scholarly journals Peak Activation Shifts in the Sensorimotor Cortex of Chronic Stroke Patients Following Robot-assisted Rehabilitation Therapy

2021 ◽  
Vol 14 (1) ◽  
pp. 8-15
Author(s):  
Loukas G. Astrakas ◽  
Shasha Li ◽  
Mark P. Ottensmeyer ◽  
Christian Pusatere ◽  
Michael A. Moskowitz ◽  
...  
Keyword(s):  
Sensorimotor Cortex ◽  
Primary Motor Cortex ◽  
Motor Task ◽  
Chronic Stroke ◽  
Repeated Measure ◽  
Robotic Device ◽  
Peak Activity ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Rehabilitation Therapy

Background: Ischemic stroke is the most common cause of complex chronic disability and the third leading cause of death worldwide. In recovering stroke patients, peak activation within the ipsilesional primary motor cortex (M1) during the performance of a simple motor task has been shown to exhibit an anterior shift in many studies and a posterior shift in other studies. Objective: We investigated this discrepancy in chronic stroke patients who completed a robot-assisted rehabilitation therapy program. Methods: Eight chronic stroke patients with an intact M1 and 13 Healthy Control (HC) volunteers underwent 300 functional magnetic resonance imaging (fMRI) scans while performing a grip task at different force levels with a robotic device. The patients were trained with the same robotic device over a 10-week intervention period and their progress was evaluated serially with the Fugl-Meyer and Modified Ashworth scales. Repeated measure analyses were used to assess group differences in locations of peak activity in the sensorimotor cortex (SM) and the relationship of such changes with scores on the Fugl-Meyer Upper Extremity (FM UE) scale. Results: Patients moving their stroke-affected hand had proportionally more peak activations in the primary motor area and fewer peak activations in the somatosensory cortex than the healthy controls (P=0.009). They also showed an anterior shift of peak activity on average of 5.3-mm (P<0.001). The shift correlated negatively with FM UE scores (P=0.002). Conclusion: A stroke rehabilitation grip task with a robotic device was confirmed to be feasible during fMRI scanning and thus amenable to be used to assess plastic changes in neurological motor activity. Location of peak activity in the SM is a promising clinical neuroimaging index for the evaluation and monitoring of chronic stroke patients.

The Combined Effects of Adaptive Control and Virtual Reality on Robot-Assisted Fine Hand Motion Rehabilitation in Chronic Stroke Patients: A Case Study

2018 ◽  
Vol 27 (1) ◽  
pp. 221-228 ◽  
Author(s):  
Xianwei Huang ◽  
Fazel Naghdy ◽  
Golshah Naghdy ◽  
Haiping Du ◽  
Catherine Todd
Keyword(s):  
Virtual Reality ◽  
Adaptive Control ◽  
Chronic Stroke ◽  
Combined Effects ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Hand Motion

Abstract T P123: Non-invasive Brain Stimulation for Motor Function of Chronic Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Eunhee Park ◽  
Tae Gun Kwon ◽  
Won Hyuk Chang ◽  
Yun-Hee Kim
Keyword(s):  
Motor Function ◽  
Brain Stimulation ◽  
Movement Time ◽  
Motor Task ◽  
Chronic Stroke ◽  
Stroke Patients ◽  
Dual Mode ◽  
Simultaneous Application ◽  
Corticomotor Excitability ◽  
Cathodal Tdcs

Objective: The purpose of this study was to investigate the effect of dual-mode noninvasive brain stimulation (NBS) by combining transcranial direct current stimulation (tDCS) over the unaffected primary motor cortex (uM1) and high-frequency repetitive transcranial magnetic stimulation (rTMS) over the affected M1 (aM1) on motor functions and corticomotor excitability in chronic stroke patients. Methods: Seventeen chronic stroke patients (12 men; mean age 58.7 years; 12 infarctions and 5 hemorrhages) participated in this double blinded random-order crossover study. All participants received three randomly arranged, dual-mode stimulations with 24 hours of washout period; Condition 1, simultaneous application of 10 Hz rTMS over the aM1 and cathodal tDCS over the uM1; Condition 2, simultaneous application of 10 Hz rTMS over the M1a and anodal tDCS over the uM1; Condition 3, 10 Hz rTMS over the aM1 and sham tDCS over the uM1. Corticomotor excitability using motor evoked potential (MEP) amplitude and hand motor functions using the sequential motor task were assessed before and after stimulation. Results: MEP amplitude was significantly increased after condition 1 and 3, respectively (p<0.05). The changes of MEP amplitude were significantly higher in condition 1 than condition 2 (p<0.05). In sequential motor task, the movement time was significantly decreased after condition 1 and 3, respectively (p<0.05). The change of movement time was significantly larger in condition 1 than the other conditions (p<0.05). Conclusions: Simultaneous stimulation of cathodal tDCS over the uM1 produced enhancement of 10 Hz rTMS effect over the aM1 in patients with stroke. These results suggest the dual-mode NBS as a method of enhancing motor function probably by inducing interhemispheric interaction of bilateral primary motor cortices in chronic stroke patients (Supported by the National Research Foundation of Korea grant (No.2011-0016960) and a KOSEF grant (M10644000022-06N4400-02210)).

