centered Accelerated Skill Acquisition Program (ASAP), dose-equivalent usual occupational therapy (DEUCC), or usual therapy (UCC). Outcomes were taken at baseline, posttreatment, 6 months, and 1 year after randomization. Longitudinal mixed effect models compared group differences in poststroke improvement during treatment and follow-up phases. RESULTS Across all groups, most improvement occurred during the treatment phase, followed by change more slowly during follow-up. Compared with DEUCC and UCC, ASAP group gains were greater during treatment for Stroke Impact Scale Hand, Strength, Mobility, Physical Function, and Participation scores, self-efficacy, perceived health, reintegration, patient-centeredness, and quality of life outcomes. ASAP participants reported higher Motor Activity Log-28 Quality of Movement than UCC posttreatment and perceived greater study-related improvements in quality of life. By end of study, all groups reached similar levels with only limited group differences. CONCLUSIONS Customized task-oriented training can be implemented to accelerate gains across a full spectrum of patient-reported outcomes. While group differences for most outcomes disappeared at 1 year, ASAP participants achieved these outcomes on average 8 months earlier (ClinicalTrials.gov: Interdisciplinary Comprehensive Arm Rehabilitation Evaluation [ICARE] Stroke Initiative, at www.ClinicalTrials.gov/ClinicalTrials.gov . Identifier: NCT00871715).
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Affiliation(s)
- Rebecca Lewthwaite
- 1 University of Southern California, Los Angeles, CA, USA.,2 Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | | | | | | | - Burl R Wagenheim
- 2 Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | | | - Alexander W Dromerick
- 4 Georgetown University, Washington, DC, USA.,5 MedStar National Rehabilitation Hospital, Washington, DC, USA.,6 VA Medical Center, Washington, DC, USA
| | - Steven L Wolf
- 3 Emory University, Atlanta, GA, USA.,7 VA Center on Visual and Neurocognitive Rehabilitation, Decatur, GA, USA
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21
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Fiandaca MS, Gross TJ, Johnson TM, Hu MT, Evetts S, Wade-Martins R, Merchant-Borna K, Bazarian J, Cheema AK, Mapstone M, Federoff HJ. Potential Metabolomic Linkage in Blood between Parkinson's Disease and Traumatic Brain Injury. Metabolites 2018; 8:metabo8030050. [PMID: 30205491 PMCID: PMC6161135 DOI: 10.3390/metabo8030050] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022] Open
Abstract
The etiologic basis for sporadic forms of neurodegenerative diseases has been elusive but likely represents the product of genetic predisposition and various environmental factors. Specific gene-environment interactions have become more salient owing, in part, to the elucidation of epigenetic mechanisms and their impact on health and disease. The linkage between traumatic brain injury (TBI) and Parkinson's disease (PD) is one such association that currently lacks a mechanistic basis. Herein, we present preliminary blood-based metabolomic evidence in support of potential association between TBI and PD. Using untargeted and targeted high-performance liquid chromatography-mass spectrometry we identified metabolomic biomarker profiles in a cohort of symptomatic mild TBI (mTBI) subjects (n = 75) 3⁻12 months following injury (subacute) and TBI controls (n = 20), and a PD cohort with known PD (n = 20) or PD dementia (PDD) (n = 20) and PD controls (n = 20). Surprisingly, blood glutamic acid levels in both the subacute mTBI (increased) and PD/PDD (decreased) groups were notably altered from control levels. The observed changes in blood glutamic acid levels in mTBI and PD/PDD are discussed in relation to other metabolite profiling studies. Should our preliminary results be replicated in comparable metabolomic investigations of TBI and PD cohorts, they may contribute to an "excitotoxic" linkage between TBI and PD/PDD.
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Affiliation(s)
- Massimo S Fiandaca
- Translational Laboratory and Biorepository, Department of Neurology, University of California Irvine School of Medicine, Irvine, CA 92697-3910, USA.
- Department of Neurological Surgery, University of California Irvine School of Medicine, Irvine, CA 92697-3910, USA.
- Department of Anatomy & Neurobiology, University of California Irvine School of Medicine, Irvine, CA 92697-3910, USA.
| | - Thomas J Gross
- Translational Laboratory and Biorepository, Department of Neurology, University of California Irvine School of Medicine, Irvine, CA 92697-3910, USA.
