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Bavikatte G, Esquenazi A, Dimyan MA, Dashtipour K, Feng W, Mayadev A, Fanning K, Musacchio T, Zuzek A, Francisco GE. Safety and real-world dosing of onabotulinumtoxinA for the treatment of adult spasticity: post hoc analysis of the Adult Spasticity International Registry study. Am J Phys Med Rehabil 2024:00002060-990000000-00390. [PMID: 38206635 DOI: 10.1097/phm.0000000000002410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To evaluate the safety of onabotulinumtoxinA treatment for spasticity across dose ranges in real-world practice. DESIGN Adult Spasticity International Registry (ASPIRE) was a multicenter, prospective, observational study (NCT01930786) of onabotulinumtoxinA treatment for adult spasticity over 2 years. Adverse events (AEs), serious AEs (SAEs), treatment-related AEs (TRAEs), and TRSAEs were sorted into 5 categories (≤200 U, 201-400 U, 401-600 U, 601-800 U, ≥801 U) based on cumulative dose per session. RESULTS In 3103 treatment sessions (T), 730 patients received ≥1 dose of onabotulinumtoxinA. Dose categories included: ≤200 U (n = 312; t = 811), 201-400 U (n = 446, t = 1366), 401-600 U (n = 244, t = 716), 601-800 U (n = 69, t = 149), ≥801 U (n = 29, t = 61). Of these patients, 261 reported 827 AEs, 94 reported 195 SAEs, 20 reported 23 TRAEs, and 2 patients treated with 201-400 U onabotulinumtoxinA reported 3 TRSAEs. TRAEs reported: ≤200 U (8 TRAEs/811, 0.9%); 201-400 U (7/1366, 0.5%); 401-600 U (6/716, 0.8%); 601-800 U (1/149, 0.7%); ≥801 U (1/61, 1.6%). CONCLUSIONS In this post hoc analysis, most treatment sessions were performed with 201-400 U onabotulinumtoxinA. Patients treated with 201-400 U onabotulinumtoxinA had an AE profile consistent with onabotulinumtoxinA package inserts globally (eg, United States, European Union, United Kingdom, Canada). No new safety signals were identified.
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Affiliation(s)
| | | | | | | | - Wuwei Feng
- Duke University School of Medicine, Durham, NC, USA
| | | | | | | | | | - Gerard E Francisco
- University of Texas McGovern Medical School and TIRR Memorial Hermann, Houston, TX, USA
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2
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Dimyan MA, Harcum S, Ermer E, Boos AF, Conroy SS, Liu F, Horn LB, Xu H, Zhan M, Chen H, Whitall J, Wittenberg GF. Baseline Predictors of Response to Repetitive Task Practice in Chronic Stroke. Neurorehabil Neural Repair 2022; 36:426-436. [PMID: 35616437 DOI: 10.1177/15459683221095171] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Repetitive task practice reduces mean upper extremity motor impairment in populations of patients with chronic stroke, but individual response is highly variable. A method to predict meaningful reduction in impairment in response to training based on biomarkers and other data collected prior to an intervention is needed to establish realistic rehabilitation goals and to effectively allocate resources. OBJECTIVES To identify prognostic factors and better understand the biological substrate for reductions in arm impairment in response to repetitive task practice among patients with chronic (≥6 months) post-stroke hemiparesis. METHODS The intervention is a form of repetitive task practice using a combination of robot-assisted therapy and functional arm use in real-world tasks. Baseline measures include the Fugl-Meyer Assessment, Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, MRI, transcranial magnetic stimulation, kinematics, accelerometry, and genomic testing. RESULTS Mean increase in FM-UE was 4.6 ± 1.0 SE, median 2.5. Approximately one-third of participants had a clinically meaningful response to the intervention, defined as an increase in FM ≥ 5. The selected logistic regression model had a receiver operating curve with AUC = .988 (Std Error = .011, 95% Wald confidence limits: .967-1) showed little evidence of overfitting. Six variables that predicted response represented impairment, functional, and genomic measures. CONCLUSION A simple weighted sum of 6 baseline factors can accurately predict clinically meaningful impairment reduction after outpatient intensive practice intervention in chronic stroke. Reduction of impairment may be a critical first step to functional improvement. Further validation and generalization of this model will increase its utility in clinical decision-making.
