scholarly journals Neuromotor Prosthetic to Treat Stroke-Related Paresis

2021 ◽  
Author(s):  
Mijail Serruya ◽  
Alessandro Napoli ◽  
Nicholas Satterthwaite ◽  
John Kardine ◽  
Joseph McCoy ◽  
...  
Keyword(s):  
Therapeutic Potential ◽  
Motor Impairment ◽  
Arm Movement ◽  
Myoelectric Control ◽  
Voluntary Control ◽  
Motor Deficits ◽  
Precentral Gyrus ◽  
Home Setting ◽  
Hemiparetic Stroke ◽  
Hand Opening

Abstract Background Functional recovery of independent arm movement typically plateaus within six months following a stroke, leaving chronic motor deficits. This feasibility study tested whether a wearable, powered exoskeletal orthosis, driven by a percutaneous, implanted brain–computer interface (BCI), using the activity of neurons in the precentral gyrus in the affected cortical hemisphere, could restore voluntary upper extremity function in a person with chronic hemiparetic subsequent to a cerebral hemispheric stroke of subcortical gray and white matter and cortical gray matter.Methods One person with chronic hemiparetic stroke with upper-limb motor impairment used a powered elbow-wrist-hand orthosis that opened and closed the affected hand using cortical activity, recorded from four 64-channel microelectrode arrays implanted in the ipsilesional precentral gyrus, based on decoding of spiking patterns and high frequency field potentials generated by imagined hand movements using technology and decoding methods used for people with other causes of paralysis. The system was evaluated in a home setting daily for 12 weeks. Results Robust single unit activity, modulating with attempted or imagined movement, was present throughout the precentral gyrus areas. The participant was able to acquire voluntary control over a hand-orthosis BCI, with a score of 10 points on the Action Research Arm Test (out of 53) using the BCI, compared to 0 without any device, and 5 using myoelectric control. Orthosis-powered hand-opening was faster with BCI control compared to myoelectric control, on a standardized object-movement task. Conclusions The findings demonstrate the therapeutic potential of an implantable BCI system coupled to a brace to “electrically bypass” the stroke and promote neurally driven limb function. The participant’s ability to rapidly acquire voluntary control over otherwise paralyzed hand opening, more than 18 months after a subcortical stroke, lays the foundation for a fully implanted movement restoration system.

scholarly journals Neuromotor Prosthetic to Treat Stroke-Related Paresis

2021 ◽  
Author(s):  
Mijail D. Serruya ◽  
Alessandro Napoli ◽  
Nicholas Satterthwaite ◽  
Joseph Kardine ◽  
Joseph McCoy ◽  
...  
Keyword(s):  
Therapeutic Potential ◽  
Motor Impairment ◽  
Arm Movement ◽  
Myoelectric Control ◽  
Voluntary Control ◽  
Motor Deficits ◽  
Precentral Gyrus ◽  
Home Setting ◽  
Hemiparetic Stroke ◽  
Hand Opening

AbstractBackgroundFunctional recovery of independent arm movement typically plateaus within six months following a stroke, leaving chronic motor deficits. This feasibility study tested whether a wearable, powered exoskeletal orthosis, driven by a percutaneous, implanted brain–computer interface (BCI), using the activity of neurons in the precentral gyrus in the affected cortical hemisphere, could restore voluntary upper extremity function in a person with chronic hemiparetic subsequent to a cerebral hemispheric stroke of subcortical gray and white matter and cortical gray matter.MethodsOne person with chronic hemiparetic stroke with upper-limb motor impairment used a powered elbow-wrist-hand orthosis that opened and closed the affected hand using cortical activity, recorded from four 64-channel microelectrode arrays implanted in the ipsilesional precentral gyrus, based on decoding of spiking patterns and high frequency field potentials generated by imagined hand movements using technology and decoding methods used for people with other causes of paralysis. The system was evaluated in a home setting daily for 12 weeks.ResultsRobust single unit activity, modulating with attempted or imagined movement, was present throughout the precentral gyrus areas. The participant was able to acquire voluntary control over a hand-orthosis BCI, with a score of 10 points on the Action Research Arm Test (out of 53) using the BCI, compared to 0 without any device, and 5 using myoelectric control. Orthosis-powered hand-opening was faster with BCI control compared to myoelectric control, on a standardized object-movement task.ConclusionsThe findings demonstrate the therapeutic potential of an implantable BCI system coupled to a brace to “electrically bypass” the stroke and promote neurally driven limb function. The participant’s ability to rapidly acquire voluntary control over otherwise paralyzed hand opening, more than 18 months after a subcortical stroke, lays the foundation for a fully implanted movement restoration system.