- Department of Anatomy & Neurobiology, University of California Irvine School of Medicine, Irvine, CA 92697-3910, USA.
| | - Thomas M Johnson
- Intrepid Spirit Concussion Recovery Center, Naval Medical Center Camp Lejeune, Jacksonville, NC 28540, USA.
| | - Michele T Hu
- Nuffield Department of Clinical Neurosciences, University of Oxford, 01865 Oxford, UK.
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford 01865, UK.
| | - Samuel Evetts
- Nuffield Department of Clinical Neurosciences, University of Oxford, 01865 Oxford, UK.
| | - Richard Wade-Martins
- Department of Physiology, Anatomy and Genetics, Oxford Parkinson's Disease Centre, University of Oxford, Oxford 01865, UK.
| | - Kian Merchant-Borna
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14604, USA.
| | - Jeffrey Bazarian
- Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14604, USA.
| | - Amrita K Cheema
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20001, USA.
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, DC 20001, USA.
| | - Mark Mapstone
- Translational Laboratory and Biorepository, Department of Neurology, University of California Irvine School of Medicine, Irvine, CA 92697-3910, USA.
| | - Howard J Federoff
- Translational Laboratory and Biorepository, Department of Neurology, University of California Irvine School of Medicine, Irvine, CA 92697-3910, USA.
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22
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Edwardson MA, Zhong X, Fiandaca MS, Federoff HJ, Cheema AK, Dromerick AW. Plasma microRNA markers of upper limb recovery following human stroke. Sci Rep 2018; 8:12558. [PMID: 30135469 PMCID: PMC6105620 DOI: 10.1038/s41598-018-31020-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/06/2018] [Indexed: 12/22/2022] Open
Abstract
Preclinical investigators have implicated several microRNAs as regulators of gene expression promoting neural plasticity following experimental stroke in rodent models. Our goal was to determine whether similar microRNAs might be identifiable in plasma of humans with variable recovery from stroke. Plasma was collected 19 days post-stroke from 27 participants with mild-moderate upper extremity impairment enrolled in the Critical Periods After Stroke Study (CPASS). MicroRNA expression was assessed using TaqMan microRNA assays. Good clinical recovery was defined as ≥6 point change in the Action Research Arm Test (ARAT) score from baseline to 6 months, with 22 subjects showing good and 5 showing poor recovery. When comparing the good versus poor recovery groups, six microRNAs showed significantly decreased expression – miR-371-3p, miR-524, miR-520g, miR-1255A, miR-453, and miR-583, while 3 showed significantly increased expression - miR-941, miR-449b, and miR-581. MiR-371-3p and miR-941 have previously been associated with neural repair mechanisms; none of the significant microRNAs have previously been associated with stroke. The 9 microRNAs converge on pathways associated with axonal guidance, developmental biology, and cancer. We conclude that plasma microRNAs may be informative regarding human neural repair mechanisms during stroke recovery and probably differ from those seen in experimental stroke models.
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Affiliation(s)
- Matthew A Edwardson
- Georgetown University, Department of Neurology, Washington, DC, USA. .,Georgetown University and MedStar National Rehabilitation Hospital, Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Washington, DC, USA.
