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Sánchez Cuesta FJ, González-Zamorano Y, Moreno-Verdú M, Vourvopoulos A, Serrano IJ, Del Castillo-Sobrino MD, Figueiredo P, Romero JP. Effects of motor imagery-based neurofeedback training after bilateral repetitive transcranial magnetic stimulation on post-stroke upper limb motor function: an exploratory crossover clinical trial. J Rehabil Med 2024; 56:jrm18253. [PMID: 38450442 PMCID: PMC10938141 DOI: 10.2340/jrm.v56.18253] [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: 07/17/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVE To examine the clinical effects of combining motor imagery-based neurofeedback training with bilateral repetitive transcranial magnetic stimulation for upper limb motor function in subacute and chronic stroke. DESIGN Clinical trial following an AB/BA crossover design with counterbalanced assignment. SUBJECTS Twenty individuals with subacute (n = 4) or chronic stroke (n = 16). METHODS Ten consecutive sessions of bilateral repetitive transcranial magnetic stimulation alone (therapy A) were compared vs a combination of10 consecutive sessions of bilateral repetitive transcranial magnetic stimulation with 12 non-consecutive sessions of motor imagery-based neurofeedback training (therapy B). Patients received both therapies (1-month washout period), in sequence AB or BA. Participants were assessed before and after each therapy and at 15-days follow-up, using the Fugl-Meyer Assessment-upper limb, hand-grip strength, and the Nottingham Sensory Assessment as primary outcome measures. RESULTS Both therapies resulted in improved functionality and sensory function. Therapy B consistently exhibited superior effects compared with therapy A, according to Fugl-Meyer Assessment and tactile and kinaesthetic sensory function across multiple time-points, irrespective of treatment sequence. No statistically significant differences between therapies were found for hand-grip strength. CONCLUSION Following subacute and chronic stroke, integrating bilateral repetitive transcranial magnetic stimulation and motor imagery-based neurofeedback training has the potential to enhance functional performance compared with using bilateral repetitive transcranial magnetic stimulation alone in upper limb recovery.
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Affiliation(s)
- Francisco José Sánchez Cuesta
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
| | - Yeray González-Zamorano
- Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, King Juan Carlos University, Alcorcón, Spain; Cognitive Neuroscience, Pain, and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - Marcos Moreno-Verdú
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain.
| | - Athanasios Vourvopoulos
- Institute for Systems and Robotics-Lisboa, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Ignacio J Serrano
- Neural and Cognitive Engineering group, Centre for Automation and Robotics (CAR) CSIC-UPM, Arganda del Rey, Madrid, Spain
| | | | - Patrícia Figueiredo
- Institute for Systems and Robotics-Lisboa, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Juan Pablo Romero
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain.
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Li W, Li C, Liu A, Lin PJ, Mo L, Zhao H, Xu Q, Meng X, Ji L. Lesion-specific cortical activation following sensory stimulation in patients with subacute stroke. J Neuroeng Rehabil 2023; 20:155. [PMID: 37957755 PMCID: PMC10644526 DOI: 10.1186/s12984-023-01276-8] [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: 08/17/2022] [Accepted: 11/01/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Sensory stimulation can play a fundamental role in the activation of the primary sensorimotor cortex (S1-M1), which can promote motor learning and M1 plasticity in stroke patients. However, studies have focused mainly on investigating the influence of brain lesion profiles on the activation patterns of S1-M1 during motor tasks instead of sensory tasks. Therefore, the objective of this study is to explore the lesion-specific activation patterns due to different brain lesion profiles and types during focal vibration (FV). METHODS In total 52 subacute stroke patients were recruited in this clinical experiment, including patients with basal ganglia hemorrhage/ischemia, brainstem ischemia, other subcortical ischemia, cortical ischemia, and mixed cortical-subcortical ischemia. Electroencephalograms (EEG) were recorded following a resting state lasting for 4 min and three sessions of FV. FV was applied over the muscle belly of the affected limb's biceps for 3 min each session. Beta motor-related EEG power desynchronization overlying S1-M1 was used to indicate the activation of S1-M1, while the laterality coefficient (LC) of the activation of S1-M1 was used to assess the interhemispheric asymmetry of brain activation. RESULTS (1) Regarding brain lesion profiles, FV could lead to the significant activation of bilateral S1-M1 in patients with basal ganglia ischemia and other subcortical ischemia. The activation of ipsilesional S1-M1 in patients with brainstem ischemia was higher than that in patients with cortical ischemia. No activation of S1-M1 was observed in patients with lesions involving cortical regions. (2) Regarding brain lesion types, FV could induce the activation of bilateral S1-M1 in patients with basal ganglia hemorrhage, which was significantly higher than that in patients with basal ganglia ischemia. Additionally, LC showed no significant correlation with the modified Barthel index (MBI) in all patients, but a positive correlation with MBI in patients with basal ganglia lesions. CONCLUSIONS These results reveal that sensory stimulation can induce lesion-specific activation patterns of S1-M1. This indicates FV could be applied in a personalized manner based on the lesion-specific activation of S1-M1 in stroke patients with different lesion profiles and types. Our study may contribute to a better understanding of the underlying mechanisms of cortical reorganization.
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Affiliation(s)
- Wei Li
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
- State Key Laboratory of Multimodal Artificial Intelligence Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Chong Li
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
- School of Clinical Medicine, Tsinghua Medicine, Tsinghua University, Beijing, China.
- Medical Research Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Aixian Liu
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Ping-Ju Lin
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
| | - Linhong Mo
- Neurological Rehabilitation Center, Beijing Rehabilitation Hospital Affiliated to Capital Medical University, Beijing, China
| | - Hongliang Zhao
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Quan Xu
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China.
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Xiangzun Meng
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
| | - Linhong Ji
- Division of Intelligent and Biomechanical System, Department of Mechanical Engineering, Tsinghua University, Haidian, Beijing, China
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Recovery of Patients With Upper Limb Paralysis Due to Stroke Who Underwent Intervention Using Low-Frequency Repetitive Transcranial Magnetic Stimulation Combined With Occupational Therapy: A Retrospective Cohort Study. Neuromodulation 2023:S1094-7159(23)00104-6. [PMID: 36932028 DOI: 10.1016/j.neurom.2023.02.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES The combination of repetitive transcranial magnetic stimulation (rTMS) and motor practice is based on the theory of neuromodulation and use-dependent plasticity. Predictive planning of occupational therapy (OT) is important for patients with rTMS conditioning. Recovery characteristics based on the severity of pretreatment upper extremity paralysis can guide the patient's practice plan for using the paretic hand. Therefore, we evaluated the recovery of patients with upper limb paralysis due to stroke who underwent a novel intervention of rTMS combined with OT (NEURO) according to the severity of upper limb paralysis based on the scores of the Fugl-Meyer assessment for upper extremity (FMA-UE) with recovery in proximal upper extremity, wrist, hand, and coordination. MATERIALS AND METHODS In this multicenter retrospective cohort study, the recovery of 1397 patients with upper limb paralysis was analyzed by severity at six hospitals that were accredited by the Japanese Stimulation Therapy Society for treatment. The delta values of the FMA-UE scores before and after NEURO were compared among the groups with severe, moderate, and mild paralysis using the generalized linear model. RESULTS NEURO significantly improved the FMA-UE total score according to the severity of paralysis (severe = 5.3, moderate = 6.0, and mild = 2.9). However, when the FMA-UE subscores were analyzed separately, the results indicated specific improvements in shoulder/elbow, wrist, fingers, and coordination movements, depending on the severity. CONCLUSIONS This study had enough patients who were divided according to severity and stratified by lesion location and handedness parameters. Our results suggest that independently of these factors, the extent of recovery of upper limb motor parts after NEURO varies according to the severity of paralysis.