Abstract 72: A Novel VLSM-CST Lesion Load Model is a Superior Predictor of Motor Outcomes of Acute Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Jasmine Wang ◽  
Wayne Feng ◽  
Pratik Y Chhatbar ◽  
Gottfried Schlaug
Keyword(s):  
Acute Stroke ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Precentral Gyrus ◽  
Stroke Patients ◽  
Lesion Load ◽  
Days Of Therapy ◽  
Motor Outcome ◽  
Motor Tracts ◽  
Best Fit

Introduction: Lesion load of the Corticospinal Tract (CST-LL) can predict 64% of the variance in 3-months outcome of acute stroke patients. Voxel-based lesion symptom mapping (VLSM) studies have revealed brain voxels associated with motor impairment. A combined VLSM- CST-LL approach may give particular weight to voxels that are both part of an impairment map and the descending motor tracts. Hypothesis: A combined VLSM-wCST-LL model can predict acute motor outcome better than weighted CST-LL alone. Methods: We derived the VLSM map from a group of 50 chronic patients with variable motor deficits relating voxels of patients’ lesions to Upper Extremity Fugl-Meyer (UE-FM) scores. A correction for multiple comparisons was applied at FDR<0.05. Resulting VLSM T-maps were multiplied using our probabilistic CST maps, and then summed to form a canonical VLSM-weighted CST tract. Individual lesion maps from 76 acute stroke patients were overlaid onto the VLSM-weighted CST map to calculate lesion load. Patients were assessed for motor impairment (UE-FM) at baseline and at 3 months. Linear regressions were fit for baseline UE-FM, wCST-LL, and Days-of-Therapy (DoT) to determine predictions of 3-months outcome. A multivariate regression was run using VSLM-weighted CST-LL, controlling for baseline UE-FM and DoT. Age was not a significant regressor. Akaike Information Criterion was run to select the best fit model. Results: The VLSM analysis determined that voxels of lesions in the precentral gyrus, premotor regions, the corona radiata region, and within the descending motor tracts were significantly related to chronic motor impairment. VLSM-CST-LL applied to a group of acute stroke patients with motor impairment predicted 85% of the variance at 3 months motor outcome. AIC results confirmed with 99% certainty that VLSM is the best fit model. Conclusions: VLSM-weighted CST-LL is the superior fit model compared to the weighted CST-LL model for predicting 3 months outcome.

scholarly journals Transcranial Direct Current Stimulation as a Treatment Tool for Mild Traumatic Brain Injury

2021 ◽  
Vol 11 (6) ◽  
pp. 806
Author(s):  
Thorsten Rudroff ◽  
Craig D. Workman
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mild Traumatic Brain Injury ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Therapeutic Potential ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Impairment ◽  
Direct Current Stimulation ◽  
Main Technique

Mild traumatic brain injury (mTBI) has been defined as a transient (<24 h) condition of confusion and/or loss of consciousness for less than 30 min after brain injury and can result in short- and long-term motor and cognitive impairments. Recent studies have documented the therapeutic potential of non-invasive neuromodulation techniques for the enhancement of cognitive and motor function in mTBI. Alongside repetitive transcranial magnetic stimulation (rTMS), the main technique used for this purpose is transcranial direct current stimulation (tDCS). The focus of this review was to provide a detailed, comprehensive (i.e., both cognitive and motor impairment) overview of the literature regarding therapeutic tDCS paradigms after mTBI. A publication search of the PubMed, Scopus, CINAHL, and PsycINFO databases was performed to identify records that applied tDCS in mTBI. The publication search yielded 14,422 records from all of the databases, however, only three met the inclusion criteria and were included in the final review. Based on the review, there is limited evidence of tDCS improving cognitive and motor performance. Surprisingly, there were only three studies that used tDCS in mTBI, which highlights an urgent need for more research to provide additional insights into ideal therapeutic brain targets and optimized stimulation parameters.