| | - Xiaogang Zhong
- Georgetown University, Department of Biostatistics, Bioinformatics, and Biomathematics, Washington, DC, USA
| | - Massimo S Fiandaca
- University of California Irvine, Department of Neurology, Irvine, CA, USA.,University of California Irvine, Department of Neurological Surgery, Irvine, CA, USA.,University of California Irvine, Department of Anatomy & Neurobiology, Irvine, CA, USA
| | - Howard J Federoff
- University of California Irvine, Department of Neurology, Irvine, CA, USA.,UC Irvine Health System, Irvine, CA, USA
| | - Amrita K Cheema
- Georgetown University, Department of Biochemistry, Washington, DC, USA.,Georgetown University, Department of Oncology, Washington, DC, USA
| | - Alexander W Dromerick
- Georgetown University, Department of Neurology, Washington, DC, USA.,Georgetown University and MedStar National Rehabilitation Hospital, Center for Brain Plasticity and Recovery, Department of Rehabilitation Medicine, Washington, DC, USA.,VA Medical Center, Washington, DC, USA
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23
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Krakauer JW, Cortés JC. A non-task-oriented approach based on high-dose playful movement exploration for rehabilitation of the upper limb early after stroke: A proposal. NeuroRehabilitation 2018; 43:31-40. [DOI: 10.3233/nre-172411] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- John W. Krakauer
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD, USA
- Neuroscience, Johns Hopkins University, Baltimore, MD, USA
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24
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Abraha B, Chaves AR, Kelly LP, Wallack EM, Wadden KP, McCarthy J, Ploughman M. A Bout of High Intensity Interval Training Lengthened Nerve Conduction Latency to the Non-exercised Affected Limb in Chronic Stroke. Front Physiol 2018; 9:827. [PMID: 30013489 PMCID: PMC6036480 DOI: 10.3389/fphys.2018.00827] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/12/2018] [Indexed: 12/13/2022] Open
Abstract
Objective: Evaluate intensity-dependent effects of a single bout of high intensity interval training (HIIT) compared to moderate intensity constant-load exercise (MICE) on corticospinal excitability (CSE) and effects on upper limb performance in chronic stroke. Design: Randomized cross-over trial. Setting: Research laboratory in a tertiary rehabilitation hospital. Participants: Convenience sample of 12 chronic stroke survivors. Outcome measures: Bilateral CSE measures of intracortical inhibition and facilitation, motor thresholds, and motor evoked potential (MEP) latency using transcranial magnetic stimulation. Upper limb functional measures of dexterity (Box and Blocks Test) and strength (pinch and grip strength). Results: Twelve (10 males; 62.50 ± 9.0 years old) chronic stroke (26.70 ± 23.0 months) survivors with moderate level of residual impairment participated. MEP latency from the ipsilesional hemisphere was lengthened after HIIT (pre: 24.27 ± 1.8 ms, and post: 25.04 ± 1.8 ms, p = 0.01) but not MICE (pre: 25.49 ± 1.10 ms, and post: 25.28 ± 1.0 ms, p = 0.44). There were no significant changes in motor thresholds, intracortical inhibition or facilitation. Pinch strength of the affected hand decreased after MICE (pre: 8.96 ± 1.9 kg vs. post: 8.40 ± 2.0 kg, p = 0.02) but not after HIIT (pre: 8.83 ± 2.0 kg vs. post: 8.65 ± 2.2 kg, p = 0.29). Regardless of type of aerobic exercise, higher total energy expenditure was associated with greater increases in pinch strength in the affected hand after exercise (R2 = 0.31, p = 0.04) and decreases in pinch strength of the less affected hand (R2 = 0.26 p = 0.02). Conclusion: A single bout of HIIT resulted in lengthened nerve conduction latency in the affected hand that was not engaged in the exercise. Longer latency could be related to the cross-over effects of fatiguing exercise or to reduced hand spasticity. Somewhat counterintuitively, pinch strength of the affected hand decreased after MICE but not HIIT. Regardless of the structure of exercise, higher energy expended was associated with pinch strength gains in the affected hand and strength losses in the less affected hand. Since aerobic exercise has acute effects on MEP latency and hand strength, it could be paired with upper limb training to potentiate beneficial effects.
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Affiliation(s)
- Beraki Abraha
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Arthur R Chaves
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Liam P Kelly
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Elizabeth M Wallack
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Katie P Wadden
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jason McCarthy
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Recovery and Performance Lab, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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25
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Kumar S, Schlaug G. Enhancing swallowing recovery after a stroke by harnessing its bihemispheric organization. Ann Neurol 2018; 83:658-660. [DOI: 10.1002/ana.25206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/04/2018] [Accepted: 03/09/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Sandeep Kumar
- Department of Neurology, Division of Cerebrovascular Diseases; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA
| | - Gottfried Schlaug
- Associate Editor, Annals of Neurology Department of Neurology, Division of Stroke Recovery and Neurorestoration and Division of Cerebrovascular Diseases Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA
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26
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Llorens R, Noé E, Alcañiz M, Deutsch JE. Time since injury limits but does not prevent improvement and maintenance of gains in balance in chronic stroke. Brain Inj 2017; 32:303-309. [PMID: 29278927 DOI: 10.1080/02699052.2017.1418905] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine the influence of time since injury on the efficacy and maintenance of gains of rehabilitation of balance after stroke. METHOD Forty-seven participants were assigned to a least (6-12 months), a moderate (12-24 months), or a most chronic (>24 months) group. Participants trained for 20 one-hour sessions, administered three to five times a week, combining conventional physical therapy and visual feedback-based exercises that trained the ankle and hip strategies. Participants were assessed before, after the intervention, and one month later with a posturography test (Sway Speed and Limits of Stability) and clinical scales. RESULTS In contrast to other subjects, the most chronic participants failed to improve their sway and to maintain the benefits detected in the Limits of Stability after the intervention. Although all the participants improved in those clinical tests that better matched the trained skills, time since injury limited the improvement, and over all, the maintenance of gains. CONCLUSION Time since injury limits but does not prevent improvement in chronic stages post-stroke, and this effect appears to be more pronounced with maintaining gains. These findings support that training duration and intensity as well as type of therapy may need to be adjusted based on time post-stroke.
