Para-Sports can Promote Functional Reorganization in the Ipsilateral Primary Motor Cortex of Lower Limbs Amputee

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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Reorganization of the primary motor cortex following lower-limb amputation for vascular disease: a pre-post-amputation comparison

Disability and Rehabilitation ◽

10.1080/09638288.2016.1207110 ◽

2016 ◽

Vol 39 (17) ◽

pp. 1722-1728 ◽

Cited By ~ 1

Author(s):

Brenton Hordacre ◽

Lynley V. Bradnam ◽

Maria Crotty

Keyword(s):

Motor Cortex ◽

Vascular Disease ◽

Lower Limb ◽

Primary Motor Cortex ◽

Lower Limb Amputation ◽

Limb Amputation

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Mirror Therapy in Lower Limb Amputees – A Look Beyond Primary Motor Cortex Reorganization

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/s-0031-1281768 ◽

2011 ◽

Vol 183 (11) ◽

pp. 1051-1057 ◽

Cited By ~ 16

Author(s):

S. Seidel ◽

G. Kasprian ◽

J. Furtner ◽

V. Schöpf ◽

M. Essmeister ◽

...

Keyword(s):

Motor Cortex ◽

Lower Limb ◽

Primary Motor Cortex ◽

Mirror Therapy ◽

Lower Limb Amputees

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Improvement of spasticity following intermittent theta burst stimulation in multiple sclerosis is associated with modulation of resting-state functional connectivity of the primary motor cortices

Multiple Sclerosis Journal ◽

10.1177/1352458516661640 ◽

2016 ◽

Vol 23 (6) ◽

pp. 855-863 ◽

Cited By ~ 17

Author(s):

Clémence Boutière ◽

Caroline Rey ◽

Wafaa Zaaraoui ◽

Arnaud Le Troter ◽

Audrey Rico ◽

...

Keyword(s):

Multiple Sclerosis ◽

Motor Cortex ◽

Resting State ◽

Primary Motor Cortex ◽

Rehabilitation Programme ◽

Lower Limbs ◽

Theta Burst Stimulation ◽

Burst Stimulation ◽

Functional Reorganization ◽

Theta Burst

Background: Intermittent theta burst stimulation (iTBS) of the primary motor cortex improves transiently lower limbs spasticity in multiple sclerosis (MS). However, the cerebral mechanisms underlying this effect have never been investigated. Objective: To assess whether modulation of spasticity induced by iTBS is underlined by functional reorganization of the primary motor cortices. Methods: A total of 17 patients with MS suffering from lower limbs spasticity were randomized to receive real iTBS or sham iTBS during the first half of a 5-week indoor rehabilitation programme. Spasticity was assessed using the Modified Ashworth Scale and the Visual Analogue Scale at baseline, after the stimulation session and at the end of the rehabilitation programme. Resting-state functional magnetic resonance imaging (fMRI) was performed at the three time points, and brain functional networks topology was analysed using graph-theoretical approach. Results: At the end of stimulation, improvement of spasticity was greater in real iTBS group than in sham iTBS group ( p = 0.026). iTBS had a significant effect on the balance of the connectivity degree between the stimulated and the homologous primary motor cortex ( p = 0.005). Changes in inter-hemispheric balance were correlated with improvement of spasticity (rho = 0.56, p = 0.015). Conclusion: This longitudinal resting-state fMRI study evidences that functional reorganization of the primary motor cortices may underlie the effect of iTBS on spasticity in MS.

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Functional reorganization oF the primary motor cortex in a patient with a large arteriovenous malFormation involving the precentral gyrus

Translational Neuroscience ◽

10.2478/s13380-013-0122-5 ◽

2013 ◽

Vol 4 (2) ◽

Author(s):

Milan Radoš ◽

Ines Nikić ◽

Marko Radoš ◽

Ivica Kostović ◽

Patrick Hof ◽

...

Keyword(s):

Motor Cortex ◽

Primary Motor Cortex ◽

Right Hemisphere ◽

Motor Area ◽

Lower Limbs ◽

Motor Deficits ◽

Precentral Gyrus ◽

Functional Reorganization ◽

The Right ◽

The Brain

AbstractIt is known that the brain can compensate for deficits induced by acquired and developmental lesions through functional reorganization of the remaining parenchyma. Arteriovenous malformations (AVM) usually appear prenatally before a functional regional organization of the brain is fully established and patients generally do not present with motor deficits even when the AVM is located in the primary motor area indicating the redistribution of functions in cortical areas that are not pathologically altered. Here we present reorganization of the motor cortex in a patient with a large AVM involving most of the left parietal lobe and the paramedian part of the left precentral gyrus that is responsible for controlling the muscles of the lower limbs. Functional MRI showed that movements of both the right and left feet activated only the primary motor cortex in the right hemisphere, while there was no activation in the left motor cortex. This suggests that complete ipsilateral control over the movements of the right foot had been established in this patient. A reconstruction of the corticospinal tract using diffusion tensor imaging showed a near-complete absence of corticospinal fibers from the part of the left precentral gyrus affected by the AVM. From this clinical presentation it can be concluded that full compensation of motor deficits had occurred by redistributing function to the corresponding motor area of the contralateral