scholarly journals The Ameliorative Effects of the Ethyl Acetate Extract ofSalicornia europaeaL. and Its Bioactive Candidate, Irilin B, on LPS-Induced Microglial Inflammation and MPTP-Intoxicated PD-Like Mouse Model

2019 ◽  
Vol 2019 ◽  
pp. 1-16 ◽  
Author(s):  
Joonsoo Kim ◽  
Govindarajan Karthivashan ◽  
Mee-Hyang Kweon ◽  
Deuk-Hoi Kim ◽  
Dong-Kug Choi
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Therapeutic Potential ◽  
Motor Deficits ◽  
Resonance Spectroscopy ◽  
Potential Candidate ◽  
Nigrostriatal Pathway ◽  
Salicornia Europaea ◽  
Isolation And Purification

Hyperactivation of microglia, the resident innate immune cells of the central nervous system, exacerbates various neurodegenerative disorders, including Parkinson’s disease (PD). Parkinson’s disease is generally characterized by a severe loss of dopaminergic neurons in the nigrostriatal pathway, with substantial neuroinflammation and motor deficits. This was experimentally replicated in animal models, using neurotoxins, i.e., LPS (lipopolysaccharides) and MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine).Salicornia europaeaL. (SE) has been used as a dietary supplement in Korea and Europe for several years, due to its nutritional and therapeutic value. In this study, we intend to investigate the antineuroinflammatory and anti-PD-like effects of the bioactive fraction/candidate of the SE extract. Initially, we screened various fractions of SE extract using anin vitroantioxidant assay. The optimal fraction was investigated for itsin vitroantineuroinflammatory potential in LPS-stimulated BV-2 microglial cells andin vivoanti-PD-like potential in MPTP-intoxicated mice. Subsequently, to identify the potential candidate responsible for the elite therapeutic potential of the optimal fraction, we conducted antioxidant activity-guided isolation and purification; the bioactive candidate was structurally characterized using nuclear magnetic resonance spectroscopy and chromatographic techniques and further investigated for itsin vitroantioxidative and antineuroinflammatory potential. The results of our study indicate that SE-EA and its bioactive candidate, Irilin B, effectively alleviate the deleterious effect of microglia-mediated neuroinflammation and promote antioxidative effects. Thus, they exhibit potential as therapeutic candidates against neuroinflammatory and oxidative stress-mediated PD-like neurodegenerative complications.

scholarly journals Eye Gaze Correlates of Motor Impairment in VR Observation of Motor Actions

2016 ◽  
Vol 55 (01) ◽  
pp. 79-83 ◽  
Author(s):  
A. Vourvopoulos ◽  
A. Bernardino ◽  
i Bermúdez Badia ◽  
J. Alves
Keyword(s):  
Virtual Reality ◽  
Smooth Pursuit ◽  
Healthy Subjects ◽  
Eye Gaze ◽  
Action Observation ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Motor Actions ◽  
Healthy Participants

Summary Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Methodologies, Models and Algorithms for Patients Rehabilitation”. Objective: Identify eye gaze correlates of motor impairment in a virtual reality motor observation task in a study with healthy participants and stroke patients. Methods: Participants consisted of a group of healthy subjects (N = 20) and a group of stroke survivors (N = 10). Both groups were required to observe a simple reach-and-grab and place-and-release task in a virtual environment. Additionally, healthy subjects were required to observe the task in a normal condition and a constrained movement condition. Eye movements were recorded during the observation task for later analysis. Results: For healthy participants, results showed differences in gaze metrics when comparing the normal and arm-constrained conditions. Differences in gaze metrics were also found when comparing dominant and non-dominant arm for saccades and smooth pursuit events. For stroke patients, results showed longer smooth pursuit segments in action observation when observing the paretic arm, thus providing evidence that the affected circuitry may be activated for eye gaze control during observation of the simulated motor action. Conclusions: This study suggests that neural motor circuits are involved, at multiple levels, in observation of motor actions displayed in a virtual reality environment. Thus, eye tracking combined with action observation tasks in a virtual reality display can be used to monitor motor deficits derived from stroke, and consequently can also be used for re -habilitation of stroke patients.