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Affiliation(s)
- Michael A Dimyan
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,Geriatrics Research, Education and Clinical Center and Maryland Exercise and Robotics Center of Excellence, Veterans Affairs Medical Center, Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Stacey Harcum
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Elsa Ermer
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Amy F Boos
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Susan S Conroy
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA
| | - Fang Liu
- Rehab & Neural Engineering Labs, Department of Physical Medicine & Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Linda B Horn
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Huichun Xu
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Zhan
- Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Hegang Chen
- Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - George F Wittenberg
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, MD, USA.,Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.,Geriatrics Research, Education and Clinical Center and Maryland Exercise and Robotics Center of Excellence, Veterans Affairs Medical Center, Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.,Geriatrics Research, Education and Clinical Center, Human Engineering Research Laboratory, VA Maryland Health Care System, Pittsburgh, PA, USA
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3
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Liew S, Zavaliangos‐Petropulu A, Jahanshad N, Lang CE, Hayward KS, Lohse KR, Juliano JM, Assogna F, Baugh LA, Bhattacharya AK, Bigjahan B, Borich MR, Boyd LA, Brodtmann A, Buetefisch CM, Byblow WD, Cassidy JM, Conforto AB, Craddock RC, Dimyan MA, Dula AN, Ermer E, Etherton MR, Fercho KA, Gregory CM, Hadidchi S, Holguin JA, Hwang DH, Jung S, Kautz SA, Khlif MS, Khoshab N, Kim B, Kim H, Kuceyeski A, Lotze M, MacIntosh BJ, Margetis JL, Mohamed FB, Piras F, Ramos‐Murguialday A, Richard G, Roberts P, Robertson AD, Rondina JM, Rost NS, Sanossian N, Schweighofer N, Seo NJ, Shiroishi MS, Soekadar SR, Spalletta G, Stinear CM, Suri A, Tang WKW, Thielman GT, Vecchio D, Villringer A, Ward NS, Werden E, Westlye LT, Winstein C, Wittenberg GF, Wong KA, Yu C, Cramer SC, Thompson PM. The ENIGMA Stroke Recovery Working Group: Big data neuroimaging to study brain-behavior relationships after stroke. Hum Brain Mapp 2022; 43:129-148. [PMID: 32310331 PMCID: PMC8675421 DOI: 10.1002/hbm.25015] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 01/28/2023] Open
Abstract
The goal of the Enhancing Neuroimaging Genetics through Meta-Analysis (ENIGMA) Stroke Recovery working group is to understand brain and behavior relationships using well-powered meta- and mega-analytic approaches. ENIGMA Stroke Recovery has data from over 2,100 stroke patients collected across 39 research studies and 10 countries around the world, comprising the largest multisite retrospective stroke data collaboration to date. This article outlines the efforts taken by the ENIGMA Stroke Recovery working group to develop neuroinformatics protocols and methods to manage multisite stroke brain magnetic resonance imaging, behavioral and demographics data. Specifically, the processes for scalable data intake and preprocessing, multisite data harmonization, and large-scale stroke lesion analysis are described, and challenges unique to this type of big data collaboration in stroke research are discussed. Finally, future directions and limitations, as well as recommendations for improved data harmonization through prospective data collection and data management, are provided.
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Affiliation(s)
- Sook‐Lei Liew
- Chan Division of Occupational Science and Occupational TherapyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Biomedical Engineering, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Neuroscience Graduate ProgramUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Artemis Zavaliangos‐Petropulu
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Neuroscience Graduate ProgramUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Imaging Genetics CenterUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Neda Jahanshad
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Imaging Genetics CenterUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Catherine E. Lang
- Program in Physical TherapyWashington University School of MedicineSt. LouisMissouriUSA
| | - Kathryn S. Hayward
- Department of Physiotherapyand Florey Institute of Neuroscience and Mental Health, University of MelbourneParkvilleVictoriaAustralia
- NHMRC Centre of Research Excellence in Stroke Rehabilitation and Brain Recovery, University of MelbourneParkvilleVictoriaAustralia
| | - Keith R. Lohse
- Department of Health, Kinesiology, and RecreationUniversity of UtahSalt Lake CityUtahUSA
- Department of Physical Therapy and Athletic TrainingUniversity of UtahSalt Lake CityUtahUSA
| | - Julia M. Juliano
- Neuroscience Graduate ProgramUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Francesca Assogna
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral NeurologyIRCCS Santa Lucia FoundationRomeItaly
| | - Lee A. Baugh
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South DakotaVermillionSouth DakotaUSA
- Sioux Falls VA Health Care SystemSioux FallsSouth DakotaUSA
| | - Anup K. Bhattacharya
- Mallinckrodt Institute of Radiology, Washington University School of MedicineSt. LouisMissouriUSA
| | - Bavrina Bigjahan
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of Radiology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Michael R. Borich
- Department of Rehabilitation MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Lara A. Boyd
- Department of Physical Therapy, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Djavad Mowafaghian Centre for Brain HealthVancouverBritish ColumbiaCanada
| | - Amy Brodtmann
- Florey Institute for Neuroscience and Mental Health, University of MelbourneParkvilleVictoriaAustralia
| | - Cathrin M. Buetefisch
- Department of Rehabilitation MedicineEmory UniversityAtlantaGeorgiaUSA
- Department of NeurologyEmory UniversityAtlantaGeorgiaUSA
| | - Winston D. Byblow
- Department of Exercise Sciences, Centre for Brain ResearchUniversity of AucklandAucklandNew Zealand
| | - Jessica M. Cassidy
- Division of Physical Therapy, Department Allied Health SciencesUniversity of North Carolina, Chapel HillChapel HillNorth CarolinaUSA
| | - Adriana B. Conforto
- Neurology Clinical Division, Hospital das Clínicas/São Paulo UniversitySão PauloBrazil