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Participation in Sports by Lower Limb Amputees in the Province of Drenthe, the Netherlands

Prosthetics and Orthotics International ◽

10.3109/03093640902984579 ◽

2009 ◽

Vol 33 (4) ◽

pp. 356-367 ◽

Cited By ~ 27

Author(s):

Cojanne Kars ◽

Marianne Hofman ◽

Jan H. B. Geertzen ◽

Gert-Jan Pepping ◽

Rienk Dekker

Keyword(s):

The Netherlands ◽

Lower Limb ◽

Sports Participation ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Recreational Activity ◽

Recreational Activities ◽

Lower Limb Amputees

The numbers of lower limb amputees participating in recreational activity date back more than 25 years. Previous studies have shown that 60% of lower limb amputees participated in recreational activities, including sports. To date, research in The Netherlands into sports participation of this specific amputee population is insufficient. The purpose of the reported survey was to investigate the sports participation habits of lower limb amputees in the Province of Drenthe, The Netherlands, using a self-constructed questionnaire. A total of 105 lower limb amputees responded (36%), a large proportion of whom were traumatic amputees (31%). Of the respondents, 34 (32%) participated in some form of sport. Results indicated that participation in sport before the amputation was a predetermining factor for amputees to participate in sports whilst the level of amputation, age and etiology were not predetermining factors of participation in sports after a lower limb amputation.

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COVID-19 era in long-term cardiac rehabilitation programs: how was muscle strenght and lean mass affected in cardiovascular patients?

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.362 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

M Borges ◽

M Lemos Pires ◽

R Pinto ◽

G De Sa ◽

I Ricardo ◽

...

Keyword(s):

Muscle Strength ◽

Cardiac Rehabilitation ◽

Lean Mass ◽

Lower Limb ◽

Lower Limbs ◽

Phase Iii ◽

Face To Face ◽

Home Based ◽

Lower Limb Strength

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Exercise prescription is one of the main components of phase III Cardiac Rehabilitation (CR) programs due to its documented prognostic benefits. It has been well established that, when added to aerobic training, resistance training (RT) leads to greater improvements in peripheral muscle strength and muscle mass in patients with cardiovascular disease (CVD). With COVID-19, most centre-based CR programs had to be suspended and CR patients had to readjust their RT program to a home-based model where weight training was more difficult to perform. How COVID-19 Era impacted lean mass and muscle strength in trained CVD patients who were attending long-term CR programs has yet to be discussed. Purpose To assess upper and lower limb muscle strength and lean mass in CVD patients who had their centre-based CR program suspended due to COVID-19 and compare it with previous assessments. Methods 87 CVD patients (mean age 62.9 ± 9.1, 82.8% male), before COVID-19, were attending a phase III centre-based CR program 3x/week and were evaluated annually. After 7 months of suspension, 57.5% (n = 50) patients returned to the face-to-face CR program. Despite all constraints caused by COVID-19, body composition and muscle strength of 35 participants (mean age 64.7 ± 7.9, 88.6% male) were assessed. We compared this assessment with previous years and established three assessment time points: M1) one year before COVID-19 (2018); M2) last assessment before COVID-19 (2019); M3) the assessment 7 months after CR program suspension (last trimester of 2020). Upper limbs strength was measured using a JAMAR dynamometer, 30 second chair stand test (number of repetitions – reps) was used to measure lower limbs strength and dual energy x-ray absorptiometry was used to measure upper and lower limbs lean mass. Repeated measures ANOVA were used. Results Intention to treat analysis showed that upper and lower limbs lean mass did not change from M1 to M2 but decreased significantly from M2 to M3 (arms lean mass in M2: 5.68 ± 1.00kg vs M3: 5.52 ± 1.06kg, p = 0.004; legs lean mass in M2: 17.40 ± 2.46kg vs M3: 16.77 ± 2.61kg, p = 0.040). Lower limb strength also decreased significantly from M2 to M3 (M2: 23.31 ± 5.76 reps vs M3: 21.11 ± 5.31 reps, p = 0.014) after remaining stable in the year prior to COVID-19. Upper limb strength improved significantly from M1 to M2 (M1: 39.00 ± 8.64kg vs M2: 40.53 ± 8.77kg, p = 0.034) but did not change significantly from M2 to M3 (M2 vs M3: 41.29 ± 9.13kg, p = 0.517). Conclusion After CR centre-based suspension due to COVID-19, we observed a decrease in upper and lower limbs lean mass and lower limb strength in previously trained CVD patients. These results should emphasize the need to promote all efforts to maintain physical activity and RT through alternative effective home-based CR programs when face-to-face models are not available or possible to be implemented.

