Effects of home-based telerehabilitation in patients with stroke

Neurology ◽  
2020 ◽  
Vol 95 (17) ◽  
pp. e2318-e2330 ◽  
Author(s):  
Jing Chen ◽  
Dalong Sun ◽  
Shufan Zhang ◽  
Yonghui Shi ◽  
Fenglei Qiao ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Motor Function ◽  
Primary Motor Cortex ◽  
Brain Plasticity ◽  
Analysis Of Covariance ◽  
Imaging Biomarkers ◽  
Motor Training ◽  
Neural Function ◽  
Resting State Functional Connectivity ◽  
Home Based

ObjectiveTo determine the effects of a 12-week home-based motor training telerehabilitation program in patients with subcortical stroke by combining motor function assessments and multimodality MRI analysis methods.MethodsFifty-two patients with stroke and hemiplegia were randomly assigned to either a home-based motor training telerehabilitation (TR) group or a conventional rehabilitation (CR) group for 12 weeks. The Fugl-Meyer assessment (FMA) for upper and lower extremities and the modified Barthel Index were used as primary outcomes. The secondary outcomes included resting-state functional connectivity (rsFC) between the bilateral M1 areas, gray matter volumes of the primary motor cortex (M1) areas, and white matter integrity of the corticospinal tract. Analysis of covariance was applied to examine the effects of the home-based motor training TR program on neural function recovery and brain plasticity.ResultsCompared with the CR group, the TR group showed significant improvement in the FMA (p = 0.011) and significantly increased M1-M1 rsFC (p = 0.031) at the end of the rehabilitation. The M1-M1 rsFC change was significantly positively correlated with the FMA change in the TR group (p = 0.018).ConclusionThis study showed a beneficial effect of the home-based motor training telerehabilitation program on motor function in patients with stroke, which was accompanied by enhanced interhemispheric functional connectivity of the M1 areas. We inferred that it is feasible, safe, and efficacious for patients with stroke to receive professional rehabilitation training at home. The combined use of imaging biomarkers should be encouraged in motor training clinical studies in patients with stroke.Classification of evidenceThis study provides Class II evidence that for patients with stroke with hemiplegia, home-based telerehabilitation compared to conventional rehabilitation significantly improves some motor function tests.

scholarly journals Motor Sequences - Separating The Sequence From The Motor. A longitudinal rsfMRI Study

2021 ◽  
Author(s):  
ATP Jäger ◽  
JM Huntenburg ◽  
SA Tremblay ◽  
U Schneider ◽  
S Grahl ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Motor Learning ◽  
Resting State ◽  
Primary Motor Cortex ◽  
Control Group ◽  
Motor Execution ◽  
Motor Sequence ◽  
Resting State Functional Connectivity ◽  
Fast Learning ◽  
Slow Learning

AbstractIn motor learning, sequence-specificity, i.e. the learning of specific sequential associations, has predominantly been studied using task-based fMRI paradigms. However, offline changes in resting state functional connectivity after sequence-specific motor learning are less well understood. Previous research has established that plastic changes following motor learning can be divided into stages including fast learning, slow learning and retention. A description of how resting state functional connectivity after sequence-specific motor sequence learning (MSL) develops across these stages is missing. This study aimed to identify plastic alterations in whole-brain functional connectivity after learning a complex motor sequence by contrasting an active group who learned a complex sequence with a control group who performed a control task matched for motor execution. Resting state fMRI and behavioural performance were collected in both groups over the course of 5 consecutive training days and at follow-up after 12 days to encompass fast learning, slow learning, overall learning and retention. Between-group interaction analyses showed sequence-specific increases in functional connectivity during fast learning in the sensorimotor territory of the internal segment of right globus pallidus (GPi), and sequence-specific decreases in right supplementary motor area (SMA) in overall learning. We found that connectivity changes in key regions of the motor network including the superior parietal cortex (SPC) and primary motor cortex (M1) were not a result of sequence-specific learning but were instead linked to motor execution. Our study confirms the sequence-specific role of SMA and GPi that has previously been identified in online task-based learning studies in humans and primates, and extends it to resting state network changes after sequence-specific MSL. Finally, our results shed light on a timing-specific plasticity mechanism between GPi and SMA following MSL.

scholarly journals Home-Based Therapy After Stroke Using the Hand Spring Operated Movement Enhancer (HandSOME II)

2021 ◽  
Vol 15 ◽  
Author(s):  
Rafael Casas ◽  
Melissa Sandison ◽  
Diane Nichols ◽  
Kaelin Martin ◽  
Khue Phan ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Real World ◽  
Brain Plasticity ◽  
Low Cost ◽  
Biomechanical Testing ◽  
Chronic Stroke ◽  
Reaching Task ◽  
Home Based ◽  
Before And After ◽  
Task Practice