- Hospital Israelita Albert EinsteinSão PauloBrazil
| | - R. Cameron Craddock
- Department of Diagnostic MedicineThe University of Texas at Austin Dell Medical SchoolAustinTexasUSA
| | - Michael A. Dimyan
- Department of Neurology and Neurorehabilitation, School of MedicineUniversity of Maryland, BaltimoreBaltimoreMarylandUSA
- VA Maryland Health Care SystemBaltimoreMarylandUSA
| | - Adrienne N. Dula
- Department of Diagnostic MedicineThe University of Texas at Austin Dell Medical SchoolAustinTexasUSA
- Department of NeurologyDell Medical School at University of Texas at AustinAustinTexasUSA
| | - Elsa Ermer
- Department of Neurology and Neurorehabilitation, School of MedicineUniversity of Maryland, BaltimoreBaltimoreMarylandUSA
| | - Mark R. Etherton
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
- J. Philip Kistler Stroke Research CenterHarvard Medical SchoolBostonMassachusettsUSA
| | - Kelene A. Fercho
- Division of Basic Biomedical Sciences, Sanford School of Medicine, University of South DakotaVermillionSouth DakotaUSA
- Federal Aviation Administration, Civil Aerospace Medical InstituteOklahoma CityOklahomaUSA
| | - Chris M. Gregory
- Department of Health Sciences and ResearchMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Shahram Hadidchi
- Department of RadiologyWayne State University/Detroit Medical CenterDetroitMichiganUSA
- Department of Internal MedicineWayne State University/Detroit Medical CenterDetroitMichiganUSA
| | - Jess A. Holguin
- Chan Division of Occupational Science and Occupational TherapyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Darryl H. Hwang
- Department of Radiology, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Simon Jung
- Department of Neurology, University of BernBernSwitzerland
| | - Steven A. Kautz
- Department of Health Sciences and ResearchMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H Johnson VA Medical CenterCharlestonSouth CarolinaUSA
| | - Mohamed Salah Khlif
- Florey Institute for Neuroscience and Mental Health, University of MelbourneParkvilleVictoriaAustralia
| | - Nima Khoshab
- Department of Anatomy and NeurobiologyUniversity of CaliforniaIrvineCaliforniaUSA
| | - Bokkyu Kim
- Department of Physical Therapy EducationState University of New York Upstate Medical UniversitySyracuseNew YorkUSA
- Division of Biokinesiology and Physical TherapyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Hosung Kim
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Amy Kuceyeski
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
- Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNew YorkUSA
| | - Martin Lotze
- Functional Imaging Unit, Center for Diagnostic RadiologySchool of Medicine, University of GreifswaldGreifswaldGermany
| | - Bradley J. MacIntosh
- Department of Medical BiophysicsUniversity of TorontoTorontoOntarioCanada
- Physical Sciences Platform, Brain Sciences ProgramSunnybrook Research InstituteTorontoOntarioCanada
| | - John L. Margetis
- Chan Division of Occupational Science and Occupational TherapyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Feroze B. Mohamed
- Department of RadiologyThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral NeurologyIRCCS Santa Lucia FoundationRomeItaly
| | - Ander Ramos‐Murguialday
- TECNALIA, Basque Research and Technology Alliance (BRTA), Neurotechnology LaboratoryDerioSpain
- Institute of Medical Psychology and Behavioural Neurobiology, University of TubingenTübingenGermany
| | - Geneviève Richard
- Department of PsychologyUniversity of OsloOsloNorway
- NORMENT, Division of Mental Health and AddictionOslo University HospitalOsloNorway
- Institute of Clinical Medicine, University of OsloOsloNorway
| | - Pamela Roberts
- Department of Physical Medicine and RehabilitationCedars‐SinaiLos AngelesCaliforniaUSA
| | - Andrew D. Robertson
- Department of KinesiologyUniversity of WaterlooWaterlooOntarioCanada
- Schlegel‐UW Research Institute for Aging, University of WaterlooWaterlooOntarioCanada
| | - Jane M. Rondina
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Natalia S. Rost
- Stroke Division, Department of NeurologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Nerses Sanossian
- Division of Neurocritical Care and Stroke, Department of Neurology, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Nicolas Schweighofer
- Division of Biokinesiology and Physical Therapy, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Na Jin Seo
- Department of Health Sciences and ResearchMedical University of South CarolinaCharlestonSouth CarolinaUSA
- Ralph H Johnson VA Medical CenterCharlestonSouth CarolinaUSA
- Division of Occupational Therapy, Department of Health Professions, Medical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Mark S. Shiroishi
- Division of Neuroradiology, Department of RadiologyKeck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Surjo R. Soekadar
- Department of Psychiatry and Psychotherapy, Clinical Neurotechnology LaboratoryCharité ‐ University Medicine BerlinBerlinGermany
- Applied Neurotechnology Laboratory, Department of Psychiatry and PsychotherapyUniversity of TübingenTübingenGermany
| | - Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral NeurologyIRCCS Santa Lucia FoundationRomeItaly
- Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | | | - Anisha Suri
- Department of Electrical and Computer EngineeringUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Wai Kwong W. Tang
- Department of PsychiatryThe Chinese University of Hong KongHong KongPeople's Republic of China
| | - Gregory T. Thielman
- Physical Therapy and Neuroscience, University of the SciencesPhiladelphiaPennsylvaniaUSA
- Samson CollegeQuezon CityPhilippines
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral NeurologyIRCCS Santa Lucia FoundationRomeItaly
| | - Arno Villringer
- Department of NeurologyMax Planck Institute for Human Cognitive and Brain SciencesLeipzigGermany
- Department of Cognitive NeurologyUniversity Hospital LeipzigLeipzigGermany
- Center for Stroke Research, Charité‐Universitätsmedizin BerlinBerlinGermany
| | - Nick S. Ward
- UCL Queen Square Institute of Neurology, University College LondonLondonUK
| | - Emilio Werden
- Florey Institute for Neuroscience and Mental Health, University of MelbourneParkvilleVictoriaAustralia
| | - Lars T. Westlye
- Department of PsychologyUniversity of OsloOsloNorway
- NORMENT, Division of Mental Health and AddictionOslo University HospitalOsloNorway
| | - Carolee Winstein
- Division of Biokinesiology and Physical Therapy, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Department of NeurologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - George F. Wittenberg
- Department of NeurologyUniversity of PittsburghPittsburghPennsylvaniaUSA