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Repetitive Transcranial Magnetic Stimulation of the Brain Region Activated by Motor Imagery Involving a Paretic Wrist and Hand for Upper-Extremity Motor Improvement in Severe Stroke: A Preliminary Study. Brain Sci 2022; 13:brainsci13010069. [PMID: 36672050 PMCID: PMC9856429 DOI: 10.3390/brainsci13010069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/14/2022] [Accepted: 12/25/2022] [Indexed: 12/31/2022] Open
Abstract
Approximately two-thirds of stroke survivors experience chronic upper-limb paresis; however, treatment options are limited. Repetitive transcranial magnetic stimulation (rTMS) can enhance motor function recovery in stroke survivors, but its efficacy is controversial. We compared the efficacy of stimulating different targets in 10 chronic stroke patients with severe upper-limb motor impairment. Motor imagery-based brain-computer interface training augmented with virtual reality was used to induce neural activity in the brain region during an imagery task. Participants were then randomly assigned to two groups: an experimental group (received high-frequency rTMS delivered to the brain region activated earlier) and a comparison group (received low-frequency rTMS delivered to the contralesional primary motor cortex). Behavioural metrics and diffusion tensor imaging were compared pre- and post rTMS. After the intervention, participants in both groups improved somewhat. This preliminary study indicates that in chronic stroke patients with severe upper-limb motor impairment, inducing activation in specific brain regions during motor imagery tasks and selecting these regions as a target is feasible. Further studies are needed to explore the efficacy of this intervention.
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Wingfield M, Fini NA, Brodtmann A, Williams G, Churilov L, Hayward KS. Upper-Limb Motor Intervention Elements That Drive Improvement in Biomarkers and Clinical Measures Post-Stroke: A Systematic Review in a Systems Paradigm. Neurorehabil Neural Repair 2022; 36:726-739. [DOI: 10.1177/15459683221129273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To use a systems paradigm to examine upper limb (UL) motor intervention elements driving biomarker and clinical measure improvement after stroke. Methods Databases were searched up to March 2022. Eligibility screening was completed by 2 authors. Studies using biomarkers and clinical measures pre- and post-upper limb intervention were included. Studies of adjunct interventions (eg, brain stimulation) were excluded. Cochrane Risk-of-Bias tools and Template for Intervention Description and Replication were used to rate studies. Studies were synthesized using a systems paradigm: intervention outcome was considered an emergent property of the systemic interactions of 4 intervention elements (demographics, type, quality, and dose) characterized by individual dimensions. Results Sixty-four studies (n = 1814 participants) containing 106 intervention groups (66 experimental; 40 control) were included. Combined biomarker and clinical outcomes defined 3 scenarios: restitution, mixed, and unchanged. The restitution scenario included more moderate-to-severely impaired participants in earlier recovery phases (<6 months). Interventions with graded difficulty were more frequently used in the restitution scenario compared with the unchanged scenario. No difference in quality or amount of therapy was identified when examining scenarios that demonstrated restitution compared to those that did not (mixed and unchanged). Conclusions A systems paradigm may be one of many approaches to understand UL motor restitution. This review found no single element consistently delivered improvements in biomarkers and clinical measures in the examined intervention groups. Complex patterns formed by multiple interacting intervention elements were observed in participants with and without restitution.
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Affiliation(s)
- Matthew Wingfield
- Department of Physiotherapy, University of Melbourne; Epworth Healthcare, Melbourne, Victoria, Australia
| | - Natalie A. Fini
- Department of Physiotherapy, University of Melbourne; Epworth Healthcare, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Cognitive Health Initiative, Central Clinical School, Monash University; Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Gavin Williams
- Department of Physiotherapy, University of Melbourne; Epworth Healthcare, Melbourne, Victoria, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Kathryn S. Hayward
- Departments of Physiotherapy, Medicine & Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Alashram AR, Padua E, Annino G. Effects of Brain-Computer Interface Controlled Functional Electrical Stimulation on Motor Recovery in Stroke Survivors: a Systematic Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Remsik AB, van Kan PLE, Gloe S, Gjini K, Williams L, Nair V, Caldera K, Williams JC, Prabhakaran V. BCI-FES With Multimodal Feedback for Motor Recovery Poststroke. Front Hum Neurosci 2022; 16:725715. [PMID: 35874158 PMCID: PMC9296822 DOI: 10.3389/fnhum.2022.725715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 05/26/2022] [Indexed: 01/31/2023] Open
Abstract
An increasing number of research teams are investigating the efficacy of brain-computer interface (BCI)-mediated interventions for promoting motor recovery following stroke. A growing body of evidence suggests that of the various BCI designs, most effective are those that deliver functional electrical stimulation (FES) of upper extremity (UE) muscles contingent on movement intent. More specifically, BCI-FES interventions utilize algorithms that isolate motor signals-user-generated intent-to-move neural activity recorded from cerebral cortical motor areas-to drive electrical stimulation of individual muscles or muscle synergies. BCI-FES interventions aim to recover sensorimotor function of an impaired extremity by facilitating and/or inducing long-term motor learning-related neuroplastic changes in appropriate control circuitry. We developed a non-invasive, electroencephalogram (EEG)-based BCI-FES system that delivers closed-loop neural activity-triggered electrical stimulation of targeted distal muscles while providing the user with multimodal sensory feedback. This BCI-FES system consists of three components: (1) EEG acquisition and signal processing to extract real-time volitional and task-dependent neural command signals from cerebral cortical motor areas, (2) FES of muscles of the impaired hand contingent on the motor cortical neural command signals, and (3) multimodal sensory feedback associated with performance of the behavioral task, including visual information, linked activation of somatosensory afferents through intact sensorimotor circuits, and electro-tactile stimulation of the tongue. In this report, we describe device parameters and intervention protocols of our BCI-FES system which, combined with standard physical rehabilitation approaches, has proven efficacious in treating UE motor impairment in stroke survivors, regardless of level of impairment and chronicity.
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Affiliation(s)
- Alexander B. Remsik
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- School of Medicine and Public Health, Institute for Clinical and Translational Research, University of Wisconsin–Madison, Madison, WI, United States
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Peter L. E. van Kan
- Department of Kinesiology, University of Wisconsin–Madison, Madison, WI, United States
- Neuroscience Training Program, University of Wisconsin–Madison, Madison, WI, United States
| | - Shawna Gloe
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Klevest Gjini
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurology, University of Wisconsin–Madison, Madison, WI, United States
| | - Leroy Williams
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Educational Psychology, University of Wisconsin–Madison, Madison, WI, United States
| | - Veena Nair
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
| | - Kristin Caldera
- Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
| | - Justin C. Williams
- Department of Biomedical Engineering, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin–Madison, Madison, WI, United States
- Neuroscience Training Program, University of Wisconsin–Madison, Madison, WI, United States
- Department of Neurology, University of Wisconsin–Madison, Madison, WI, United States
- Department of Psychiatry, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
- Medical Scientist Training Program, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, WI, United States
- Department of Psychology, University of Wisconsin–Madison, Madison, WI, United States
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Tan G, Wang J, Liu J, Sheng Y, Xie Q, Liu H. A framework for quantifying the effects of transcranial magnetic stimulation on motor recovery from hemiparesis: Corticomuscular Network. J Neural Eng 2022; 19. [PMID: 35366651 DOI: 10.1088/1741-2552/ac636b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/01/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Transcranial magnetic stimulation (TMS) is an experimental therapy for promoting motor recovery from hemiparesis. At present, hemiparesis patients' responses to TMS are variable. To maximize its therapeutic potential, we need an approach that relates the electrophysiology of motor recovery and TMS. To this end, we propose Corticomuscular Network (CMN) representing the holistic motor system, including the cortico-cortical pathway, corticospinal tract, and muscle co-activation. METHODS CMN is made up of coherence between pairs of electrode signals and spatial locations of the electrodes. We associated coherence and graph features of CMN with Fugl-Meyer Assessment (FMA) for the upper extremity. Besides, we compared CMN between 8 patients with hemiparesis and 6 healthy controls and contrasted CMN of patients before and after a 1Hz TMS. MAIN RESULTS Corticomuscular coherence (CMC) correlated positively with FMA. The regression model between FMA and CMC between 5 pairs of channels had 0.99 adjusted R^2 and a p-value less than 0.01. Compared to healthy controls, CMN of patients tended to be a small-world network and was more interconnected with higher CMC. CMC between cortex and triceps brachii long head was higher in patients. 15-minute 1Hz TMS protocol induced coherence changes beyond the stimulation side and had a limited impact on CMN parameters that are related to motor recovery. SIGNIFICANCE CMN is a potential clinical approach to quantify rehabilitating progress. It also sheds light on the desirable electrophysiological effects of TMS based on which rehabilitating strategies can be optimized.