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Affiliation(s)
- Roberto Llorens
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain.,b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Enrique Noé
- b Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales NISA , Fundación Hospitales NISA , Valencia , Spain
| | - Mariano Alcañiz
- a Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería , Universitat Politècnica de València , Valencia , Spain
| | - Judith E Deutsch
- c Rivers Lab, Department of Movement and Rehabilitation Sciences , Rutgers University-School of Professions , Newark , USA
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27
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Barker RN, Hayward KS, Carson RG, Lloyd D, Brauer SG. SMART Arm Training With Outcome-Triggered Electrical Stimulation in Subacute Stroke Survivors With Severe Arm Disability: A Randomized Controlled Trial. Neurorehabil Neural Repair 2017; 31:1005-1016. [DOI: 10.1177/1545968317744276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background. Stroke survivors with severe upper limb disability need opportunities to engage in task-oriented practice to achieve meaningful recovery. Objective. To compare the effect of SMART Arm training, with or without outcome-triggered electrical stimulation to usual therapy, on arm function for stroke survivors with severe upper limb disability undergoing inpatient rehabilitation. Methods. A prospective, multicenter, randomized controlled trial was conducted with 3 parallel groups, concealed allocation, assessor blinding and intention-to-treat analysis. Fifty inpatients within 4 months of stroke with severe upper limb disability were randomly allocated to 60 min/d, 5 days a week for 4 weeks of (1) SMART Arm with outcome-triggered electrical stimulation and usual therapy, (2) SMART Arm alone and usual therapy, or (3) usual therapy. Assessment occurred at baseline (0 weeks), posttraining (4 weeks), and follow-up (26 and 52 weeks). The primary outcome measure was Motor Assessment Scale item 6 (MAS6) at posttraining. Results. All groups demonstrated a statistically ( P < .001) and clinically significant improvement in arm function at posttraining (MAS6 change ≥1 point) and at 52 weeks (MAS6 change ≥2 points). There were no differences in improvement in arm function between groups (P = .367). There were greater odds of a higher MAS6 score in SMART Arm groups as compared with usual therapy alone posttraining (SMART Arm stimulation generalized odds ratio [GenOR] = 1.47, 95%CI = 1.23-1.71) and at 26 weeks (SMART Arm alone GenOR = 1.31, 95% CI = 1.05-1.57). Conclusion. SMART Arm training supported a clinically significant improvement in arm function, which was similar to usual therapy. All groups maintained gains at 12 months.
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Affiliation(s)
| | - Kathryn S. Hayward
- The University of Queensland, Brisbane, Queensland, Australia
- James Cook University, Mount Isa, Queensland, Australia
| | - Richard G. Carson
- The University of Queensland, Brisbane, Queensland, Australia
- Trinity College Dublin, Dublin, Ireland
- Queen’s University Belfast, Belfast, UK
| | - David Lloyd
- The University of Queensland, Brisbane, Queensland, Australia
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28
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Raffin E, Hummel FC. Restoring Motor Functions After Stroke: Multiple Approaches and Opportunities. Neuroscientist 2017; 24:400-416. [DOI: 10.1177/1073858417737486] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More than 1.5 million people suffer a stroke in Europe per year and more than 70% of stroke survivors experience limited functional recovery of their upper limb, resulting in diminished quality of life. Therefore, interventions to address upper-limb impairment are a priority for stroke survivors and clinicians. While a significant body of evidence supports the use of conventional treatments, such as intensive motor training or constraint-induced movement therapy, the limited and heterogeneous improvements they allow are, for most patients, usually not sufficient to return to full autonomy. Various innovative neurorehabilitation strategies are emerging in order to enhance beneficial plasticity and improve motor recovery. Among them, robotic technologies, brain-computer interfaces, or noninvasive brain stimulation (NIBS) are showing encouraging results. These innovative interventions, such as NIBS, will only provide maximized effects, if the field moves away from the “one-fits all” approach toward a “patient-tailored” approach. After summarizing the most commonly used rehabilitation approaches, we will focus on NIBS and highlight the factors that limit its widespread use in clinical settings. Subsequently, we will propose potential biomarkers that might help to stratify stroke patients in order to identify the individualized optimal therapy. We will discuss future methodological developments, which could open new avenues for poststroke rehabilitation, toward more patient-tailored precision medicine approaches and pathophysiologically motivated strategies.