The Role of Robotic Path Assistance and Weight Support in Facilitating 3D Movements in Individuals With Poststroke Hemiparesis

2020 ◽  
Vol 34 (2) ◽  
pp. 134-147
Author(s):  
Preeti Raghavan ◽  
Seda Bilaloglu ◽  
Syed Zain Ali ◽  
Xin Jin ◽  
Viswanath Aluru ◽  
...  
Keyword(s):  
Scale Score ◽  
Motor Impairment ◽  
Movement Control ◽  
Arm Movement ◽  
Random Order ◽  
Healthy Controls ◽  
High Functioning ◽  
Weight Support ◽  
Speed Error ◽  
Low Functioning

Background. High-intensity repetitive training is challenging to provide poststroke. Robotic approaches can facilitate such training by unweighting the limb and/or by improving trajectory control, but the extent to which these types of assistance are necessary is not known. Objective. The purpose of this study was to examine the extent to which robotic path assistance and/or weight support facilitate repetitive 3D movements in high functioning and low functioning subjects with poststroke arm motor impairment relative to healthy controls. Methods. Seven healthy controls and 18 subjects with chronic poststroke right-sided hemiparesis performed 300 repetitions of a 3D circle-drawing task using a 3D Cable-driven Arm Exoskeleton (CAREX) robot. Subjects performed 100 repetitions each with path assistance alone, weight support alone, and path assistance plus weight support in a random order over a single session. Kinematic data from the task were used to compute the normalized error and speed as well as the speed-error relationship. Results. Low functioning stroke subjects (Fugl-Meyer Scale score = 16.6 ± 6.5) showed the lowest error with path assistance plus weight support, whereas high functioning stroke subjects (Fugl-Meyer Scale score = 59.6 ± 6.8) moved faster with path assistance alone. When both speed and error were considered together, low functioning subjects significantly reduced their error and increased their speed but showed no difference across the robotic conditions. Conclusions. Robotic assistance can facilitate repetitive task performance in individuals with severe arm motor impairment, but path assistance provides little advantage over weight support alone. Future studies focusing on antigravity arm movement control are warranted poststroke.

scholarly journals 4451 On the loss of individual joint controllability and the organization of muscle synergies in the impaired arm following a stroke: A pilot study

2020 ◽  
Vol 4 (s1) ◽  
pp. 33-33
Author(s):  
Dongwon Kim ◽  
Kyung Koh ◽  
Raziyeh Baghi ◽  
Li-Chuan Lo ◽  
Chunyang Zhang ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Motor Coordination ◽  
Wrist Joint ◽  
Arm Movement ◽  
Motor Deficits ◽  
Mechanical Resistance ◽  
Muscle Synergies ◽  
Study Population ◽  
Joint Range ◽  
Distal Joint

OBJECTIVES/GOALS: Damage to the sensorimotor cortex areas or/and motor/sensory pathways after a stroke could lead the motor system to a loss of controllability for joints. We investigate the loss of individual joint controllability called a loss of individualization during arm movement, which would provide an insight into abnormal motor coordination. METHODS/STUDY POPULATION: We recruit 12 chronic stroke survivors with Fugl-Meyer score between 26 and 50. A robotic exoskeleton with minimum mechanical resistance is equipped to measure the movements of the shoulder, elbow and wrist joints, respectively. Surface EMGs on muscles related to the joints are recorded using 11 wireless pre-amplified electrodes. Participants are asked to move the shoulder, elbow, or wrist joint individually throughout their range of motion, without moving the other joints voluntarily. RESULTS/ANTICIPATED RESULTS: It would be expected that participants show more difficulty in individualization of the distal joint in comparison with the proximal joint. A reduced joint range of motion would be observed in a descending order of the wrist, elbow and shoulder. These results are in line with the proximal-to-distal gradient of motor deficits after a stroke. Intention of moving the distal joint would induce a greater deviation in the position of the proximal joint than that of the distal joint when moving the proximal joint. A non-negative matrix factorization algorithm would reveal a decreased number of muscle synergies in the groups with a loss of individuation in comparison with the groups with no loss. DISCUSSION/SIGNIFICANCE OF IMPACT: We demonstrate that a stroke leads to a lack of individual joint controllability, with a greater deficits on the distal joint, and that it is related to a decreased number of muscle synergies across the corresponding joints. CONFLICT OF INTEREST DESCRIPTION: N/A.