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Affiliation(s)
- Gansheng Tan
- Washington University in St Louis, 520 S Euclid Ave, St. Louis, MO 63110, St Louis, Missouri, 63130-4899, UNITED STATES
| | - Jixian Wang
- Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, 800 Dongchuan Rd, Shanghai, 200025, CHINA
| | - Jinbiao Liu
- Shanghai Jiao Tong University, 800 Dongchuan Rd, Shanghai, 200240, CHINA
| | - Yixuan Sheng
- Shanghai Jiao Tong University, 800 Dongchuan Rd, Shanghai, 200240, CHINA
| | - Qing Xie
- Ruijin Hospital, 800 Dongchuan Rd, Shanghai, 200025, CHINA
| | - Honghai Liu
- Harbin Institute of Technology Shenzhen, Pingshan 1 Rd, Nanshan, Shenzhen, Guangdong, 518055, CHINA
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Alionte C, Notte C, Strubakos CD. From symmetry to chaos and back: Understanding and imaging the mechanisms of neural repair after stroke. Life Sci 2022; 288:120161. [PMID: 34813796 DOI: 10.1016/j.lfs.2021.120161] [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: 08/27/2021] [Revised: 11/06/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
Neuroscience has made strides in recent years allowing us insight into the workings of the brain - from the molecular to the regional anatomy. These insights have given researchers an advantage in seeking novel therapies for neurological disorders, specifically stroke. Yet despite these discoveries, many aspects of stroke remain poorly understood - specifically post-stroke recovery. This review article seeks to outline cutting-edge neuroimaging technologies, and the current level of understanding of neurological repair after stroke, with the main focus on the mechanism of axonal sprouting. Neuronal connectivity has varying levels of complexity that allow neuronal networks to process information and give rise to our day-to-day functioning. As stroke causes the death of groups of regional neurons, it is likely that the reestablishment of function seen in some stroke patients is related to shifting patterns of functional connectivity. This paper touches on the timeline and limits on the amount of functional recovery, as well as the differences in organization of neuronal networks in a healthy versus post stroke brain. Finally, we discuss how the previously mentioned methods of imaging are critical in understanding the mechanisms of functional recovery. The mechanism of axonal sprouting and its theorized different types are explained, along with potential ways of imaging them in rodents. The hope is that, with a better understanding of the mechanisms underlying brain recovery, researchers can apply this knowledge to better help stroke patients and be of use in clinical settings.
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Affiliation(s)
- Caroline Alionte
- Department of Physics, University of Windsor, Windsor, Ontario N9B 3P4, Canada
| | - Christian Notte
- Department of Physics, University of Windsor, Windsor, Ontario N9B 3P4, Canada
| | - Christos D Strubakos
- Department of Psychology, University of Windsor, Windsor, Ontario N9B 3P4, Canada; Department of Languages, Literatures, and Cultures, University of Windsor, Windsor, Ontario N9B 3P4, Canada.
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Cassidy JM, Mark JI, Cramer SC. Functional connectivity drives stroke recovery: shifting the paradigm from correlation to causation. Brain 2021; 145:1211-1228. [PMID: 34932786 DOI: 10.1093/brain/awab469] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/20/2021] [Accepted: 11/26/2021] [Indexed: 11/14/2022] Open
Abstract
Stroke is a leading cause of disability, with deficits encompassing multiple functional domains. The heterogeneity underlying stroke poses significant challenges in the prediction of post-stroke recovery, prompting the development of neuroimaging-based biomarkers. Structural neuroimaging measurements, particularly those reflecting corticospinal tract injury, are well-documented in the literature as potential biomarker candidates of post-stroke motor recovery. Consistent with the view of stroke as a 'circuitopathy', functional neuroimaging measures probing functional connectivity may also prove informative in post-stroke recovery. An important step in the development of biomarkers based on functional neural network connectivity is the establishment of causality between connectivity and post-stroke recovery. Current evidence predominantly involves statistical correlations between connectivity measures and post-stroke behavioral status, either cross-sectionally or serially over time. However, the advancement of functional connectivity application in stroke depends on devising experiments that infer causality. In 1965, Sir Austin Bradford Hill introduced nine viewpoints to consider when determining the causality of an association: [1] Strength, [2] Consistency [3] Specificity, [4] Temporality, [5] Biological gradient, [6] Plausibility, [7] Coherence, [8] Experiment, and [9] Analogy. Collectively referred to as the Bradford Hill Criteria, these points have been widely adopted in epidemiology. In this review, we assert the value of implementing Bradford Hill's framework to stroke rehabilitation and neuroimaging. We focus on the role of neural network connectivity measurements acquired from task-oriented and resting-state functional magnetic resonance imaging, electroencephalography, magnetoencephalography, and functional near-infrared spectroscopy in describing and predicting post-stroke behavioral status and recovery. We also identify research opportunities within each Bradford Hill tenet to shift the experimental paradigm from correlation to causation.
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Affiliation(s)
- Jessica M Cassidy
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jasper I Mark
- Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Steven C Cramer
- Department of Neurology, University of California, Los Angeles; and California Rehabilitation Institute, Los Angeles, CA USA
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Vinehout K, Tynes K, Sotelo MR, Hyngstrom AS, McGuire JR, Schmit BD. Changes in Cortical Activity in Stroke Survivors Undergoing Botulinum Neurotoxin Therapy for Treatment of Focal Spasticity. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:735819. [PMID: 36188774 PMCID: PMC9397708 DOI: 10.3389/fresc.2021.735819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
Abstract
Background: Botulinum NeuroToxin-A (BoNT-A) relieves muscle spasticity and increases range of motion necessary for stroke rehabilitation. Determining the effects of BoNT-A therapy on brain neuroplasticity could help physicians customize its use and predict its outcome. Objective: The purpose of this study was to investigate the effects of Botulinum Toxin-A therapy for treatment of focal spasticity on brain activation and functional connectivity. Design: We used functional Magnetic Resonance Imaging (fMRI) to track changes in blood oxygen-level dependent (BOLD) activation and functional connectivity associated with BoNT-A therapy in nine chronic stroke participants, and eight age-matched controls. Scans were acquired before BoNT-A injections (W0) and 6 weeks after the injections (W6). The task fMRI scan consisted of a block design of alternating mass finger flexion and extension. The voxel-level changes in BOLD activation, and pairwise changes in functional connectivity were analyzed for BoNT-A treatment (stroke W0 vs. W6). Results: BoNT-A injection therapy resulted in significant increases in brain activation in the contralesional premotor cortex, cingulate gyrus, thalamus, superior cerebellum, and in the ipsilesional sensory integration area. Lastly, cerebellar connectivity correlated with the Fugl-Meyer assessment of motor impairment before injection, while premotor connectivity correlated with the Fugl-Meyer score after injection. Conclusion: BoNT-A therapy for treatment of focal spasticity resulted in increased brain activation in areas associated with motor control, and cerebellar connectivity correlated with motor impairment before injection. These results suggest that neuroplastic effects might take place in response to improvements in focal spasticity.
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Affiliation(s)
- Kaleb Vinehout
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Kelsey Tynes
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Miguel R. Sotelo
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Allison S. Hyngstrom
- Department of Physical Therapy, Marquette University, Milwaukee, WI, United States
| | - John R. McGuire
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian D. Schmit
- Department of Biomedical Engineering, Marquette University and the Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Brian D. Schmit
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Remsik AB, Gjini K, Williams L, van Kan PLE, Gloe S, Bjorklund E, Rivera CA, Romero S, Young BM, Nair VA, Caldera KE, Williams JC, Prabhakaran V. Ipsilesional Mu Rhythm Desynchronization Correlates With Improvements in Affected Hand Grip Strength and Functional Connectivity in Sensorimotor Cortices Following BCI-FES Intervention for Upper Extremity in Stroke Survivors. Front Hum Neurosci 2021; 15:725645. [PMID: 34776902 PMCID: PMC8581197 DOI: 10.3389/fnhum.2021.725645] [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: 06/15/2021] [Accepted: 10/01/2021] [Indexed: 12/13/2022] Open
Abstract
Stroke is a leading cause of acquired long-term upper extremity motor disability. Current standard of care trajectories fail to deliver sufficient motor rehabilitation to stroke survivors. Recent research suggests that use of brain-computer interface (BCI) devices improves motor function in stroke survivors, regardless of stroke severity and chronicity, and may induce and/or facilitate neuroplastic changes associated with motor rehabilitation. The present sub analyses of ongoing crossover-controlled trial NCT02098265 examine first whether, during movements of the affected hand compared to rest, ipsilesional Mu rhythm desynchronization of cerebral cortical sensorimotor areas [Brodmann’s areas (BA) 1-7] is localized and tracks with changes in grip force strength. Secondly, we test the hypothesis that BCI intervention results in changes in frequency-specific directional flow of information transmission (direct path functional connectivity) in BA 1-7 by measuring changes in isolated effective coherence (iCoh) between cerebral cortical sensorimotor areas thought to relate to electrophysiological signatures of motor actions and motor learning. A sample of 16 stroke survivors with right hemisphere lesions (left hand motor impairment), received a maximum of 18–30 h of BCI intervention. Electroencephalograms were recorded during intervention sessions while outcome measures of motor function and capacity were assessed at baseline and completion of intervention. Greater desynchronization of Mu rhythm, during movements of the impaired hand compared to rest, were primarily localized to ipsilesional sensorimotor cortices (BA 1-7). In addition, increased Mu desynchronization in the ipsilesional primary motor cortex, Post vs. Pre BCI intervention, correlated significantly with improvements in hand function as assessed by grip force measurements. Moreover, the results show a significant change in the direction of causal information flow, as measured by iCoh, toward the ipsilesional motor (BA 4) and ipsilesional premotor cortices (BA 6) during BCI intervention. Significant iCoh increases from ipsilesional BA 4 to ipsilesional BA 6 were observed in both Mu [8–12 Hz] and Beta [18–26 Hz] frequency ranges. In summary, the present results are indicative of improvements in motor capacity and behavior, and they are consistent with the view that BCI-FES intervention improves functional motor capacity of the ipsilesional hemisphere and the impaired hand.