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Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽

10.1136/bmjopen-2017-016566 ◽

2017 ◽

Vol 7 (8) ◽

pp. e016566

Author(s):

Eline C C van Lieshout ◽

Johanna M A Visser-Meily ◽

Sebastiaan F W Neggers ◽

H Bart van der Worp ◽

Rick M Dijkhuizen

Keyword(s):

Motor Cortex ◽

Upper Limb ◽

Brain Stimulation ◽

Primary Outcome ◽

Primary Motor Cortex ◽

Repetitive Transcranial Magnetic Stimulation ◽

Stroke Patients ◽

Post Stroke ◽

Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

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Perceptual correlates of successful body-prosthesis interaction in lower limb amputees: psychometric characterization and development of the Prosthesis Embodiment Scale

10.31234/osf.io/7wqrc ◽

2020 ◽

Author(s):

Robin Bekrater-Bodmann

Keyword(s):

Lower Limb ◽

Principal Axis ◽

The Body ◽

Limb Amputation ◽

Prosthetic Device ◽

Online Questionnaire ◽

Final Version ◽

Principal Axis Factoring ◽

Test Retest Reliability ◽

Lower Limb Amputees

Prostheses are used to at least partly restore the body after limb amputation. Making the user accepting the prosthetic device as part of his or her body, i.e., inducing prosthesis embodiment, has been identified as major aim of prosthetic treatment. However, up to now, there is no consensus about the psychometric nature of prosthesis embodiment in limb amputees. In the present study, 118 unilateral lower limb amputees using a prosthesis were asked to complete an online questionnaire targeting prosthesis embodiment. Principal axis factoring revealed the factor structure of prosthesis embodiment, i.e., Ownership/Integrity, Agency, and Anatomical Plausibility, which resembles the embodiment structure previously found in normally-limbed participants. The majority of amputees achieved substantial embodiment of the prosthesis as assessed with the final version of the newly developed Prosthesis Embodiment Scale. Internal consistency was excellent, and test-retest reliability was acceptable, while the instrument was also sensitive for new prosthetic supply. Validation on the basis of relationships to locomotor capability, prosthesis satisfaction, and prosthesis adjustment was performed. The Prosthesis Embodiment Scale could be a valuable tool for the phenomenological assessment of successful body-prosthesis interaction in rehabilitative and research contexts, the latter which might further benefit from the comparability of psychometrically evaluated data.

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Clinical Features and Outcomes Following Bilateral Lower Limb Amputation in Korea

Prosthetics and Orthotics International ◽

10.1080/03093640600608074 ◽

2006 ◽

Vol 30 (2) ◽

pp. 155-164 ◽

Cited By ~ 5

Author(s):

Ji Cheol Shin ◽

Eun Joo Kim ◽

Chang Il Park ◽

Eun Sook Park ◽

Kyoo-Ho Shin

Keyword(s):

Clinical Features ◽

Lower Limb ◽

Daily Living ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Medical Problems ◽

Amputation Level ◽

Significant Difference ◽

Bilateral Lower Limb ◽

Lower Limb Amputees

The objectives of this study were to evaluate the clinical features and outcomes of 43 bilateral lower limb amputees. The clinical features obtained included the causes of amputation, level of amputation, concurrent medical problems, and stump condition. Outcome measures were obtained using the activities of daily living (ADL) index, the Frenchay Activities Index (FAI), and mobility grading with prostheses or wheelchair. Of 33 amputees who were prosthetic ambulators, 22 (67%), mainly bilateral trans-tibial (TT) amputees, were community ambulators, and participated in activities which included stair-walking, and six of 11 household ambulators were combination trans-femoral (TF) and TT amputees. Of 10 amputees who were wheelchair ambulators, only one was able to perform wheelchair transfers independently and five were independent wheelchair ambulators. Using the ADL index and FAI, there was no significant difference in scores according to the level of amputation ( p > 0.05), but the scores of community prosthetic ambulators were significantly higher than those of wheelchair ambulators ( p < 0.05). Age was found to be negatively correlated with ADL index and FAI scores ( r = −0.518 vs. r = −0.550) ( p < 0.01). This study concludes that overall independence in ADL after bilateral lower limb amputation improved with young age and prosthetic mobility.

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