- Department of Veterans AffairsUniversity Drive CampusPittsburghPennsylvaniaUSA
| | - Kristin A. Wong
- Department of Physical Medicine and RehabilitationDell Medical School, University of Texas AustinAustinTexasUSA
| | - Chunshui Yu
- Department of RadiologyTianjin Medical University General HospitalTianjinChina
- Tianjin Key Laboratory of Functional ImagingTianjin Medical University General HospitalTianjinChina
| | - Steven C. Cramer
- Department of NeurologyUCLA and California Rehabilitation InstituteLos AngelesCaliforniaUSA
| | - Paul M. Thompson
- Department of NeurologyUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
- Imaging Genetics CenterUSC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern CaliforniaLos AngelesCaliforniaUSA
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Ermer E, Harcum S, Lush J, Magder LS, Whitall J, Wittenberg GF, Dimyan MA. Contraction Phase and Force Differentially Change Motor Evoked Potential Recruitment Slope and Interhemispheric Inhibition in Young Versus Old. Front Hum Neurosci 2020; 14:581008. [PMID: 33132888 PMCID: PMC7573560 DOI: 10.3389/fnhum.2020.581008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/15/2020] [Indexed: 11/13/2022] Open
Abstract
Interhemispheric interactions are important for arm coordination and hemispheric specialization. Unilateral voluntary static contraction is known to increase bilateral corticospinal motor evoked potential (MEP) amplitude. It is unknown how increasing and decreasing contraction affect the opposite limb. Since dynamic muscle contraction is more ecologically relevant to daily activities, we studied MEP recruitment using a novel method and short interval interhemispheric inhibition (IHI) from active to resting hemisphere at 4 phases of contralateral ECR contraction: Rest, Ramp Up [increasing at 25% of maximum voluntary contraction (MVC)], Execution (tonic at 50% MVC), and Ramp Down (relaxation at 25% MVC) in 42 healthy adults. We analyzed the linear portion of resting extensor carpi radialis (ECR) MEP recruitment by stimulating at multiple intensities and comparing slopes, expressed as mV per TMS stimulation level, via linear mixed modeling. In younger participants (age ≤ 30), resting ECR MEP recruitment slopes were significantly and equally larger both at Ramp Up (slope increase = 0.047, p < 0.001) and Ramp Down (slope increase = 0.031, p < 0.001) compared to rest, despite opposite directions of force change. In contrast, Active ECR MEP recruitment slopes were larger in Ramp Down than all other phases (Rest:0.184, p < 0.001; Ramp Up:0.128, p = 0.001; Execution: p = 0.003). Older (age ≥ 60) participants’ resting MEP recruitment slope was higher than younger participants across all phases. IHI did not reduce MEP recruitment slope equally in old compared to young. In conclusion, our data indicate that MEP recruitment slope in the resting limb is affected by the homologous active limb contraction force, irrespective of the direction of force change. The active arm MEP recruitment slope, in contrast, remains relatively unaffected. Older participants had steeper MEP recruitment slopes and less interhemispheric inhibition compared to younger participants.
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Affiliation(s)
- Elsa Ermer
- University of Maryland, Baltimore, MD, United States.,Department of Neurology, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Stacey Harcum
- University of Maryland, Baltimore, MD, United States
| | - Jaime Lush
- University of Maryland, Baltimore, MD, United States.,Department of Neurology, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Laurence S Magder
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Jill Whitall
- University of Maryland, Baltimore, MD, United States.,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - George F Wittenberg
- University of Maryland, Baltimore, MD, United States.,Department of Neurology, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Michael A Dimyan
- University of Maryland, Baltimore, MD, United States.,Department of Neurology, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States.,Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
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Harcum S, Conroy SS, Boos A, Ermer E, Xu H, Zhan M, Chen H, Whitall J, Dimyan MA, Wittenberg GF. Methods for an Investigation of Neurophysiological and Kinematic Predictors of Response to Upper Extremity Repetitive Task Practice in Chronic Stroke. Arch Rehabil Res Clin Transl 2019; 1. [PMID: 32292910 PMCID: PMC7155389 DOI: 10.1016/j.arrct.2019.100024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To demonstrate the feasibility of algorithmic prediction using a model of baseline arm movement, genetic factors, demographic characteristics, and multimodal assessment of the structure and function of motor pathways. To identify prognostic factors and the biological substrate for reductions in arm impairment in response to repetitive task practice. Design This prospective single-group interventional study seeks to predict response to a repetitive task practice program using an intent-to-treat paradigm. Response is measured as a change of ≥5 points on the Upper Extremity Fugl-Meyer from baseline to final evaluation (at the end of training). Setting General community. Participants Anticipated enrollment of community-dwelling adults with chronic stroke (N = 96; onset≥6mo) and moderate to severe residual hemiparesis of the upper limb as defined by a score of 10-45 points on the Upper Extremity Fugl-Meyer. Intervention The intervention is a form of repetitive task practice using a combination of robot-assisted therapy coupled with functional arm use in real-world tasks administered over 12 weeks. Main Outcome Measures Upper Extremity Fugl-Meyer Assessment (primary outcome), Wolf Motor Function Test, Action Research Arm Test, Stroke Impact Scale, questionnaires on pain and expectancy, magnetic resonance imaging, transcranial magnetic stimulation, arm kinematics, accelerometry, and a saliva sample for genetic testing. Results Methods for this trial are outlined, and an illustration of interindividual variability is provided by example of 2 participants who present similarly at baseline but achieve markedly different outcomes. Conclusion This article presents the design, methodology, and rationale of an ongoing study to develop a predictive model of response to a standardized therapy for stroke survivors with chronic hemiparesis. Applying concepts from precision medicine to neurorehabilitation is practicable and needed to establish realistic rehabilitation goals and to effectively allocate resources.