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Affiliation(s)
- Alexander B Remsik
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States.,Institute for Clinical and Translational Research, University of Wisconsin-Madison, Madison, WI, United States
| | - Klevest Gjini
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States
| | - Leroy Williams
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI, United States.,Center for Women's Health Research, University of Wisconsin-Madison, Madison, WI, United States
| | - Peter L E van Kan
- Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States.,Neuroscience Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Shawna Gloe
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Erik Bjorklund
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Clinical Neuroengineering Training Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Cameron A Rivera
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Sophia Romero
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Brittany M Young
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States.,Neuroscience Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.,Clinical Neuroengineering Training Program, University of Wisconsin-Madison, Madison, WI, United States.,Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Veena A Nair
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Kristin E Caldera
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Justin C Williams
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, United States.,Department of Neurological Surgery, University of Wisconsin-Madison, Madison, WI, United States
| | - Vivek Prabhakaran
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States.,Department of Neurology, University of Wisconsin-Madison, Madison, WI, United States.,Neuroscience Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.,Medical Scientist Training Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States.,Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States.,Department of Psychology, University of Wisconsin-Madison, Madison, WI, United States
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13
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Classification of Limb and Mobility Impairments in Persons With Stroke Using the STREAM. J Neurol Phys Ther 2021; 46:96-102. [PMID: 34775436 DOI: 10.1097/npt.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Classification of functional impairment in persons with stroke can influence treatment planning but this information is missing in the Stroke Rehabilitation Assessment of Movement (STREAM) Scale. This study aimed to establish the classification of limb mobility impairments and item difficulty of the STREAM. METHODS Rasch analysis was conducted on the STREAM scores to examine the person and item reliability, the item difficulty, and level of impairments. A total of 240 participants were evaluated using the STREAM, the Fugl-Meyer Stroke Assessment (FM), and the Functional Ambulation Categories (FAC). The concurrent validity of the STREAM extremity (STREAM-E) category with the FM-motor category and the STREAM mobility (STREAM-M) category with the FAC category was analyzed using the Spearman rank-order correlation. RESULTS Person reliabilities of the STREAM-E and STREAM-M were 0.92 and 0.80, respectively. High-item reliability was observed in both STREAM-E (0.97) and STREAM-M (0.99). The STREAM items "flexes hip and knee in supine" and "rolls onto side" were the easiest items, whereas the "dorsiflexes affected ankle with knee extended" item was the most difficult item. The STREAM-E category demonstrated excellent concurrent validity with the FM-motor category (ρ = 0.83) in classifying individuals with stroke into 5 groups: mild, moderate, moderately severe, severe, and very severe limb impairment. The STREAM-M category showed a moderate correlation with the FAC category (ρ = 0.71) in categorizing persons with stroke into 3 groups: mild, moderate, and severe mobility impairment. DISCUSSION AND CONCLUSIONS Findings can be used in the assessment and treatment planning of persons with stroke.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A373).
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Nakanishi T, Mizuguchi N, Nakagawa K, Nakazawa K. Para-Sports can Promote Functional Reorganization in the Ipsilateral Primary Motor Cortex of Lower Limbs Amputee. Neurorehabil Neural Repair 2021; 35:1112-1123. [PMID: 34720011 DOI: 10.1177/15459683211056660] [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] [Indexed: 11/17/2022]
Abstract
Background. Drastic functional reorganization was observed in the ipsilateral primary motor cortex (M1) of a Paralympic long jumper with a unilateral below-knee amputation in our previous study. However, it remains unclear whether long-term para-sports are associated with ipsilateral M1 reorganization since only 1 athlete with amputation was investigated. Objective. This study aimed to investigate the relationship between the long-term para-sports and ipsilateral M1 reorganization after lower limb amputation. Methods. Lower limb rhythmic muscle contraction tasks with functional magnetic resonance imaging and T1-weighted structural imaging were performed in 30 lower limb amputees with different para-sports experiences in the chronic phase. Results. Brain activity in the ipsilateral primary motor and somatosensory areas (SM1) as well as the contralateral dorsolateral prefrontal cortex, SM1, and inferior temporal gyrus showed a positive correlation with the years of routine para-sports participation (sports years) during contraction of the amputated knee. Indeed, twelve of the 30 participants who exhibited significant ipsilateral M1 activation during amputated knee contraction had a relatively longer history of para-sports participation. No significant correlation was found in the structural analysis. Conclusions. Long-term para-sports could lead to extensive reorganization at the brain network level, not only bilateral M1 reorganization but also reorganization of the frontal lobe and visual pathways. These results suggest that the interaction of injury-induced and use-dependent cortical plasticity might bring about drastic reorganization in lower limb amputees.
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Affiliation(s)
- Tomoya Nakanishi
- Department of Life Sciences, Graduate School of Arts and Sciences, 68394The University of Tokyo, Meguro-ku, Tokyo, Japan.,Japan Society for the Promotion of Science, Chiyoda-ku, Tokyo, Japan
| | - Nobuaki Mizuguchi
- Department of Life Sciences, Graduate School of Arts and Sciences, 68394The University of Tokyo, Meguro-ku, Tokyo, Japan.,Research Organization of Science and Technology, 12696Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Kento Nakagawa
- Faculty of Sport Sciences, 13148Waseda University, Tokorozawa, Saitama, Japan
| | - Kimitaka Nakazawa
- Department of Life Sciences, Graduate School of Arts and Sciences, 68394The University of Tokyo, Meguro-ku, Tokyo, Japan
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15
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Zhou S, Guo Z, Wong K, Zhu H, Huang Y, Hu X, Zheng YP. Pathway-specific cortico-muscular coherence in proximal-to-distal compensation during fine motor control of finger extension after stroke. J Neural Eng 2021; 18. [PMID: 34428752 DOI: 10.1088/1741-2552/ac20bc] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022]
Abstract
Objective.Proximal-to-distal compensation is commonly observed in the upper extremity (UE) after a stroke, mainly due to the impaired fine motor control in hand joints. However, little is known about its related neural reorganization. This study investigated the pathway-specific corticomuscular interaction in proximal-to-distal UE compensation during fine motor control of finger extension post-stroke by directed corticomuscular coherence (dCMC).Approach.We recruited 14 chronic stroke participants and 11 unimpaired controls. Electroencephalogram (EEG) from the sensorimotor area was concurrently recorded with electromyography (EMG) from extensor digitorum (ED), flexor digitorum (FD), triceps brachii (TRI) and biceps brachii (BIC) muscles in both sides of the stroke participants and in the dominant (right) side of the controls during the unilateral isometric finger extension at 20% maximal voluntary contractions. The dCMC was analyzed in descending (EEG → EMG) and ascending pathways (EMG → EEG) via the directed coherence. It was also analyzed in stable (segments with higher EMG stability) and less-stable periods (segments with lower EMG stability) subdivided from the whole movement period to investigate the fine motor control. Finally, the corticomuscular conduction time was estimated by dCMC phase delay.Main results.The affected limb had significantly lower descending dCMC in distal UE (ED and FD) than BIC (P< 0.05). It showed the descending dominance (significantly higher descending dCMC than the ascending,P< 0.05) in proximal UE (BIC and TRI) rather than the distal UE as in the controls. In the less-stable period, the affected limb had significantly lower EMG stability but higher ascending dCMC (P< 0.05) in distal UE than the controls. Furthermore, significantly prolonged descending conduction time (∼38.8 ms) was found in ED in the affected limb than the unaffected (∼26.94 ms) and control limbs (∼25.74 ms) (P< 0.05).Significance.The proximal-to-distal UE compensation in fine motor control post-stroke exhibited altered descending dominance from the distal to proximal UE, increased ascending feedbacks from the distal UE for fine motor control, and prolonged descending conduction time in the agonist muscle.