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Affiliation(s)
- Estelle Raffin
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
| | - Friedhelm C. Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL Valais), Clinique Romande de Réadaptation, Sion, Switzerland
- Clinical Neuroscience, University of Geneva Medical School, Geneva, Switzerland
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Bernhardt J, Borschmann K, Boyd L, Carmichael ST, Corbett D, Cramer SC, Hoffmann T, Kwakkel G, Savitz S, Saposnik G, Walker M, Ward N. Moving Rehabilitation Research Forward: Developing Consensus Statements for Rehabilitation and Recovery Research. Neurorehabil Neural Repair 2017; 31:694-698. [DOI: 10.1177/1545968317724290] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Stroke recovery is the next frontier in stroke medicine. While growth in rehabilitation and recovery research is exponential, a number of barriers hamper our ability to rapidly progress the field. Standardized terminology is absent in both animal and human research, methods are poorly described, recovery biomarkers are not well defined, and we lack consistent timeframes or measures to examine outcomes. Agreed methods and conventions for developing, monitoring, evaluating and reporting interventions directed at improving recovery are lacking, and current approaches are often not underpinned by biology. We urgently need to better understand the biology of recovery and its time course in both animals and humans to translate evidence from basic science into clinical trials. A new international partnership of stroke recovery and rehabilitation experts has committed to advancing the research agenda. In May 2016, the first Stroke Recovery and Rehabilitation Roundtable will be held, with the aim of achieving an agreed approach to the development, conduct and reporting of research. A range of methods will be used to achieve consensus in four priority areas: pre-clinical recovery research; biomarkers of recovery; intervention development, monitoring and reporting; and measurement in clinical trials. We hope to foster a global network of researchers committed to advancing this exciting field. Recovery from stroke is challenging for many survivors. They deserve effective treatments underpinned by our evolving understanding of brain recovery and human behaviour. Working together, we can develop game-changing interventions to improve recovery and quality of life in those living with stroke.
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Affiliation(s)
- Julie Bernhardt
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Karen Borschmann
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
| | - Lara Boyd
- Department of Physical Therapy and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, BC, Canada
| | - S. Thomas Carmichael
- Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
- Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, Canada
| | - Steven C. Cramer
- Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine, USA
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sean Savitz
- Stroke Program, McGovern Medical School, UT Health, Houston, Texas, USA
| | | | - Marion Walker
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Nick Ward
- Sobell Department of Motor Neuroscience UCL Institute of Neurology, Queen Square, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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Abstract
Stroke instigates a dynamic process of repair and remodelling of remaining neural circuits, and this process is shaped by behavioural experiences. The onset of motor disability simultaneously creates a powerful incentive to develop new, compensatory ways of performing daily activities. Compensatory movement strategies that are developed in response to motor impairments can be a dominant force in shaping post-stroke neural remodelling responses and can have mixed effects on functional outcome. The possibility of selectively harnessing the effects of compensatory behaviour on neural reorganization is still an insufficiently explored route for optimizing functional outcome after stroke.
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Affiliation(s)
- Theresa A Jones
- Department of Psychology and Institute for Neuroscience, University of Texas at Austin, Texas 78712, USA
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31
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Hylin MJ, Kerr AL, Holden R. Understanding the Mechanisms of Recovery and/or Compensation following Injury. Neural Plast 2017; 2017:7125057. [PMID: 28512585 PMCID: PMC5415868 DOI: 10.1155/2017/7125057] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/24/2017] [Accepted: 03/26/2017] [Indexed: 11/30/2022] Open
Abstract
Injury due to stroke and traumatic brain injury result in significant long-term effects upon behavioral functioning. One central question to rehabilitation research is whether the nature of behavioral improvement observed is due to recovery or the development of compensatory mechanisms. The nature of functional improvement can be viewed from the perspective of behavioral changes or changes in neuroanatomical plasticity that follows. Research suggests that these changes correspond to each other in a bidirectional manner. Mechanisms surrounding phenomena like neural plasticity may offer an opportunity to explain how variables such as experience can impact improvement and influence the definition of recovery. What is more, the intensity of the rehabilitative experiences may influence the ability to recover function and support functional improvement of behavior. All of this impacts how researchers, clinicians, and medical professionals utilize rehabilitation.