Upper limb robot-assisted therapy in subacute and chronic stroke patients using an innovative end-effector haptic device: A pilot study

2018 ◽  
Vol 42 (1) ◽  
pp. 43-52 ◽  
Author(s):  
S. Mazzoleni ◽  
E. Battini ◽  
R. Crecchi ◽  
P. Dario ◽  
F. Posteraro
Keyword(s):  
Pilot Study ◽  
Upper Limb ◽  
Chronic Stroke ◽  
Haptic Device ◽  
Stroke Patients ◽  
Robot Assisted ◽  
End Effector

scholarly journals The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Ana Dionísio ◽  
Rita Gouveia ◽  
João Castelhano ◽  
Isabel Catarina Duarte ◽  
Gustavo C. Santo ◽  
...  
Keyword(s):  
Motor Function ◽  
Primary Motor Cortex ◽  
Phase Iii ◽  
Repeated Measure ◽  
Controlled Study ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke ◽  
Theta Burst

Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitability, oscillatory patterns, and motor function, the main aim being to identify potentially beneficial neurophysiological effects.Materials and Methods: We applied randomized real or placebo stimulation over the unaffected primary motor cortex of 10 subacute (7 ± 3 days) post-stroke patients. Neurophysiological measurements were performed using electroencephalography and electromyography. Motor function was assessed with the Wolf Motor Function Test. We performed a repeated measure study with the recordings taken pre-, post-cTBS, and at 3 months' follow-up.Results: We investigated changes in motor rhythms during arm elevation and thumb opposition tasks and found significant changes in beta power of the affected thumb's opposition, specifically after real cTBS. Our results are consistent with an excitatory response (increase in event-related desynchronization) in the sensorimotor cortical areas of the affected hemisphere, after stimulation. Neither peak-to-peak amplitude of motor-evoked potentials nor motor performance were significantly altered.Conclusions: Consistently with the theoretical prediction, this contralateral inhibitory stimulation paradigm changes neurophysiology, leading to a significant excitatory impact on the cortical oscillatory patterns of the contralateral hemisphere. These proof-of-concept results provide evidence for the potential role of continuous TBS in the neurorehabilitation of post-stroke patients. We suggest that these changes in ERS/ERD patterns should be further explored in future phase IIb/phase III clinical trials, in larger samples of poststroke patients.

The Influence of Cortico-Cerebellar Structural Connectivity on Cortical Excitability in Chronic Stroke

2019 ◽  
Vol 30 (3) ◽  
pp. 1330-1344
Author(s):  
Stephanie Guder ◽  
Benedikt M Frey ◽  
Winifried Backhaus ◽  
Hanna Braass ◽  
Jan E Timmermann ◽  
...  
Keyword(s):  
Primary Motor Cortex ◽  
Structural Integrity ◽  
Cortical Excitability ◽  
Structural Information ◽  
Motor Evoked Potentials ◽  
Structural Connectivity ◽  
Chronic Stroke ◽  
Motor Output ◽  
Healthy Controls ◽  
Stroke Patients

Abstract Brain imaging has recently evidenced that the structural state of distinct reciprocal cortico-cerebellar fiber tracts, the dentato-thalamo-cortical tract (DTCT), and the cortico-ponto-cerebellar tract (CPCeT), significantly influences residual motor output in chronic stroke patients, independent from the level of damage to the corticospinal tract (CST). Whether such structural information might also directly relate to measures of cortical excitability is an open question. Eighteen chronic stroke patients with supratentorial ischemic lesions and 17 healthy controls underwent transcranial magnetic stimulation to assess recruitment curves of motor evoked potentials of both hemispheres. Diffusion-weighted imaging and probabilistic tractography were applied to reconstruct reciprocal cortico-cerebellar motor tracts between the primary motor cortex and the cerebellum. Tract-related microstructure was estimated by means of fractional anisotropy, and linear regression modeling was used to relate it to cortical excitability. The main finding was a significant association between cortical excitability and the structural integrity of the DTCT, the main cerebellar outflow tract, independent from the level of damage to the CST. A comparable relationship was neither detectable for the CPCeT nor for the healthy controls. This finding contributes to a mechanistic understanding of the putative supportive role of the cerebellum for residual motor output by facilitating cortical excitability after stroke.

scholarly journals Acupuncture Enhances Effective Connectivity between Cerebellum and Primary Sensorimotor Cortex in Patients with Stable Recovery Stroke