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Affiliation(s)
- Stacey Harcum
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland
| | - Susan S Conroy
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland
| | - Amy Boos
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Elsa Ermer
- Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Huichun Xu
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Min Zhan
- Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Hegang Chen
- Department of Epidemiology and Preventative Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jill Whitall
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael A Dimyan
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland.,Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland
| | - George F Wittenberg
- VA Maryland Health Care System, Baltimore VA Medical Center, Baltimore, Maryland.,Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, Maryland.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Geriatrics Research, Education, and Clinical Center Et Maryland Exercise and Robotics Center of Excellence, Veterans Affairs Medical Center, Older Americans Independence Center, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Wittenberg GF, Dimyan MA. How do the physiology and transcallosal effects of the unaffected hemisphere change during inpatient rehabilitation after stroke? Clin Neurophysiol 2014; 125:1932-3. [DOI: 10.1016/j.clinph.2014.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/07/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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7
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Dimyan MA, Perez MA, Auh S, Tarula E, Wilson M, Cohen LG. Nonparetic arm force does not overinhibit the paretic arm in chronic poststroke hemiparesis. Arch Phys Med Rehabil 2014; 95:849-56. [PMID: 24440364 DOI: 10.1016/j.apmr.2013.12.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 12/27/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine whether nonparetic arm force overinhibits the paretic arm in patients with chronic unilateral poststroke hemiparesis. DESIGN Case-control neurophysiological and behavioral study of patients with chronic stroke. SETTING Research institution. PARTICIPANTS Eighty-six referred patients were screened to enroll 9 participants (N=9) with a >6 month history of 1 unilateral ischemic infarct that resulted in arm hemiparesis with residual ability to produce 1Nm of wrist flexion torque and without contraindication to transcranial magnetic stimulation. Eight age- and handedness-matched healthy volunteers without neurologic diagnosis were studied for comparison. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Change in interhemispheric inhibition targeting the ipsilesional primary motor cortex (M1) during nonparetic arm force. We hypothesized that interhemispheric inhibition would increase more in healthy controls than in patients with hemiparesis. RESULTS Healthy age-matched controls had significantly greater increases in inhibition from their active to resting M1 than patients with stroke from their active contralesional to resting ipsilesional M1 in the same scenario (20%±7% vs -1%±4%, F1,12=6.61, P=.025). Patients with greater increases in contralesional to ipsilesional inhibition were better performers on the 9-hole peg test of paretic arm function. CONCLUSIONS Our findings reveal that producing force with the nonparetic arm does not necessarily overinhibit the paretic arm. Though our study is limited in generalizability by the small sample size, we found that greater active contralesional to resting ipsilesional M1 inhibition was related with better recovery in this subset of patients with chronic poststroke.
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Affiliation(s)
- Michael A Dimyan
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.
| | - Monica A Perez
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Sungyoung Auh
- Clinical Neurosciences Program, Division of Intramural Research, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Erick Tarula
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Matthew Wilson
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Leonardo G Cohen
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
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Abstract
Approximately one-third of patients with stroke exhibit persistent disability after the initial cerebrovascular episode, with motor impairments accounting for most poststroke disability. Exercise and training have long been used to restore motor function after stroke. Better training strategies and therapies to enhance the effects of these rehabilitative protocols are currently being developed for poststroke disability. The advancement of our understanding of the neuroplastic changes associated with poststroke motor impairment and the innate mechanisms of repair is crucial to this endeavor. Pharmaceutical, biological and electrophysiological treatments that augment neuroplasticity are being explored to further extend the boundaries of poststroke rehabilitation. Potential motor rehabilitation therapies, such as stem cell therapy, exogenous tissue engineering and brain-computer interface technologies, could be integral in helping patients with stroke regain motor control. As the methods for providing motor rehabilitation change, the primary goals of poststroke rehabilitation will be driven by the activity and quality of life needs of individual patients. This Review aims to provide a focused overview of neuroplasticity associated with poststroke motor impairment, and the latest experimental interventions being developed to manipulate neuroplasticity to enhance motor rehabilitation.
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Affiliation(s)
- Michael A Dimyan
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892-1428, USA
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9
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Censor N, Dimyan MA, Cohen LG. Modification of existing human motor memories is enabled by primary cortical processing during memory reactivation. Curr Biol 2011; 20:1545-9. [PMID: 20817532 DOI: 10.1016/j.cub.2010.07.047] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 07/01/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
Abstract
One of the most challenging tasks of the brain is to constantly update the internal neural representations of existing memories. Animal studies have used invasive methods such as direct microfusion of protein inhibitors to designated brain areas, in order to study the neural mechanisms underlying modification of already existing memories after their reactivation during recall [1-4]. Because such interventions are not possible in humans, it is not known how these neural processes operate in the human brain. In a series of experiments we show here that when an existing human motor memory is reactivated during recall, modification of the memory is blocked by virtual lesion [5] of the related primary cortical human brain area. The virtual lesion was induced by noninvasive repetitive transcranial magnetic stimulation guided by a frameless stereotactic brain navigation system and each subject's brain image. The results demonstrate that primary cortical processing in the human brain interacting with pre-existing reactivated memory traces is critical for successful modification of the existing related memory. Modulation of reactivated memories by noninvasive cortical stimulation may have important implications for human memory research and have far-reaching clinical applications.
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Affiliation(s)
- Nitzan Censor
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
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10
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Dimyan MA, Cohen LG. Contribution of transcranial magnetic stimulation to the understanding of functional recovery mechanisms after stroke. Neurorehabil Neural Repair 2009; 24:125-35. [PMID: 19767591 DOI: 10.1177/1545968309345270] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Motor impairments are a major cause of morbidity and disability after stroke. This article reviews evidence obtained using transcranial magnetic stimulation (TMS) that provides new insight into mechanisms of impaired motor control and disability. They briefly discuss the use of TMS in the diagnosis, prognosis, and therapy of poststroke motor disability. Particular emphasis is placed on TMS as a tool to explore mechanisms of neuroplasticity during spontaneous and treatment-induced recovery of motor function to develop more rational and clinically useful interventions for stroke rehabilitation.
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Affiliation(s)
- Michael A Dimyan
- Human Cortical Physiology and Stroke Neurorehabilitation Section, NINDS, NIH, Bethesda, Maryland, USA.