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Affiliation(s)
- Michael J. Hylin
- Neurotrauma and Rehabilitation Laboratory, Department of Psychology, Southern Illinois University, Carbondale, IL, USA
| | - Abigail L. Kerr
- Department of Psychology, Illinois Wesleyan University, Bloomington, IL, USA
| | - Ryan Holden
- Neurotrauma and Rehabilitation Laboratory, Department of Psychology, Southern Illinois University, Carbondale, IL, USA
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Abstract
We examined the patterns and variability of recovery post-stroke in
multiple behavioral domains. A large cohort of first time stroke patients with
heterogeneous lesions was studied prospectively and longitudinally at 1-2 weeks,
3 months and one year post-injury with structural MRI to measure lesion anatomy
and in-depth neuropsychological assessment. Impairment was described at all
timepoints by a few clusters of correlated deficits. The time course and
magnitude of recovery was similar across domains, with change scores largely
proportional to the initial deficit and most recovery occurring within the first
three months. Damage to specific white matter tracts produced poorer recovery
over several domains: attention and superior longitudinal fasciculus II/III,
language and posterior arcuate fasciculus, motor and corticospinal tract.
Finally, after accounting for the severity of the initial deficit, language and
visual memory recovery/outcome was worse with lower education, while the
occurrence of multiple deficits negatively impacted attention recovery.
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Edwardson MA, Wang X, Liu B, Ding L, Lane CJ, Park C, Nelsen MA, Jones TA, Wolf SL, Winstein CJ, Dromerick AW. Stroke Lesions in a Large Upper Limb Rehabilitation Trial Cohort Rarely Match Lesions in Common Preclinical Models. Neurorehabil Neural Repair 2017; 31:509-520. [PMID: 28337932 DOI: 10.1177/1545968316688799] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Stroke patients with mild-moderate upper extremity motor impairments and minimal sensory and cognitive deficits provide a useful model to study recovery and improve rehabilitation. Laboratory-based investigators use lesioning techniques for similar goals. OBJECTIVE To determine whether stroke lesions in an upper extremity rehabilitation trial cohort match lesions from the preclinical stroke recovery models used to drive translational research. METHODS Clinical neuroimages from 297 participants enrolled in the Interdisciplinary Comprehensive Arm Rehabilitation Evaluation (ICARE) study were reviewed. Images were characterized based on lesion type (ischemic or hemorrhagic), volume, vascular territory, depth (cortical gray matter, cortical white matter, subcortical), old strokes, and leukoaraiosis. Lesions were compared with those of preclinical stroke models commonly used to study upper limb recovery. RESULTS Among the ischemic stroke participants, median infarct volume was 1.8 mL, with most lesions confined to subcortical structures (61%) including the anterior choroidal artery territory (30%) and the pons (23%). Of ICARE participants, <1% had lesions resembling proximal middle cerebral artery or surface vessel occlusion models. Preclinical models of subcortical white matter injury best resembled the ICARE population (33%). Intracranial hemorrhage participants had small (median 12.5 mL) lesions that best matched the capsular hematoma preclinical model. CONCLUSIONS ICARE subjects are not representative of all stroke patients, but they represent a clinically and scientifically important subgroup. Compared with lesions in general stroke populations and widely studied animal models of recovery, ICARE participants had smaller, more subcortically based strokes. Improved preclinical-clinical translational efforts may require better alignment of lesions between preclinical and human stroke recovery models.