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Affiliation(s)
- Sa Zhou
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Ziqi Guo
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Kiufung Wong
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Hanlin Zhu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Yanhuan Huang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
| | - Xiaoling Hu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, People's Republic of China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, People's Republic of China.,University Research Facility in Behavioural and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, People's Republic of China
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16
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Combined real-time fMRI and real time fNIRS brain computer interface (BCI): Training of volitional wrist extension after stroke, a case series pilot study. PLoS One 2021; 16:e0250431. [PMID: 33956845 PMCID: PMC8101762 DOI: 10.1371/journal.pone.0250431] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 04/01/2021] [Indexed: 02/07/2023] Open
Abstract
Objective Pilot testing of real time functional magnetic resonance imaging (rt-fMRI) and real time functional near infrared spectroscopy (rt-fNIRS) as brain computer interface (BCI) neural feedback systems combined with motor learning for motor recovery in chronic severely impaired stroke survivors. Approach We enrolled a four-case series and administered three sequential rt-fMRI and ten rt-fNIRS neural feedback sessions interleaved with motor learning sessions. Measures were: Arm Motor Assessment Tool, functional domain (AMAT-F; 13 complex functional tasks), Fugl-Meyer arm coordination scale (FM); active wrist extension range of motion (ROM); volume of activation (fMRI); and fNIRS HbO concentration. Performance during neural feedback was assessed, in part, using percent successful brain modulations during rt-fNIRS. Main results Pre-/post-treatment mean clinically significant improvement in AMAT-F (.49 ± 0.22) and FM (10.0 ± 3.3); active wrist ROM improvement ranged from 20° to 50°. Baseline to follow-up change in brain signal was as follows: fMRI volume of activation was reduced in almost all ROIs for three subjects, and for one subject there was an increase or no change; fNIRS HbO was within normal range, except for one subject who increased beyond normal at post-treatment. During rt-fNIRS neural feedback training, there was successful brain signal modulation (42%–78%). Significance Severely impaired stroke survivors successfully engaged in spatially focused BCI systems, rt-fMRI and rt-fNIRS, to clinically significantly improve motor function. At the least, equivalency in motor recovery was demonstrated with prior long-duration motor learning studies (without neural feedback), indicating that no loss of motor improvement resulted from substituting neural feedback sessions for motor learning sessions. Given that the current neural feedback protocol did not prevent the motor improvements observed in other long duration studies, even in the presence of fewer sessions of motor learning in the current work, the results support further study of neural feedback and its potential for recovery of motor function in stroke survivors. In future work, expanding the sophistication of either or both rt-fMRI and rt-fNIRS could hold the potential for further reducing the number of hours of training needed and/or the degree of recovery. ClinicalTrials.gov ID:NCT02856035.
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Mekbib DB, Debeli DK, Zhang L, Fang S, Shao Y, Yang W, Han J, Jiang H, Zhu J, Zhao Z, Cheng R, Ye X, Zhang J, Xu D. A novel fully immersive virtual reality environment for upper extremity rehabilitation in patients with stroke. Ann N Y Acad Sci 2021; 1493:75-89. [PMID: 33442915 DOI: 10.1111/nyas.14554] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/11/2022]
Abstract
Given the rising incidence of stroke, several technology-driven methods for rehabilitation have recently been developed. Virtual reality (VR) is a promising therapeutic technology among them. We recently developed a neuroscientifically grounded VR system to aid recovery of motor function poststroke. The developed system provides unilateral and bilateral upper extremity (UE) training in a fully immersive virtual environment that may stimulate and activate mirror neurons (MNs) in the brain necessary for UE rehabilitation. Twenty-three participants were randomized to a VR group (n = 12) to receive VR intervention (8 h within 2 weeks) plus 8-h occupational therapy (OT) or a control group (n = 11) to receive time-matched OT alone. Treatment effects on motor recovery and cortical reorganization were investigated using the Barthel Index (BI), Fugl-Meyer Upper Extremity (FM-UE), and resting-state fMRI. Both groups significantly improved BI (P < 0.05), reflecting the recovery of UE motor function. The VR group revealed significant improvements on FM-UE scores (P < 0.05) than the control group. Neural activity increased after the intervention, particularly in the brain areas implicating MNs, such as in the primary motor cortex. Overall, results suggested that using a neuroscientifically grounded VR system might offer additional benefits for UE rehabilitation in patients receiving OT.
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Affiliation(s)
- Destaw B Mekbib
- Interdisciplinary Institute of Neuroscience and Technology (ZIINT), College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, China
| | - Dereje Kebebew Debeli
- State Key Laboratory of Chemical Engineering, College of Chemical and Biological Engineering, Zhejiang University, Hangzhou, China
| | - Li Zhang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Shan Fang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Yuling Shao
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Wei Yang
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jiawei Han
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongjie Jiang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Junming Zhu
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiyong Zhao
- MOE & Shanghai Key Laboratory of Brain Functional Genomics (East China Normal University), Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
- Shanghai Key Laboratory of Magnetic Resonance, Institute of Cognitive Neuroscience, East China Normal University, Shanghai, China
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China
| | - Ruidong Cheng
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Xiangming Ye
- Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Jianmin Zhang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Dongrong Xu
- Molecular Imaging and Neuropathology Division, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York City, New York
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Senesh MR, Barragan K, Reinkensmeyer DJ. Rudimentary Dexterity Corresponds With Reduced Ability to Move in Synergy After Stroke: Evidence of Competition Between Corticoreticulospinal and Corticospinal Tracts? Neurorehabil Neural Repair 2020; 34:904-914. [PMID: 32830602 DOI: 10.1177/1545968320943582] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE When a stroke damages the corticospinal tract (CST), it has been hypothesized that the motor system switches to using the corticoreticulospinal tract (CRST) resulting in abnormal arm synergies. Is use of these tracts mutually exclusive, or can the motor system spontaneously switch between them depending on the type of movement it wants to make? If the motor system can share control at will, then people with a rudimentary ability to make dexterous movements should be able to perform synergistic arm movements as well. METHODS We analyzed clinical assessments of 319 persons' abilities to perform "out-of-synergy" and "in-synergy" arm movements after chronic stroke using the Upper Extremity Fugl-Meyer (UEFM) scale. RESULTS We identified a moderate range of arm impairment (UEFM = ~30-40) where subjects had a rudimentary ability to make out-of-synergy (~23%-50% on the out-of-synergy score) and dexterous hand movements (~3-10 blocks on Box and Blocks Test). Below this range persons could perform in-synergy but not out-of-synergy or dexterous movements. In the moderate range, however, scoring better on out-of-synergy movements correlated with scoring worse on in-synergy movements (P = .001, r ≈ -0.6). CONCLUSION Rudimentary dexterity corresponded with reduced ability to move the arm in-synergy. This finding supports the idea that CST and CRST compete and has implications for rehabilitation therapy.
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Cinar E, Saxena S, Gagnon I. Differential Effects of Concurrent Tasks on Gait in Typically Developing Children: A Meta-Analysis. J Mot Behav 2020; 53:509-522. [PMID: 32677588 DOI: 10.1080/00222895.2020.1791038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The objective of this study was to systematically analyze the literature surrounding dual-task (DT) effects on gait in typically developing children (TDC) and to conduct meta-analyses where applicable. After reviewing the abstracts of 676 articles, a total of 22 studies were included. The outcomes of interest were relative change in gait speed, cadence, stride length, double support time, variability in stride length between single and DT walking; and the exposures were concurrent tasks used for DT gait assessment. DT significantly affected each gait parameter (point estimate (PE), ranged from PE, -0.10; 95% CI, -0.13 to -0.08; p < .001 to PE, -0.66; 95% CI, -0.94 to -0.38; p < .001). The strength of DT effects varied by the concurrent task used. The greatest DT effect on gait speed, which was the most commonly presented outcome, was reported when upper extremity complex functional tasks (PE, -0.36; 95% CI, -0.49 to -0.23; p < .001, fine motor tasks (PE, -0.35; 95% CI, -0.38 to -0.32; p < .001), and verbal fluency tasks (PE, -0.26; 95% CI, -0.30 to -0.21; p < .001) were completed concurrently with gait. Children and adolescents experience performance decrements when they walk under DT conditions. Concurrent tasks differentially affect the degree of DT interference for each gait parameter.