2014 ◽  
Vol 2014 ◽  
pp. 1-9 ◽  
Author(s):  
Zijing Xie ◽  
Fangyuan Cui ◽  
Yihuai Zou ◽  
Lijun Bai
Keyword(s):  
Motor Learning ◽  
Sensorimotor Cortex ◽  
Effective Connectivity ◽  
Motor Task ◽  
Stroke Patients ◽  
Movement Coordination ◽  
Subacute Stroke ◽  
Primary Sensorimotor Cortex ◽  
Recovery Stroke ◽  
Hemiparetic Stroke

Recent neuroimaging studies have demonstrated that stimulation of acupuncture at motor-implicated acupoints modulates activities of brain areas relevant to the processing of motor functions. This study aims to investigate acupuncture-induced changes in effective connectivity among motor areas in hemiparetic stroke patients by using the multivariate Granger causal analysis. A total of 9 stable recovery stroke patients and 8 healthy controls were recruited and underwent three runs of fMRI scan: passive finger movements and resting state before and after manual acupuncture stimuli. Stroke patients showed significantly attenuated effective connectivity between cortical and subcortical areas during passive motor task, which indicates inefficient information transmissions between cortical and subcortical motor-related regions. Acupuncture at motor-implicated acupoints showed specific modulations of motor-related network in stroke patients relative to healthy control subjects. This specific modulation enhanced bidirectionally effective connectivity between the cerebellum and primary sensorimotor cortex in stroke patients, which may compensate for the attenuated effective connectivity between cortical and subcortical areas during passive motor task and, consequently, contribute to improvement of movement coordination and motor learning in subacute stroke patients. Our results suggested that further efficacy studies of acupuncture in motor recovery can focus on the improvement of movement coordination and motor learning during motor rehabilitation.

Wrist Robot-Assisted Rehabilitation Treatment in Subacute and Chronic Stroke Patients: From Distal-to-Proximal Motor Recovery

2018 ◽  
Vol 26 (9) ◽  
pp. 1889-1896 ◽  
Author(s):  
Stefano Mazzoleni ◽  
Vi-Do Tran ◽  
Paolo Dario ◽  
Federico Posteraro
Keyword(s):  
Chronic Stroke ◽  
Motor Recovery ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Rehabilitation Treatment

scholarly journals The Influence of Primary Motor Cortex Inhibition on Upper Limb Impairment and Function in Chronic Stroke: A Multimodal Study

2019 ◽  
Vol 33 (2) ◽  
pp. 130-140 ◽  
Author(s):  
Ronan A. Mooney ◽  
Suzanne J. Ackerley ◽  
Deshan K. Rajeswaran ◽  
John Cirillo ◽  
P. Alan Barber ◽  
...  
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Motor Impairment ◽  
Intracortical Inhibition ◽  
Chronic Stroke ◽  
Stroke Patients ◽  
Gaba Concentration ◽  
Chronic Stage ◽  
And Function

Background. Stroke is a leading cause of adult disability owing largely to motor impairment and loss of function. After stroke, there may be abnormalities in γ-aminobutyric acid (GABA)-mediated inhibitory function within primary motor cortex (M1), which may have implications for residual motor impairment and the potential for functional improvements at the chronic stage. Objective. To quantify GABA neurotransmission and concentration within ipsilesional and contralesional M1 and determine if they relate to upper limb impairment and function at the chronic stage of stroke. Methods. Twelve chronic stroke patients and 16 age-similar controls were recruited for the study. Upper limb impairment and function were assessed with the Fugl-Meyer Upper Extremity Scale and Action Research Arm Test. Threshold tracking paired-pulse transcranial magnetic stimulation protocols were used to examine short- and long-interval intracortical inhibition and late cortical disinhibition. Magnetic resonance spectroscopy was used to evaluate GABA concentration. Results. Short-interval intracortical inhibition was similar between patients and controls ( P = .10). Long-interval intracortical inhibition was greater in ipsilesional M1 compared with controls ( P < .001). Patients who did not exhibit late cortical disinhibition in ipsilesional M1 were those with greater upper limb impairment and worse function ( P = .002 and P = .017). GABA concentration was lower within ipsilesional ( P = .009) and contralesional ( P = .021) M1 compared with controls, resulting in an elevated excitation-inhibition ratio for patients. Conclusion. These findings indicate that ipsilesional and contralesional M1 GABAergic inhibition are altered in this small cohort of chronic stroke patients. Further study is warranted to determine how M1 inhibitory networks might be targeted to improve motor function.

Effects of walking distance over robot-assisted training on walking ability in chronic stroke patients

2020 ◽  
Vol 81 ◽  
pp. 279-283
Author(s):  
Manabu Nankaku ◽  
Hiroki Tanaka ◽  
Ryosuke Ikeguchi ◽  
Takayuki Kikuchi ◽  
Susumu Miyamoto ◽  
...  
Keyword(s):  
Chronic Stroke ◽  
Walking Distance ◽  
Walking Ability ◽  
Stroke Patients ◽  
Robot Assisted
Sign in / Sign up

Export Citation Format

Share Document