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11
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Ragert P, Camus M, Vandermeeren Y, Dimyan MA, Cohen LG. Modulation of effects of intermittent theta burst stimulation applied over primary motor cortex (M1) by conditioning stimulation of the opposite M1. J Neurophysiol 2009; 102:766-73. [PMID: 19474173 DOI: 10.1152/jn.00274.2009] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The excitability of the human primary motor cortex (M1) as tested with transcranial magnetic stimulation (TMS) depends on its previous history of neural activity. Homeostatic plasticity might be one important physiological mechanism for the regulation of corticospinal excitability and synaptic plasticity. Although homeostatic plasticity has been demonstrated locally within M1, it is not known whether priming M1 could result in similar homeostatic effects in the homologous M1 of the opposite hemisphere. Here, we sought to determine whether down-regulating excitability (priming) in the right (R) M1 with 1-Hz repetitive transcranial magnetic stimulation (rTMS) changes the excitability-enhancing effect of intermittent theta burst stimulation (iTBS) applied over the homologous left (L) M1. Subjects were randomly allocated to one of four experimental groups in a sham-controlled parallel design with real or sham R M1 1-Hz TMS stimulation always preceding L M1 iTBS or sham by about 10 min. The primary outcome measure was corticospinal excitability in the L M1, as measured by recruitment curves (RCs). Secondary outcome measures included pinch force, simple reaction time, and tapping speed assessed in the right hand. The main finding of this study was that preconditioning R M1 with 1-Hz rTMS significantly decreased the excitability-enhancing effects of subsequent L M1 iTBS on RCs. Application of 1-Hz rTMS over R M1 alone and iTBS over L M1 alone resulted in increased RC in L M1 relative to sham interventions. The present findings are consistent with the hypothesis that homeostatic mechanisms operating across hemispheric boundaries contribute to regulate motor cortical function in the primary motor cortex.
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Affiliation(s)
- Patrick Ragert
- Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20817, USA
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12
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Affiliation(s)
- Michael A Dimyan
- Human Cortical Physiology Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1428, USA.
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13
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Hanakawa T, Dimyan MA, Hallett M. Motor planning, imagery, and execution in the distributed motor network: a time-course study with functional MRI. Cereb Cortex 2008; 18:2775-88. [PMID: 18359777 DOI: 10.1093/cercor/bhn036] [Citation(s) in RCA: 347] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Activation of motor-related areas has consistently been found during various motor imagery tasks and is regarded as the central mechanism generating motor imagery. However, the extent to which motor execution and imagery share neural substrates remains controversial. We examined brain activity during preparation for and execution of physical or mental finger tapping. During a functional magnetic resonance imaging at 3 T, 13 healthy volunteers performed an instructed delay finger-tapping task either in a physical mode or mental mode. Number stimuli instructed subjects about a finger-tapping sequence. After an instructed delay period, cue stimuli prompted them either to execute the tapping movement or to imagine it. Two types of planning/preparatory activity common for movement and imagery were found: instruction stimulus-related activity represented widely in multiple motor-related areas and delay period activity in the medial frontal areas. Although brain activity during movement execution and imagery was largely shared in the distributed motor network, imagery-related activity was in general more closely related to instruction-related activity than to the motor execution-related activity. Specifically, activity in the medial superior frontal gyrus, anterior cingulate cortex, precentral sulcus, supramarginal gyrus, fusiform gyrus, and posterolateral cerebellum likely reflects willed generation of virtual motor commands and analysis of virtual sensory signals.
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Affiliation(s)
- Takashi Hanakawa
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892, USA
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14
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Buch E, Weber C, Cohen LG, Braun C, Dimyan MA, Ard T, Mellinger J, Caria A, Soekadar S, Fourkas A, Birbaumer N. Think to move: a neuromagnetic brain-computer interface (BCI) system for chronic stroke. Stroke 2008; 39:910-7. [PMID: 18258825 PMCID: PMC5494966 DOI: 10.1161/strokeaha.107.505313] [Citation(s) in RCA: 341] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is a leading cause of long-term motor disability among adults. Present rehabilitative interventions are largely unsuccessful in improving the most severe cases of motor impairment, particularly in relation to hand function. Here we tested the hypothesis that patients experiencing hand plegia as a result of a single, unilateral subcortical, cortical or mixed stroke occurring at least 1 year previously, could be trained to operate a mechanical hand orthosis through a brain-computer interface (BCI). METHODS Eight patients with chronic hand plegia resulting from stroke (residual finger extension function rated on the Medical Research Council scale=0/5) were recruited from the Stroke Neurorehabilitation Clinic, Human Cortical Physiology Section of the National Institute for Neurological Disorders and Stroke (NINDS) (n=5) and the Clinic of Neurology of the University of Tübingen (n=3). Diagnostic MRIs revealed single, unilateral subcortical, cortical or mixed lesions in all patients. A magnetoencephalography-based BCI system was used for this study. Patients participated in between 13 to 22 training sessions geared to volitionally modulate micro rhythm amplitude originating in sensorimotor areas of the cortex, which in turn raised or lowered a screen cursor in the direction of a target displayed on the screen through the BCI interface. Performance feedback was provided visually in real-time. Successful trials (in which the cursor made contact with the target) resulted in opening/closing of an orthosis attached to the paralyzed hand. RESULTS Training resulted in successful BCI control in 6 of 8 patients. This control was associated with increased range and specificity of mu rhythm modulation as recorded from sensors overlying central ipsilesional (4 patients) or contralesional (2 patients) regions of the array. Clinical scales used to rate hand function showed no significant improvement after training. CONCLUSIONS These results suggest that volitional control of neuromagnetic activity features recorded over central scalp regions can be achieved with BCI training after stroke, and used to control grasping actions through a mechanical hand orthosis.