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Affiliation(s)
- Eda Cinar
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
| | - Shikha Saxena
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada.,Children's Hospital of Eastern Ontario Research Institute University of Ottawa, Ottawa, Ontario, Canada
| | - Isabelle Gagnon
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada.,Concussion Research Lab, Trauma Center, Montreal Children's Hospital, MUHC, Westmount, Québec, Canada
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20
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Rieke JD, Matarasso AK, Yusufali MM, Ravindran A, Alcantara J, White KD, Daly JJ. Development of a combined, sequential real-time fMRI and fNIRS neurofeedback system to enhance motor learning after stroke. J Neurosci Methods 2020; 341:108719. [PMID: 32439425 DOI: 10.1016/j.jneumeth.2020.108719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND After stroke, wrist extension dyscoordination precludes functional arm/hand. We developed a more spatially precise brain signal for use in brain computer interface (BCI's) for stroke survivors. NEW METHOD Combination BCI protocol of real-time functional magnetic resonance imaging (rt-fMRI) sequentially followed by functional near infrared spectroscopy (rt-fNIRS) neurofeedback, interleaved with motor learning sessions without neural feedback. Custom Matlab and Python code was developed to provide rt-fNIRS-based feedback to the chronic stroke survivor, system user. RESULTS The user achieved a maximum of 71 % brain signal accuracy during rt-fNIRS neural training; progressive focus of brain activation across rt-fMRI neural training; increasing trend of brain signal amplitude during wrist extension across rt-fNIRS training; and clinically significant recovery of arm coordination and active wrist extension. COMPARISON WITH EXISTING METHODS Neurorehabilitation, peripherally directed, shows limited efficacy, as do EEG-based BCIs, for motor recovery of moderate/severely impaired stroke survivors. EEG-based BCIs are based on electrophysiological signal; whereas, rt-fMRI and rt-fNIRS are based on neurovascular signal. CONCLUSION The system functioned well during user testing. Methods are detailed for others' use. The system user successfully engaged rt-fMRI and rt-fNIRS neurofeedback systems, modulated brain signal during rt-fMRI and rt-fNIRS training, according to volume of brain activation and intensity of signal, respectively, and clinically significantly improved limb coordination and active wrist extension. fNIRS use in this case demonstrates a feasible/practical BCI system for further study with regard to use in chronic stroke rehab, and fMRI worked in concept, but cost and some patient-use issues make it less feasible for clinical practice.
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Affiliation(s)
- Jake D Rieke
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Department of Biomedical Engineering (BME), NEB Building, University of Florida, Gainesville, FL, 32608, USA
| | - Avi K Matarasso
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Dept of Chemical Engineering, NEB Building, UF, Gainesville, FL, 32608, USA
| | - M Minhal Yusufali
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Department of Biomedical Engineering (BME), NEB Building, University of Florida, Gainesville, FL, 32608, USA
| | - Aniruddh Ravindran
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Department of Biomedical Engineering (BME), NEB Building, University of Florida, Gainesville, FL, 32608, USA
| | - Jose Alcantara
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Department of Biomedical Engineering (BME), NEB Building, University of Florida, Gainesville, FL, 32608, USA
| | - Keith D White
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA
| | - Janis J Daly
- Brain Rehabilitation Research Center (BRRC), Malcom Randall VA Medical Center (VA), 1600 SW Archer Rd, Gainesville, FL, 32608, USA; Dept of Neurology, College of Medicine, UF, Gainesville, FL, 32608, USA.
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21
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Daly JJ, McCabe JP, Holcomb J, Monkiewicz M, Gansen J, Pundik S. Long-Dose Intensive Therapy Is Necessary for Strong, Clinically Significant, Upper Limb Functional Gains and Retained Gains in Severe/Moderate Chronic Stroke. Neurorehabil Neural Repair 2019; 33:523-537. [PMID: 31131743 PMCID: PMC6625035 DOI: 10.1177/1545968319846120] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background. Effective treatment methods are needed for moderate/severely impairment chronic stroke. Objective. The questions were the following: (1) Is there need for long-dose therapy or is there a mid-treatment plateau? (2) Are the observed gains from the prior-studied protocol retained after treatment? Methods. Single-blind, stratified/randomized design, with 3 applied technology treatment groups, combined with motor learning, for long-duration treatment (300 hours of treatment). Measures were Arm Motor Ability Test time and coordination-function (AMAT-T, AMAT-F, respectively), acquired pre-/posttreatment and 3-month follow-up (3moF/U); Fugl-Meyer (FM), acquired similarly with addition of mid-treatment. Findings. There was no group difference in treatment response (P ≥ .16), therefore data were combined for remaining analyses (n = 31; except for FM pre/mid/post, n = 36). Pre-to-Mid-treatment and Mid-to-Posttreatment gains of FM were statistically and clinically significant (P < .0001; 4.7 points and P < .001; 5.1 points, respectively), indicating no plateau at 150 hours and benefit of second half of treatment. From baseline to 3moF/U: (1) FM gains were twice the clinically significant benchmark, (2) AMAT-F gains were greater than clinically significant benchmark, and (3) there was statistically significant improvement in FM (P < .0001); AMAT-F (P < .0001); AMAT-T (P < .0001). These gains indicate retained clinically and statistically significant gains at 3moFU. From posttreatment to 3moF/U, gains on FM were maintained. There were statistically significant gains in AMAT-F (P = .0379) and AMAT-T P = .003.
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Affiliation(s)
- Janis J. Daly
- Malcom Randall Gainesville DVA Medical
Center, Gainesville, FL, USA
- College of Medicine, University of
Florida, Gainesville, FL, USA
| | | | | | | | - Jennifer Gansen
- Louis Stokes Cleveland VA Medical
Center, Cleveland, OH, USA
| | - Svetlana Pundik
- Louis Stokes Cleveland VA Medical
Center, Cleveland, OH, USA
- Case Western Reserve University School
of Medicine, Cleveland, OH, USA
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22
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Elgueta-Cancino E, Massé-Alarie H, Schabrun SM, Hodges PW. Electrical Stimulation of Back Muscles Does Not Prime the Corticospinal Pathway. Neuromodulation 2019; 22:555-563. [PMID: 31232503 DOI: 10.1111/ner.12978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate whether peripheral electrical stimulation (PES) of back extensor muscles changes excitability of the corticospinal pathway of the stimulated muscle and synergist trunk muscles. METHODS In 12 volunteers with no history of low back pain (LBP), intramuscular fine-wire electrodes recorded electromyography (EMG) from the deep multifidus (DM) and longissimus muscles. Surface electrodes recorded general EMG from the erector spinae and abdominal muscles. Single- and paired-pulse transcranial magnetic stimulation (TMS) paradigms tested corticospinal excitability, short-interval intracortical inhibition (SICI-2 and 3 ms), and intracortical facilitation (ICF) optimized for recordings of DM. Active motor threshold (aMT) to evoke a motor-evoked potential (MEP) in DM was determined and stimulation was applied at 120% of this intensity. PES was provided via electrodes placed over the right multifidus. The effect of 20-min PES (ramped motor activation) was studied. RESULTS Mean aMT for DM was 42.7 ± 10% of the maximal stimulator output. No effects of PES were found on MEP amplitude (single-pulse TMS) for any trunk muscles examined. There was no evidence for changes in SICI or ICF; that is, conditioned MEP amplitude was not different between trials after PES. CONCLUSION Results indicate that, unlike previous reports that show increased corticospinal excitability of limb muscles, PES of back muscles does not modify the corticospinal excitability. This difference in response of the motor pathway of back muscles to PES might be explained by the lesser importance of voluntary cortical drive to these muscles and the greater role of postural networks. Whether PES influences back muscle training remains unclear, yet the present results suggest that potential effects are unlikely to be explained by the effects of PES at corticospinal level with the parameters used in this study.