scholarly journals Crocetin Alleviates Inflammation in MPTP-Induced Parkinson’s Disease Models through Improving Mitochondrial Functions

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Na Dong ◽  
Zhong Dong ◽  
Ying Chen ◽  
Xiaosu Gu
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Mitochondrial Permeability Transition ◽  
Therapeutic Potential ◽  
Adenine Nucleotide ◽  
Motor Deficits ◽  
Dependent Manner ◽  
Cyclophilin D ◽  
Mitochondrial Functions

Parkinson’s disease (PD) is the second most common neurodegenerative disease. Crocetin, derived from saffron, exerts multiple pharmacological properties, such as anti-inflammatory, antioxidant, antifatigue, and anticancer effects. However, the effect of crocetin on PD remains unclear. In this study, we designed experiments to investigate the effect of crocetin against MPTP-induced PD models and the underlying mechanisms. Our results showed that crocetin treatment attenuates MPTP-induced motor deficits and protects dopaminergic neurons. Both in vivo and in vitro experiments demonstrated that crocetin treatment decreased the expression of inflammatory associated genes and inflammatory cytokines. Furthermore, crocetin treatment protected mitochondrial functions against MPP+ induced damage by regulating the mPTP (mitochondrial permeability transition pore) viability in the interaction of ANT (adenine nucleotide translocase) and Cyp D (Cyclophilin D) dependent manner. Therefore, our results demonstrate that crocetin has therapeutic potential in Parkinson’s disease.

scholarly journals Marked increases in concentrations of apolipoprotein in the cerebrospinal fluid of poliovirus-infected macaques: relations between apolipoprotein concentrations and severity of brain injury

1997 ◽  
Vol 321 (1) ◽  
pp. 145-149 ◽  
Author(s):  
Kuniaki SAITO ◽  
Mitsuru SEISHIMA ◽  
Melvyn P. HEYES ◽  
Hua SONG ◽  
Suwako FUJIGAKI ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Motor Impairment ◽  
Motor Deficits ◽  
Cns Injury ◽  
Functional Roles ◽  
Apolipoprotein A ◽  
Apo E ◽  
Complete Paralysis ◽  
The Central Nervous System ◽  
Vascular Component

Apolipoproteins in cerebrospinal fluid (CSF) might have important functional roles in the pathophysiology of brain and lipid metabolism in the vascular component. The present study examined apolipoprotein A-I (apo-A-I) and apolipoprotein E (apo-E) levels in CSF and serum from poliovirus-infected macaques. Poliovirus-infected macaques developed motor deficits and were classified into three groups: (1) muscle weakness in one or both legs; (2) partial paralysis in one or both legs; (3) complete paralysis in one or both legs. No motor deficits were evident in the control or sham-treated macaques. Apo-A-I concentrations in CSF were markedly elevated in poliovirus-infected macaques with weakness, partial or complete paralysis, in comparison with either control or sham-treated animals, and were proportional to the severity of motor impairment. Apo-E concentrations in CSF were also significantly elevated in poliovirus-infected macaques with complete paralysis. The magnitude of increase in CSF apo-A-I or apo-E concentrations was also closely associated with the degree of histologic neurological damage and inflammation (lesion scores). However, no changes in serum apo-A-I and apo-E concentrations were observed in the poliovirus-infected macaques compared with control macaques. Furthermore there were no significant correlations apo-A-I or apo-E concentrations between serum and CSF. We hypothesize that the elevation of apo-A-I and apo-E concentrations after poliovirus infection is caused by immune stimulation within the central nervous system (CNS). Measures of CSF apo-A-I and apo-E levels might serve as a useful marker for the severity and/or the range of CNS injury.

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