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Affiliation(s)
- Ethan Buch
- Human Cortical Physiology Section, Stroke Neurorehabilitation Clinic, NINDS, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892-1430, USA
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15
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Reis J, Swayne OB, Vandermeeren Y, Camus M, Dimyan MA, Harris-Love M, Perez MA, Ragert P, Rothwell JC, Cohen LG. Contribution of transcranial magnetic stimulation to the understanding of cortical mechanisms involved in motor control. J Physiol 2007; 586:325-51. [PMID: 17974592 DOI: 10.1113/jphysiol.2007.144824] [Citation(s) in RCA: 420] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) was initially used to evaluate the integrity of the corticospinal tract in humans non-invasively. Since these early studies, the development of paired-pulse and repetitive TMS protocols allowed investigators to explore inhibitory and excitatory interactions of various motor and non-motor cortical regions within and across cerebral hemispheres. These applications have provided insight into the intracortical physiological processes underlying the functional role of different brain regions in various cognitive processes, motor control in health and disease and neuroplastic changes during recovery of function after brain lesions. Used in combination with neuroimaging tools, TMS provides valuable information on functional connectivity between different brain regions, and on the relationship between physiological processes and the anatomical configuration of specific brain areas and connected pathways. More recently, there has been increasing interest in the extent to which these physiological processes are modulated depending on the behavioural setting. The purpose of this paper is (a) to present an up-to-date review of the available electrophysiological data and the impact on our understanding of human motor behaviour and (b) to discuss some of the gaps in our present knowledge as well as future directions of research in a format accessible to new students and/or investigators. Finally, areas of uncertainty and limitations in the interpretation of TMS studies are discussed in some detail.
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Affiliation(s)
- Janine Reis
- Human Cortical Physiology Section, National Institute of Health, National Institute of Neurological Disorders and Stroke, 10 Center Drive, Bldg 10, Rm 5 N226, Bethesda, MD 20892, USA
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16
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Hanakawa T, Dimyan MA, Hallett M. The representation of blinking movement in cingulate motor areas: a functional magnetic resonance imaging study. Cereb Cortex 2007; 18:930-7. [PMID: 17652462 DOI: 10.1093/cercor/bhm129] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recent anatomical evidence from nonhuman primates indicates that cingulate motor areas (CMAs) play a substantial role in the cortical control of upper facial movement. Using event-related functional magnetic resonance imaging in 10 healthy subjects, we examined brain activity associated with volitional eye closure involving primarily the bilateral orbicularis oculi. The findings were compared with those from bimanual tapping, which should identify medial frontal areas nonsomatotopically or somatotopically related to bilateral movements. In a group-level analysis, the blinking task was associated with rostral cingulate activity more strongly than the bimanual tapping task. By contrast, the bimanual task activated the caudal cingulate zone plus supplementary motor areas. An individual-level analysis indicated that 2 foci of blinking-specific activity were situated in the cingulate or paracingulate sulcus: one close to the genu of the corpus callosum (anterior part of rostral cingulate zone) and the posterior part of rostral cingulate zone. The present data support the notion that direct cortical innervation of the facial subnuclei from the CMAs might control upper face movement in humans, as previously implied in nonhuman primates. The CMAs may contribute to the sparing of upper facial muscles after a stroke involving the lateral precentral motor regions.
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Affiliation(s)
- Takashi Hanakawa
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1428, USA
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17
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Hanakawa T, Honda M, Zito G, Dimyan MA, Hallett M. Brain activity during visuomotor behavior triggered by arbitrary and spatially constrained cues: an fMRI study in humans. Exp Brain Res 2006; 172:275-82. [PMID: 16418844 DOI: 10.1007/s00221-005-0336-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2005] [Accepted: 12/12/2005] [Indexed: 10/25/2022]
Abstract
Rule-based behavior associating nonspatial visual stimuli with learned responses is called arbitrary visuomotor mapping, an ability that enriches behavioral repertoire. To better understand the underlying neural correlates, the present functional magnetic resonance imaging (fMRI) study explored brain activity during visually informed movement involving two different types of cues and two different effectors. After being trained on the tasks, six healthy subjects performed right or left finger tapping tasks according to either arbitrary cues or spatially constrained cues. An event-related fMRI experiment was conducted on a 3-T MRI. The image data were analyzed with statistical parametric mapping. With the aid of the probabilistic architectonic map in the stereotaxic space, we identified three types of task-related brain activity: cue-selective, effector-selective, and nonselective. The left ventrolateral prefrontal cortex and the rostral part of the right dorsal premotor cortex (PMd) exhibited cue-selective activity, which was greater during the arbitrary condition than the spatially constrained condition. The left ventral prefrontal activity may reflect retrieval of visuomotor association from memory in arbitrary context. The rostral part of the left PMd showed nonselective activity while the caudal part of the PMd on each side showed conspicuous effector-selective activity to the contralateral movement. These findings suggest functional demarcation of the PMd between its rostral and dorsal parts during visuomotor mapping.
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Affiliation(s)
- Takashi Hanakawa
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-1428, USA
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18
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Hanakawa T, Immisch I, Toma K, Dimyan MA, Van Gelderen P, Hallett M. Functional properties of brain areas associated with motor execution and imagery. J Neurophysiol 2003; 89:989-1002. [PMID: 12574475 DOI: 10.1152/jn.00132.2002] [Citation(s) in RCA: 436] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Imagining motor acts is a cognitive task that engages parts of the executive motor system. While motor imagery has been intensively studied using neuroimaging techniques, most studies lack behavioral observations. Here, we used functional MRI to compare the functional neuroanatomy of motor execution and imagery using a task that objectively assesses imagery performance. With surface electromyographic monitoring within a scanner, 10 healthy subjects performed sequential finger-tapping movements according to visually presented number stimuli in either a movement or an imagery mode of performance. We also examined effects of varied and fixed stimulus types that differ in stimulus dependency of the task. Statistical parametric mapping revealed movement-predominant activity, imagery-predominant activity, and activity common to both movement and imagery modes of performance (movement-and-imagery activity). The movement-predominant activity included the primary sensory and motor areas, parietal operculum, and anterior cerebellum that had little imagery-related activity (-0.1 ~ 0.1%), and the caudal premotor areas and area 5 that had mild-to-moderate imagery-related activity (0.2 ~ 0.7%). Many frontoparietal areas and posterior cerebellum demonstrated movement-and-imagery activity. Imagery-predominant areas included the precentral sulcus at the level of middle frontal gyrus and the posterior superior parietal cortex/precuneus. Moreover, activity of the superior precentral sulcus and intraparietal sulcus areas, predominantly on the left, was associated with accuracy of the imagery task performance. Activity of the inferior precentral sulcus (area 6/44) showed stimulus-type effect particularly for the imagery mode. A time-course analysis of activity suggested a functional gradient, which was characterized by a more "executive" or more "imaginative" property in many areas related to movement and/or imagery. The results from the present study provide new insights into the functional neuroanatomy of motor imagery, including the effects of imagery performance and stimulus-dependency on brain activity.