We have developed a passive and lightweight wearable hand exoskeleton (HandSOME II) that improves range of motion and functional task practice in laboratory testing. For this longitudinal study, we recruited 15 individuals with chronic stroke and asked them to use the device at home for 1.5 h per weekday for 8 weeks. Subjects visited the clinic once per week to report progress and troubleshoot problems. Subjects were then given the HandSOME II for the next 3 months, and asked to continue to use it, but without any scheduled contact with the project team. Clinical evaluations and biomechanical testing was performed before and after the 8 week intervention and at the 3 month followup. EEG measures were taken before and after the 8 weeks of training to examine any recovery associated brain reorganization. Ten subjects completed the study. After 8 weeks of training, functional ability (Action Research Arm Test), flexor tone (Modified Ashworth Test), and real world use of the impaired limb (Motor Activity Log) improved significantly (p < 0.05). Gains in real world use were retained at the 3-month followup (p = 0.005). At both post-training and followup time points, biomechanical testing found significant gains in finger ROM and hand displacement in a reaching task (p < 0.05). Baseline functional connectivity correlated with gains in motor function, while changes in EEG functional connectivity paralleled changes in motor recovery. HandSOME II is a low-cost, home-based intervention that elicits brain plasticity and can improve functional motor outcomes in the chronic stroke population.

scholarly journals Functional Connectivity and Networks Underlying Complex Tool-Use Movement in Assembly Workers: An fMRI Study

2021 ◽  
Vol 15 ◽  
Author(s):  
Seira Taniguchi ◽  
Yuichiro Higashi ◽  
Hirotaka Kataoka ◽  
Hiroshi Nakajima ◽  
Tetsuya Shimokawa
Keyword(s):  
Functional Connectivity ◽  
Tool Use ◽  
Repeated Measures ◽  
Inferior Frontal Gyrus ◽  
Real Life ◽  
Analysis Of Covariance ◽  
Repeated Measure ◽  
Angular Gyrus ◽  
Middle Temporal Gyrus ◽  
Resting State Functional Connectivity

The aim of this study was to identify the functional connectivity and networks utilized during tool-use in real assembly workers. These brain networks have not been elucidated because the use of tools in real-life settings is more complex than that in experimental environments. We evaluated task-related functional magnetic resonance imaging in 13 assembly workers (trained workers, TW) and 27 age-matched volunteers (untrained workers, UTW) during a tool-use pantomiming task, and resting-state functional connectivity was also analyzed. Two-way repeated-measures analysis of covariance was conducted with the group as a between-subject factor (TW > UTW) and condition (task > resting) as a repeated measure, controlling for assembly time and accuracy as covariates. We identified two patterns of functional connectivity in the whole brain within three networks that distinguished TW from UTW. TW had higher connectivity than UTW between the left middle temporal gyrus and right cerebellum Crus II (false discovery rate corrected p-value, p-FDR = 0.002) as well as between the left supplementary motor area and the pars triangularis of the right inferior frontal gyrus (p-FDR = 0.010). These network integrities may allow for TW to perform rapid tool-use. In contrast, UTW showed a stronger integrity compared to TW between the left paracentral lobule and right angular gyrus (p-FDR = 0.004), which may reflect a greater reliance on sensorimotor input to acquire complex tool-use ability than that of TW. Additionally, the fronto-parietal network was identified as a common network between groups. These findings support our hypothesis that assembly workers have stronger connectivity in tool-specific motor regions and the cerebellum, whereas UTW have greater involvement of sensorimotor networks during a tool-use task.

scholarly journals An investigation of resting state functional connectivity of the anterior and posterior Hippocampal subregions in posttraumatic stress disorder and its relationship with symptoms

2021 ◽  
Author(s):  
Bailee L. Malivoire
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Functional Connectivity ◽  
Posttraumatic Stress ◽  
Resting State ◽  
Stress Disorder ◽  
Brain Regions ◽  
Imaging Biomarkers ◽  
Resting State Functional Connectivity ◽  
Hippocampal Activity ◽  
The Right

Posttraumatic stress disorder (PTSD) is associated with abnormal hippocampal activity; however, the functional connectivity (FC) of the hippocampus with other brain regions and its relations with symptoms warrants further attention. I investigated FC of the hippocampus at a subregional level in PTSD during a resting state compared to trauma exposed controls (TECs). Based on imaging literature in PTSD, I targeted the FCs of the hippocampal head and tail subregions with the amygdala, medial prefrontal cortex (mPFC), and the posterior cingulate (PCC). The PTSD group had significantly greater FC compared to the TEC group between the left hippocampal head and the right amygdala, and for the left hippocampal tail with bilateral PCC. Resting state FC predicted symptom severity at time of scan and 4-months post-scan. These results highlight abnormal illness-related FC with both the hippocampal head and tail and provide support for future investigations of imaging biomarkers predictive of disease progression.