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Affiliation(s)
- Edith Elgueta-Cancino
- Centre of Clinical Excellence Research in Spinal Pain Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Hugo Massé-Alarie
- Centre of Clinical Excellence Research in Spinal Pain Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Siobhan M Schabrun
- Brain Rehabilitation and Neuroplasticity Unit, School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
| | - Paul W Hodges
- Centre of Clinical Excellence Research in Spinal Pain Injury and Health, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
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23
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Manuweera T, Yarossi M, Adamovich S, Tunik E. Parietal Activation Associated With Target-Directed Right Hand Movement Is Lateralized by Mirror Feedback to the Ipsilateral Hemisphere. Front Hum Neurosci 2019; 12:531. [PMID: 30687047 PMCID: PMC6333851 DOI: 10.3389/fnhum.2018.00531] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 12/17/2018] [Indexed: 01/23/2023] Open
Abstract
Current research shows promise in restoring impaired hand function after stroke with the help of Mirror Visual Feedback (MVF), putatively by facilitating activation of sensorimotor areas of the brain ipsilateral to the moving limb. However, the MVF related clinical effects show variability across studies. MVF tasks that have been used place varying amounts of visuomotor demand on one’s ability to complete the task. Therefore, we ask here whether varying visuomotor demand during MVF may translate to differences in brain activation patterns. If so, we argue that this may provide a mechanistic explanation for variable clinical effects. To address this, we used functional magnetic resonance imaging (fMRI) to investigate the interaction of target directed movement and MVF on the activation of, and functional connectivity between, regions within the visuomotor network. In an event-related fMRI design, twenty healthy subjects performed finger flexion movements using their dominant right hand, with feedback presented in a virtual reality (VR) environment. Visual feedback was presented in real time VR as either veridical feedback with and without a target (VT+ and VT-, respectively), or MVF with and without a target (MT+ and MT-, respectively). fMRI contrasts revealed predominantly activation in the ipsilateral intraparietal sulcus for the main effect of MVF and bilateral superior parietal activation for the main effect of target. Importantly, we noted significant and robust activation lateralized to the ipsilateral parietal cortex alone in the MT+ contrast with respect to the other conditions. This suggests that combining MVF with targeted movements performed using the right hand may redirect enhanced bilateral parietal activation due to target presentation to the ipsilateral cortex. Moreover, functional connectivity analysis revealed that the interaction between the ipsilateral parietal lobe and the motor cortex was significantly greater during target-directed movements with mirror feedback compared to veridical feedback. These findings provide a normative basis to investigate the integrity of these networks in patient populations. Identification of the brain regions involved in target directed movement with MVF in stroke may have important implications for optimal delivery of MVF based therapy.
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Affiliation(s)
- Thushini Manuweera
- Rutgers School of Graduate Studies, Rutgers University, Newark, NJ, United States.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Mathew Yarossi
- Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA, United States
| | - Sergei Adamovich
- Rutgers School of Graduate Studies, Rutgers University, Newark, NJ, United States.,Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, NJ, United States
| | - Eugene Tunik
- Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA, United States.,Department of Electrical and Computer Engineering, College of Engineering, Northeastern University, Boston, MA, United States
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24
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Biasiucci A, Leeb R, Iturrate I, Perdikis S, Al-Khodairy A, Corbet T, Schnider A, Schmidlin T, Zhang H, Bassolino M, Viceic D, Vuadens P, Guggisberg AG, Millán JDR. Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke. Nat Commun 2018; 9:2421. [PMID: 29925890 PMCID: PMC6010454 DOI: 10.1038/s41467-018-04673-z] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 05/09/2018] [Indexed: 12/29/2022] Open
Abstract
Brain-computer interfaces (BCI) are used in stroke rehabilitation to translate brain signals into intended movements of the paralyzed limb. However, the efficacy and mechanisms of BCI-based therapies remain unclear. Here we show that BCI coupled to functional electrical stimulation (FES) elicits significant, clinically relevant, and lasting motor recovery in chronic stroke survivors more effectively than sham FES. Such recovery is associated to quantitative signatures of functional neuroplasticity. BCI patients exhibit a significant functional recovery after the intervention, which remains 6-12 months after the end of therapy. Electroencephalography analysis pinpoints significant differences in favor of the BCI group, mainly consisting in an increase in functional connectivity between motor areas in the affected hemisphere. This increase is significantly correlated with functional improvement. Results illustrate how a BCI-FES therapy can drive significant functional recovery and purposeful plasticity thanks to contingent activation of body natural efferent and afferent pathways.
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Affiliation(s)
- A Biasiucci
- Defitech Foundation Chair in Brain-Machine Interface, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - R Leeb
- Defitech Foundation Chair in Brain-Machine Interface, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland.,Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Sion, 1951, Switzerland
| | - I Iturrate
- Defitech Foundation Chair in Brain-Machine Interface, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - S Perdikis
- Defitech Foundation Chair in Brain-Machine Interface, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland.,Wyss Center for Bio and Neuroengineering, Geneva, 1202, Switzerland
| | - A Al-Khodairy
- SUVACare - Clinique Romande de Réadaptation, Sion, 1951, Switzerland
| | - T Corbet
- Defitech Foundation Chair in Brain-Machine Interface, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - A Schnider
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, 1211, Switzerland
| | - T Schmidlin
- Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Sion, 1951, Switzerland
| | - H Zhang
- Defitech Foundation Chair in Brain-Machine Interface, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland
| | - M Bassolino
- Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Sion, 1951, Switzerland
| | - D Viceic
- Center for Neuroprosthetics, École Polytechnique Fédérale de Lausanne, Sion, 1951, Switzerland
| | - P Vuadens
- SUVACare - Clinique Romande de Réadaptation, Sion, 1951, Switzerland
| | - A G Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital of Geneva, Geneva, 1211, Switzerland
| | - J D R Millán
- Defitech Foundation Chair in Brain-Machine Interface, Center for Neuroprosthetics and Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Geneva, 1202, Switzerland.
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25
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Pundik S, Scoco A, Skelly M, McCabe JP, Daly JJ. Greater Cortical Thickness Is Associated With Enhanced Sensory Function After Arm Rehabilitation in Chronic Stroke. Neurorehabil Neural Repair 2018; 32:590-601. [DOI: 10.1177/1545968318778810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Somatosensory function is critical to normal motor control. After stroke, dysfunction of the sensory systems prevents normal motor function and degrades quality of life. Structural neuroplasticity underpinnings of sensory recovery after stroke are not fully understood. The objective of this study was to identify changes in bilateral cortical thickness (CT) that may drive recovery of sensory acuity. Methods. Chronic stroke survivors (n = 20) were treated with 12 weeks of rehabilitation. Measures were sensory acuity (monofilament), Fugl-Meyer upper limb and CT change. Permutation-based general linear regression modeling identified cortical regions in which change in CT was associated with change in sensory acuity. Results. For the ipsilesional hemisphere in response to treatment, CT increase was significantly associated with sensory improvement in the area encompassing the occipital pole, lateral occipital cortex (inferior and superior divisions), intracalcarine cortex, cuneal cortex, precuneus cortex, inferior temporal gyrus, occipital fusiform gyrus, supracalcarine cortex, and temporal occipital fusiform cortex. For the contralesional hemisphere, increased CT was associated with improved sensory acuity within the posterior parietal cortex that included supramarginal and angular gyri. Following upper limb therapy, monofilament test score changed from 45.0 ± 13.3 to 42.6 ± 12.9 mm ( P = .063) and Fugl-Meyer score changed from 22.1 ± 7.8 to 32.3 ± 10.1 ( P < .001). Conclusions. Rehabilitation in the chronic stage after stroke produced structural brain changes that were strongly associated with enhanced sensory acuity. Improved sensory perception was associated with increased CT in bilateral high-order association sensory cortices reflecting the complex nature of sensory function and recovery in response to rehabilitation.