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Affiliation(s)
- Takashi Hanakawa
- Human Motor Control Section, Medical Neurology Branch, National Institutes of Health, Bethesda, Maryland 20892, USA
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19
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Abstract
Learning alters receptive field (RF) tuning in the primary auditory cortex (ACx) to emphasize the frequency of a tonal conditioned stimulus. RF plasticity is a candidate substrate of memory, as it is associative, specific, discriminative, rapidly induced, and enduring. The authors hypothesized that it is produced by the release of acetylcholine in the ACx from the basal forebrain (BasF), caused by presentation of reinforced but not nonreinforced conditioned stimuli. Waking adult male Hartley guinea pigs (n = 16) received 1 of 2 tones followed by BasF stimulation, in a single session of 30 pseudo-random order trials each. RFs from neuronal discharges before and after differential pairing revealed the induction of predicted plasticity, as well as increased responses to the paired tone and decreased responses to the unpaired tone. Thus, highly specific, learning-induced RF plasticity in the ACx may be produced by activation of the BasF by a reinforced conditioned stimulus.
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Affiliation(s)
- M A Dimyan
- Center for the Neurobiology of Learning and Memory, Department of Neurobiology and Behavior, University of California, Irvine, USA
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20
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Abstract
Learning alters receptive field (RF) tuning in the primary auditory cortex (ACx) to emphasize the frequency of a tonal conditioned stimulus. RF plasticity is a candidate substrate of memory, as it is associative, specific, discriminative, rapidly induced, and enduring. The authors hypothesized that it is produced by the release of acetylcholine in the ACx from the basal forebrain (BasF), caused by presentation of reinforced but not nonreinforced conditioned stimuli. Waking adult male Hartley guinea pigs (n = 16) received 1 of 2 tones followed by BasF stimulation, in a single session of 30 pseudo-random order trials each. RFs from neuronal discharges before and after differential pairing revealed the induction of predicted plasticity, as well as increased responses to the paired tone and decreased responses to the unpaired tone. Thus, highly specific, learning-induced RF plasticity in the ACx may be produced by activation of the BasF by a reinforced conditioned stimulus.
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Affiliation(s)
- M A Dimyan
- Center for the Neurobiology of Learning and Memory, Department of Neurobiology and Behavior, University of California, Irvine, USA
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21
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Bjordahl TS, Dimyan MA, Weinberger NM. Induction of long-term receptive field plasticity in the auditory cortex of the waking guinea pig by stimulation of the nucleus basalis. Behav Neurosci 1998. [PMID: 9676965 DOI: 10.1037//0735-7044.112.3.467] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Learning induces neuronal receptive field (RF) plasticity in primary auditory cortex. This plasticity constitutes physiological memory as it is associative, highly specific, discriminative, develops rapidly, and is retained indefinitely. This study examined whether pairing a tone with activation of the nucleus basalis could induce RF plasticity in the waking guinea pig and, if so, whether it could be retained for 24 hr. Subjects received 40 trials of a single frequency paired with electrical stimulation of the nucleus basalis (NB) at tone offset. The physiological effectiveness of NB stimulation was assessed later while subjects were anesthetized with urethane by noting whether stimulation produced cortical desynchronization. Subjects in which NB stimulation was effective did develop RF plasticity and this was retained for 24 hr. Thus, activation of the NB during normal learning may be sufficient to induce enduring physiological memory in auditory cortex.
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Affiliation(s)
- T S Bjordahl
- Department of Psychobiology, Center for the Neurobiology of Learning and Memory, University of California, Irvine 92697-3800, USA
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Bjordahl TS, Dimyan MA, Weinberger NM. Induction of long-term receptive field plasticity in the auditory cortex of the waking guinea pig by stimulation of the nucleus basalis. Behav Neurosci 1998; 112:467-79. [PMID: 9676965 DOI: 10.1037/0735-7044.112.3.467] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Learning induces neuronal receptive field (RF) plasticity in primary auditory cortex. This plasticity constitutes physiological memory as it is associative, highly specific, discriminative, develops rapidly, and is retained indefinitely. This study examined whether pairing a tone with activation of the nucleus basalis could induce RF plasticity in the waking guinea pig and, if so, whether it could be retained for 24 hr. Subjects received 40 trials of a single frequency paired with electrical stimulation of the nucleus basalis (NB) at tone offset. The physiological effectiveness of NB stimulation was assessed later while subjects were anesthetized with urethane by noting whether stimulation produced cortical desynchronization. Subjects in which NB stimulation was effective did develop RF plasticity and this was retained for 24 hr. Thus, activation of the NB during normal learning may be sufficient to induce enduring physiological memory in auditory cortex.
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Affiliation(s)
- T S Bjordahl
- Department of Psychobiology, Center for the Neurobiology of Learning and Memory, University of California, Irvine 92697-3800, USA
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