Fatigue in multiple sclerosis: The contribution of resting-state functional connectivity reorganization

2017 ◽  
Vol 24 (13) ◽  
pp. 1696-1705 ◽  
Author(s):  
Alvino Bisecco ◽  
Federica Di Nardo ◽  
Renato Docimo ◽  
Giuseppina Caiazzo ◽  
Alessandro d’Ambrosio ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Regression Analysis ◽  
Functional Connectivity ◽  
Motor Cortex ◽  
Resting State ◽  
Primary Motor Cortex ◽  
Linear Regression Analysis ◽  
Posterior Cingulate Cortex ◽  
Resting State Functional Connectivity ◽  
Sensorimotor Network

Objectives: To investigate resting-state functional connectivity (RS-FC) of the default-mode network (DMN) and of sensorimotor network (SMN) network in relapsing remitting (RR) multiple sclerosis (MS) patients with fatigue (F) and without fatigue(NF). Methods: In all, 59 RRMS patients and 29 healthy controls (HC) underwent magnetic resonance imaging (MRI) protocol including resting-state fMRI (RS-fMRI). Functional connectivity of the DMN and SMN was evaluated by independent component analysis (ICA). A linear regression analysis was performed to explore whether fatigue was mainly driven by changes observed in the DMN or in the SMN. Regional gray matter atrophy was assessed by voxel-based morphometry (VBM). Results: Compared to HC, F-MS patients showed a stronger RS-FC in the posterior cingulate cortex (PCC) and a reduced RS-FC in the anterior cingulated cortex (ACC) of the DMN. F-MS patients, compared to NF-MS patients, revealed (1) an increased RS-FC in the PCC and a reduced RS-FC in the ACC of the DMN and (2) an increased RS-FC in the primary motor cortex and in the supplementary motor cortex of the SMN. The regression analysis suggested that fatigue is mainly driven by RS-FC changes of the DMN. Conclusions: Fatigue in RRMS is mainly associated to a functional rearrangement of non-motor RS networks.

scholarly journals Genetic Contribution of Synapse-Associated Protein 97 to Orbitofrontal–Striatal–Thalamic Circuitry Connectivity Changes in First-Episode Schizophrenia

2021 ◽  
Vol 12 ◽  
Author(s):  
Xusan Xu ◽  
Shucun Luo ◽  
Xia Wen ◽  
Xiaoxia Wang ◽  
Jingwen Yin ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Negative Symptoms ◽  
Clinical Performance ◽  
Clinical Manifestations ◽  
Analysis Of Covariance ◽  
First Episode ◽  
Imaging Data ◽  
Resting State Functional Connectivity ◽  
Mental Symptoms ◽  
First Episode Schizophrenia

Functional and structural disturbances in the orbitofrontal–striatal–thalamic circuitry are thought to be associated with mental symptoms and neurocognitive impairments in schizophrenia. This study tested whether synapse-associated protein 97 (SAP97), a reasonable candidate gene for schizophrenia, is related to orbitofrontal–striatal–thalamic connection changes in first-episode schizophrenia (FES) patients and the clinical performance of schizophrenic patients by affecting this integrity. Fifty-two FES patients and 52 matched healthy controls were recruited. All subjects underwent genotyping via the improved multiplex ligation detection reaction technique and scanning with magnetic resonance imaging (MRI) to provide orbitofrontal–striatal–thalamic functional and structural imaging data. A two-way analysis of covariance model was employed to examine abnormal brain connectivities, and Spearman correlations were applied to estimate the relationships between brain connectivity and clinical manifestations. In the FES group, those with the SAP97 rs3915512 TT genotype showed lower structural and functional connectivity than A allele carriers between the orbitofrontal gyrus and striatum/thalamus. In the FES group, negative correlations were found between resting-state functional connectivity (RSFC) in the orbitofrontal gyrus and thalamus, and positive symptoms between structural connections in the orbitofrontal gyrus and striatum and cognitive functions, and positive correlations were suggested between RSFC in the orbitofrontal gyrus and thalamus and negative symptoms. Our findings suggested that the SAP97 rs3915512 polymorphism may be involved in mental symptoms and cognitive dysfunction in FES patients by influencing structural and functional connectivity of the orbitofrontal–striatal and orbitofrontal–thalamic regions.

scholarly journals Primary motor cortex mapping in brain-lesioned patients using MEG resting-state functional connectivity

2014 ◽  
Vol 8 ◽  
Author(s):  
Coquelet Nicolas ◽  
Wens Vincent ◽  
Bourguignon Mathieu ◽  
Carrette Evelien ◽  
Op De Beeck Marc ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Motor Cortex ◽  
Resting State ◽  
Primary Motor Cortex ◽  
Resting State Functional Connectivity ◽  
Motor Cortex Mapping

scholarly journals Predictors and brain connectivity changes associated with arm motor function improvement from intensive practice in chronic stroke

