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Zhang A, Xing Y, Zheng J, Li C, Hua Y, Hu J, Tian Z, Bai Y. Constraint-Induced Movement Therapy Modulates Neuron Recruitment and Neurotransmission Homeostasis of the Contralesional Cortex to Enhance Function Recovery after Ischemic Stroke. ACS OMEGA 2024; 9:21612-21625. [PMID: 38764659 PMCID: PMC11097180 DOI: 10.1021/acsomega.4c02537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
Stroke often results in long-term and severe limb dysfunction for a majority of patients, significantly limiting their activities and social participation. Constraint-induced movement therapy (CIMT) is a rehabilitation approach aimed explicitly at enhancing upper limb motor function following a stroke. However, the precise mechanism remains unknown. This study explores how CIMT may alleviate forelimb paralysis in ischemic mice, potentially through structural and functional remodeling of brain regions beyond the infarct area, especially the contralateral cortex. We demonstrated that CIMT recruits neurons from the contralesional cortex into the network that innervates the affected forelimb, as evidenced by PRV retrograde nerve tracing. Additionally, we investigated how CIMT influences synaptic plasticity in the contralateral cortex by evaluating synaptic growth marker levels and neurotransmission's homeostatic regulation. Our findings uncover a rehabilitative mechanism by which CIMT treats ischemic stroke, characterized by increased recruitment of neurons from the contralateral cortex into the network that innervates the affected forelimb, facilitated by homeostatic regulation of neurotransmission.
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Affiliation(s)
- Anjing Zhang
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
- Department
of Neurological Rehabilitation Medicine, The First Rehabilitation Hospital of Shanghai, Shanghai 200093, P.R. China
| | - Ying Xing
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Jiayuan Zheng
- Department
of Integrative Medicine and Neurobiology, School of Basic Medical
Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers
Center for Brain Science, Institutes of Brain Science, Institute of
Acupuncture Research, Academy of Integrative Medicine, Shanghai Key
Laboratory for Acupuncture Mechanism and Acupoint Function, Shanghai
Medical College, Fudan University, Shanghai 200433, China
| | - Congqin Li
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Yan Hua
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Jian Hu
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Zhanzhuang Tian
- Department
of Integrative Medicine and Neurobiology, School of Basic Medical
Sciences, State Key Laboratory of Medical Neurobiology and MOE Frontiers
Center for Brain Science, Institutes of Brain Science, Institute of
Acupuncture Research, Academy of Integrative Medicine, Shanghai Key
Laboratory for Acupuncture Mechanism and Acupoint Function, Shanghai
Medical College, Fudan University, Shanghai 200433, China
| | - Yulong Bai
- Department
of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
- National
Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
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Zhang H, Liu J, Bingham D, Orr A, Kawabori M, Kim JY, Zheng Z, Lam TI, Massa SM, Swanson RA, Yenari MA. Use of Botulinum Toxin for Limb Immobilization for Rehabilitation in Rats with Experimental Stroke. Biomolecules 2023; 13:512. [PMID: 36979446 PMCID: PMC10046338 DOI: 10.3390/biom13030512] [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: 01/27/2023] [Revised: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Motor rehabilitation strategies after unilateral stroke suggest that the immobilization of the healthy, unimpaired limb can promote the functional recovery of a paretic limb. In rodents, this has been modeled using casts, harnesses, and other means of restricting the use of the non-paretic forelimb in models of experimental stroke. Here, we evaluated an alternative approach, using botulinum toxin injections to limit the function of the non-paretic forelimb. Adult male rats were subjected to permanent ligation of the left distal middle cerebral artery, resulting in right forelimb paresis. The rats were then subjected to: (1) no treatment; (2) botulinum toxin injections 1 day post stroke; or (3) cast placement 5 days post stroke. Casts were removed after 5 weeks, while the botulinum toxin injection effectively immobilized subjects for approximately the same duration. Rats with bilateral forelimb impairment due to the stroke plus casting or botulinum injections were still able to feed and groom normally. Both immobilization groups showed modest recovery following the stroke compared to those that did not receive immobilization, but the casting approach led to unacceptable levels of animal stress. The botulinum toxin approach to limb immobilization had both advantages and disadvantages over traditional physical limb immobilization. The major advantage was that it was far less stress-inducing to the subject animals and appeared to be well tolerated. A disadvantage was that the paresis took roughly 10 weeks to fully resolve, and any degree of residual paresis could confound the interpretation of the behavioral assessments.
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Affiliation(s)
- Hongxia Zhang
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Jialing Liu
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Deborah Bingham
- Department of Neurological Surgery, University of California, San Francisco, CA 94143, USA
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
| | - Adrienne Orr
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Masahito Kawabori
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Neurology, University of California, San Francisco, CA 94143, USA
- Department of Neurosurgery, Hokkaido University, Sapporo 060-0808, Japan
| | - Jong Youl Kim
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Neurology, University of California, San Francisco, CA 94143, USA
- Department of Anatomy, Yonsei University, Seoul 03722, Republic of Korea
| | - Zhen Zheng
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Tina I. Lam
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Stephen M. Massa
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Raymond A. Swanson
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Midori A. Yenari
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA
- Department of Neurology, University of California, San Francisco, CA 94143, USA
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Gular K, Sivasubramanian V, Reddy RS, Tedla JS, Dixit S. The Mediating Effect of Age, Gender, and Post-Stroke Duration on the Association between Trunk and Upper Limb Recovery in Subacute Stroke Population: A Cross-Sectional Study with Mediation Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15644. [PMID: 36497718 PMCID: PMC9738511 DOI: 10.3390/ijerph192315644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The trunk acts as proximal support with which limbs execute smooth and purposeful movement. Furthermore, as upper extremity functions are an integral component of daily living activities, exploring the association between trunk and upper extremity recovery will guide therapists in developing appropriate rehabilitation goals and interventions. The objectives of this study were to (1) assess the association between trunk and upper extremity recovery in the subacute stroke population and (2) assess the effect of trunk control on upper extremity impairment and function with age, gender, and duration of stroke as mediators using mediation analysis in subacute stroke individuals. METHODS This cross-sectional study included 54 subacute stroke participants with a mean age of 58.37 ± 6.11 years. The trunk impairment scale (TIS) assessed the trunk's stability, mobility, and coordination. The level of upper extremity impairment was evaluated using the Fugl-Meyer Assessment scale (FMA). The quality and quantity of upper limb motor functions were measured using the Wolf motor function test (WMFT). RESULTS The TIS exhibited moderate positive correlations with the FMA-UE, WMFT-time scale (TS), and WMFT-functional ability scale (FAS) at p < 0.001. The mediation analysis reported a profound mediation effect of post-stroke duration on the association of trunk and upper limb recovery. CONCLUSIONS The study results substantiated that trunk control significantly correlates with upper limb impairment and the quality and quantity of its use in the subacute stroke population. Post-stroke duration proved to mediate the association between trunk and upper limb recovery. Therefore, the assessment and intervention of trunk and upper extremity motor control considering the post-stroke duration is vital and should be incorporated in stroke rehabilitation aiming at functional independence.
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Affiliation(s)
- Kumar Gular
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Viswanathan Sivasubramanian
- Division of Physical Medicine and Rehabilitation, Rajah Muthiah Medical College and Hospital, Annamalai University, Annamalai Nagar 608 002, India
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
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