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Affiliation(s)
- Svetlana Pundik
- Case Western Reserve University, Cleveland, OH, USA
- Cleveland VA Medical Center, Cleveland, OH, USA
| | - Aleka Scoco
- Case Western Reserve University, Cleveland, OH, USA
| | | | | | - Janis J. Daly
- University of Florida, Gainesville, FL, USA
- Gainesville VA Medical Center, Gainesville, FL, USA
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26
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Carvalho R, Azevedo E, Marques P, Dias N, Cerqueira JJ. Physiotherapy based on problem-solving in upper limb function and neuroplasticity in chronic stroke patients: A case series. J Eval Clin Pract 2018; 24:552-560. [PMID: 29691951 DOI: 10.1111/jep.12921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/27/2018] [Accepted: 03/02/2018] [Indexed: 12/13/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Upper limb recovery is one of the main concerns of stroke neurorehabilitation. Neuroplasticity might underlie such recovery, particularly in the chronic phase. The purpose of this study was to assess the effect of physiotherapy based on problem-solving in recovering arm function in chronic stroke patients and explore its neuroplastic changes. METHODS A small sample research design with a n of 3 using a pre-post test design was carried out. Neuroplasticity and function were assessed by using functional magnetic resonance imaging (during motor imagery and performance), action research arm test, motor assessment scale, and Fugl-Meyer assessment scale, at 3 sequential time periods: baseline(m0-before a 4-week period without physiotherapy), pre-treatment(m1), and post-treatment(m2). Minimal clinical important differences and a recovery score were assessed. Assessors were blinded to moment assignment. Patients1 underwent physiotherapy sessions, 50 minutes, 5 days/week for 4 weeks. Four control subjects served as a reference for functional magnetic resonance imaging changes. RESULTS All patients recovered more than 20% after intervention. Stroke patients had similar increased areas as healthy subjects during motor execution but not during imagination at baseline. Consequently, all patients increased activity in the contralateral precentral area after intervention. CONCLUSIONS This study indicates that 4 weeks of physiotherapy promoted the recovery of arm function and neuroplasticity in all chronic stroke patients. Future research is recommended to determine the efficacy of this therapy.
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Affiliation(s)
- Raquel Carvalho
- Department of Physical Therapy, CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies, Portugal.,Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal
| | - Elsa Azevedo
- Department of Neurology, Hospital São João and Faculty of Medicine of University of Porto, Portugal
| | - Paulo Marques
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Nuno Dias
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.,DIGARC, Polytechnic Institute of Cavado and Ave, Barcelos, Portugal
| | - João José Cerqueira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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27
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Toward precision medicine: tailoring interventional strategies based on noninvasive brain stimulation for motor recovery after stroke. Curr Opin Neurol 2017; 30:388-397. [DOI: 10.1097/wco.0000000000000462] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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28
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Harris-Love ML, Harrington RM. Non-Invasive Brain Stimulation to Enhance Upper Limb Motor Practice Poststroke: A Model for Selection of Cortical Site. Front Neurol 2017; 8:224. [PMID: 28611727 PMCID: PMC5447046 DOI: 10.3389/fneur.2017.00224] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/09/2017] [Indexed: 12/15/2022] Open
Abstract
Motor practice is an essential part of upper limb motor recovery following stroke. To be effective, it must be intensive with a high number of repetitions. Despite the time and effort required, gains made from practice alone are often relatively limited, and substantial residual impairment remains. Using non-invasive brain stimulation to modulate cortical excitability prior to practice could enhance the effects of practice and provide greater returns on the investment of time and effort. However, determining which cortical area to target is not trivial. The implications of relevant conceptual frameworks such as Interhemispheric Competition and Bimodal Balance Recovery are discussed. In addition, we introduce the STAC (Structural reserve, Task Attributes, Connectivity) framework, which incorporates patient-, site-, and task-specific factors. An example is provided of how this framework can assist in selecting a cortical region to target for priming prior to reaching practice poststroke. We suggest that this expanded patient-, site-, and task-specific approach provides a useful model for guiding the development of more successful approaches to neuromodulation for enhancing motor recovery after stroke.
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Affiliation(s)
- Michelle L Harris-Love
- Bioengineering Department, Volgenau School of Engineering, George Mason University, Fairfax, VA, United States.,MedStar National Rehabilitation Hospital, Washington, DC, United States
| | - Rachael M Harrington
- MedStar National Rehabilitation Hospital, Washington, DC, United States.,Interdisciplinary Program in Neuroscience, Georgetown University, Washington, DC, United States
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29
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Abstract
Brain-computer interface (BCI) technology can restore communication and control to people who are severely paralyzed. There has been speculation that this technology might also be useful for a variety of diverse therapeutic applications. This survey considers possible ways that BCI technology can be applied to motor rehabilitation following stroke, Parkinson's disease, and psychiatric disorders. We consider potential neural signals as well as the design and goals of BCI-based therapeutic applications. These diverse applications all share a reliance on neuroimaging and signal processing technologies. At the same time, each of these potential applications presents a series of unique challenges.
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Affiliation(s)
| | - Janis Daly
- Brain Rehabilitation Research Program, McKnight Brain Institute, University of Florida, Gainesville, FL
| | - Chadwick Boulay
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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30
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Jang SH, Seo JP, Lee SH, Jin SH, Yeo SS. The cortical activation pattern during bilateral arm raising movements. Neural Regen Res 2017; 12:317-320. [PMID: 28400816 PMCID: PMC5361518 DOI: 10.4103/1673-5374.200817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Bilateral arm raising movements have been used in brain rehabilitation for a long time. However, no study has been reported on the effect of these movements on the cerebral cortex. In this study, using functional near infrared spectroscopy (fNIRS), we attempted to investigate cortical activation generated during bilateral arm raising movements. Ten normal subjects were recruited for this study. fNIRS was performed using an fNIRS system with 49 channels. Bilateral arm raising movements were performed in sitting position at the rate of 0.5 Hz. We measured values of oxyhemoglobin and total hemoglobin in five regions of interest: the primary sensorimotor cortex, premotor cortex, supplementary motor area, prefrontal cortex, and posterior parietal cortex. During performance of bilateral arm raising movements, oxyhemoglobin and total hemoglobin values in the primary sensorimotor cortex, premotor cortex, supplementary motor area, and prefrontal cortex were similar, but higher in these regions than those in the prefrontal cortex. We observed activation of the arm somatotopic areas of the primary sensorimotor cortex and premotor cortex in both hemispheres during bilateral arm raising movements. According to this result, bilateral arm raising movements appeared to induce large-scale neuronal activation and therefore arm raising movements would be good exercise for recovery of brain functions.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jung Pyo Seo
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Seung-Hyun Lee
- Robot System Research Division, Daegu Gyeongbuk Institute of Science & Technology, Daegu, Republic of Korea
| | - Sang-Hyun Jin
- Robot System Research Division, Daegu Gyeongbuk Institute of Science & Technology, Daegu, Republic of Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan-si, Chungnam, Republic of Korea
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31
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Cassidy JM, Cramer SC. Spontaneous and Therapeutic-Induced Mechanisms of Functional Recovery After Stroke. Transl Stroke Res 2016; 8:33-46. [PMID: 27109642 DOI: 10.1007/s12975-016-0467-5] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/13/2016] [Accepted: 04/18/2016] [Indexed: 01/05/2023]
Abstract
With increasing rates of survival throughout the past several years, stroke remains one of the leading causes of adult disability. Following the onset of stroke, spontaneous mechanisms of recovery at the cellular, molecular, and systems levels ensue. The degree of spontaneous recovery is generally incomplete and variable among individuals. Typically, the best recovery outcomes entail the restitution of function in injured but surviving neural matter. An assortment of restorative therapies exists or is under development with the goal of potentiating restitution of function in damaged areas or in nearby ipsilesional regions by fostering neuroplastic changes, which often rely on mechanisms similar to those observed during spontaneous recovery. Advancements in stroke rehabilitation depend on the elucidation of both spontaneous and therapeutic-driven mechanisms of recovery. Further, the implementation of neural biomarkers in research and clinical settings will enable a multimodal approach to probing brain state and predicting the extent of post-stroke functional recovery. This review will discuss spontaneous and therapeutic-induced mechanisms driving post-stroke functional recovery while underscoring several potential restorative therapies and biomarkers.
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Affiliation(s)
- Jessica M Cassidy
- Department of Neurology, University of California, Irvine Medical Center, 200 S. Manchester Ave, Suite 206, Orange, CA, 92868-4280, USA
| | - Steven C Cramer
- Department of Neurology, University of California, Irvine Medical Center, 200 S. Manchester Ave, Suite 206, Orange, CA, 92868-4280, USA. .,Department of Anatomy & Neurobiology, University of California, Irvine, Irvine, CA, 92697, USA. .,Department of Physical Medicine & Rehabilitation, University of California, Irvine Medical Center, 200 S. Manchester Ave, Suite 210, Orange, CA, 92868-5397, USA. .,Sue & Bill Gross Stem Cell Research Center, University of California, Irvine, 845 Health Sciences Rd, Irvine, 92697, CA, USA.
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