F1000Research ◽  
2017 ◽  
Vol 5 ◽  
pp. 2119 ◽  
Author(s):  
George F. Wittenberg ◽  
Lorie G. Richards ◽  
Lauren M. Jones-Lush ◽  
Steven R. Roys ◽  
Rao P. Gullapalli ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Functional Connectivity ◽  
Motor Cortex ◽  
Upper Extremity ◽  
Fractional Anisotropy ◽  
Motor Function ◽  
Primary Motor Cortex ◽  
Chronic Stroke ◽  
Blood Oxygenation ◽  
Affected Side

Background and Purpose: The brain changes that underlie therapy-induced improvement in motor function after stroke remain obscure. This study sought to demonstrate the feasibility and utility of measuring motor system physiology in a clinical trial of intensive upper extremity rehabilitation in chronic stroke-related hemiparesis. Methods: This was a substudy of two multi-center clinical trials of intensive robotic and intensive conventional therapy arm therapy in chronic, significantly hemiparetic, stroke patients. Transcranial magnetic stimulation was used to measure motor cortical output to the biceps and extensor digitorum communus muscles. Magnetic resonance imaging (MRI) was used to determine the cortical anatomy, as well as to measure fractional anisotropy, and blood oxygenation (BOLD) during an eyes-closed rest state. Region-of-interest time-series correlation analysis was performed on the BOLD signal to determine interregional connectivity. Functional status was measured with the upper extremity Fugl-Meyer and Wolf Motor Function Test. Results: Motor evoked potential (MEP) presence was associated with better functional outcomes, but the effect was not significant when considering baseline impairment. Affected side internal capsule fractional anisotropy was associated with better function at baseline. Affected side primary motor cortex (M1) activity became more correlated with other frontal motor regions after treatment. Resting state connectivity between affected hemisphere M1 and dorsal premotor area (PMAd) predicted recovery. Conclusions: Presence of motor evoked potentials in the affected motor cortex and its functional connectivity with PMAd may be useful in predicting recovery. Functional connectivity in the motor network shows a trends towards increasing after intensive robotic or non-robotic arm therapy. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00372411 \& NCT00333983.

scholarly journals Multiple Sclerosis: Changes in Thalamic Resting-State Functional Connectivity Induced by a Home-based Cognitive Rehabilitation Program

Radiology ◽  
2016 ◽  
Vol 280 (1) ◽  
pp. 202-211 ◽  
Author(s):  
Laura De Giglio ◽  
Francesca Tona ◽  
Francesca De Luca ◽  
Nikolaos Petsas ◽  
Luca Prosperini ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Functional Connectivity ◽  
Resting State ◽  
Cognitive Rehabilitation ◽  
Rehabilitation Program ◽  
Resting State Functional Connectivity ◽  
Home Based

scholarly journals Altered Functional Connectivity of Cognitive-Related Cerebellar Subregions in Well-Recovered Stroke Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Wei Li ◽  
Tong Han ◽  
Wen Qin ◽  
Jing Zhang ◽  
Huaigui Liu ◽  
...  
Keyword(s):  
Prefrontal Cortex ◽  
Functional Connectivity ◽  
Cognitive Control ◽  
Motor Function ◽  
Posterior Parietal Cortex ◽  
Control Function ◽  
Posterior Cingulate Cortex ◽  
Resting State Functional Connectivity ◽  
Stroke Patients ◽  
Frontoparietal Network

The cerebellum contains several cognitive-related subregions that are involved in different functional networks. The cerebellar crus II is correlated with the frontoparietal network (FPN), whereas the cerebellar IX is associated with the default-mode network (DMN). These two networks are anticorrelated and cooperatively implicated in cognitive control, which may facilitate the motor recovery in stroke patients. In the present study, we aimed to investigate the resting-state functional connectivity (rsFC) changes in 25 subcortical ischemic stroke patients with well-recovered global motor function. Consistent with previous studies, the crus II was correlated with the FPN, including the dorsolateral prefrontal cortex (DLPFC) and posterior parietal cortex, and the cerebellar IX was correlated with the DMN, including the posterior cingulate cortex/precuneus (PCC/Pcu), medial prefrontal cortex (MPFC), DLPFC, lateral parietal cortices, and anterior temporal cortices. No significantly increased rsFCs of these cerebellar subregions were found in stroke patients, suggesting that the rsFCs of the cognitive-related cerebellar subregions are not the critical factors contributing to the recovery of motor function in stroke patients. The finding of the disconnection in the cerebellar-related cognitive control networks may possibly explain the deficits in cognitive control function even in stroke patients with well-recovered global motor function.

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