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Affiliation(s)
- Matthew A Edwardson
- 1 Georgetown University, Washington, DC, USA.,2 MedStar National Rehabilitation Hospital, Washington, DC, USA
| | - Ximing Wang
- 3 University of Southern California, Los Angeles, CA, USA
| | - Brent Liu
- 3 University of Southern California, Los Angeles, CA, USA
| | - Li Ding
- 3 University of Southern California, Los Angeles, CA, USA
| | | | - Caron Park
- 3 University of Southern California, Los Angeles, CA, USA
| | | | | | - Steven L Wolf
- 5 Emory University, Atlanta, GA, USA.,6 VA Center on Visual and Neurocognitive Rehabilitation, Decatur, GA, USA
| | | | - Alexander W Dromerick
- 1 Georgetown University, Washington, DC, USA.,2 MedStar National Rehabilitation Hospital, Washington, DC, USA.,7 VA Medical Center, Washington, DC, USA
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34
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Sanchez-Mendoza EH, Hermann DM. Correlates of Post-Stroke Brain Plasticity, Relationship to Pathophysiological Settings and Implications for Human Proof-of-Concept Studies. Front Cell Neurosci 2016; 10:196. [PMID: 27547178 PMCID: PMC4974253 DOI: 10.3389/fncel.2016.00196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 01/01/2023] Open
Abstract
The promotion of neurological recovery by enhancing neuroplasticity has recently obtained strong attention in the stroke field. Experimental studies support the hypothesis that stroke recovery can be improved by therapeutic interventions that augment neuronal sprouting. However plasticity responses of neurons are highly complex, involving the growth and differentiation of axons, dendrites, dendritic spines and synapses, which depend on the pathophysiological setting and are tightly controlled by extracellular and intracellular signals. Thorough mechanistic insights are needed into how neuronal plasticity is influenced by plasticity-promoting therapies in order not to risk the success of future clinical proof-of-concept studies.
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35
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Bernhardt J, Borschmann K, Boyd L, Thomas Carmichael S, Corbett D, Cramer SC, Hoffmann T, Kwakkel G, Savitz SI, Saposnik G, Walker M, Ward N. Moving rehabilitation research forward: Developing consensus statements for rehabilitation and recovery research. Int J Stroke 2016; 11:454-8. [PMID: 27073187 DOI: 10.1177/1747493016643851] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/15/2016] [Indexed: 12/18/2022]
Abstract
Stroke recovery is the next frontier in stroke medicine. While growth in rehabilitation and recovery research is exponential, a number of barriers hamper our ability to rapidly progress the field. Standardized terminology is absent in both animal and human research, methods are poorly described, recovery biomarkers are not well defined, and we lack consistent timeframes or measures to examine outcomes. Agreed methods and conventions for developing, monitoring, evaluating and reporting interventions directed at improving recovery are lacking, and current approaches are often not underpinned by biology. We urgently need to better understand the biology of recovery and its time course in both animals and humans to translate evidence from basic science into clinical trials. A new international partnership of stroke recovery and rehabilitation experts has committed to advancing the research agenda. In May 2016, the first Stroke Recovery and Rehabilitation Roundtable will be held, with the aim of achieving an agreed approach to the development, conduct and reporting of research. A range of methods will be used to achieve consensus in four priority areas: pre-clinical recovery research; biomarkers of recovery; intervention development, monitoring and reporting; and measurement in clinical trials. We hope to foster a global network of researchers committed to advancing this exciting field. Recovery from stroke is challenging for many survivors. They deserve effective treatments underpinned by our evolving understanding of brain recovery and human behaviour. Working together, we can develop game-changing interventions to improve recovery and quality of life in those living with stroke.
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Affiliation(s)
- Julie Bernhardt
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Karen Borschmann
- NHMRC Centre for Research Excellence in Stroke Rehabilitation and Recovery, Victoria, Australia The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Lara Boyd
- Department of Physical Therapy and the Djavad Mowafaghian Centre for Brain Health, University of British Columbia, BC, Canada
| | - S Thomas Carmichael
- Departments of Neurology and Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, USA
| | - Dale Corbett
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, University of Ottawa, Ottawa, Canada
| | - Steven C Cramer
- Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine, USA
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | - Gert Kwakkel
- Department of Rehabilitation Medicine, Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sean I Savitz
- Stroke Program, McGovern Medical School, UTHealth, Houston, Texas, USA
| | - Gustavo Saposnik
- Department of Medicine, University of Toronto, Toronto, Canada Stroke Outcomes Research Center, Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Marion Walker
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Nick Ward
- Sobell Department of Motor Neuroscience UCL Institute of Neurology, Queen Square, London, UK National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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