scholarly journals Ipsilesional Mu Rhythm Desynchronization Correlates With Improvements in Affected Hand Grip Strength and Functional Connectivity in Sensorimotor Cortices Following BCI-FES Intervention for Upper Extremity in Stroke Survivors

2021 ◽  
Vol 15 ◽  
Author(s):  
Alexander B. Remsik ◽  
Klevest Gjini ◽  
Leroy Williams ◽  
Peter L. E. van Kan ◽  
Shawna Gloe ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Upper Extremity ◽  
Motor Function ◽  
Grip Force ◽  
Primary Motor Cortex ◽  
Right Hemisphere ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Mu Rhythm ◽  
Motor Rehabilitation

Stroke is a leading cause of acquired long-term upper extremity motor disability. Current standard of care trajectories fail to deliver sufficient motor rehabilitation to stroke survivors. Recent research suggests that use of brain-computer interface (BCI) devices improves motor function in stroke survivors, regardless of stroke severity and chronicity, and may induce and/or facilitate neuroplastic changes associated with motor rehabilitation. The present sub analyses of ongoing crossover-controlled trial NCT02098265 examine first whether, during movements of the affected hand compared to rest, ipsilesional Mu rhythm desynchronization of cerebral cortical sensorimotor areas [Brodmann’s areas (BA) 1-7] is localized and tracks with changes in grip force strength. Secondly, we test the hypothesis that BCI intervention results in changes in frequency-specific directional flow of information transmission (direct path functional connectivity) in BA 1-7 by measuring changes in isolated effective coherence (iCoh) between cerebral cortical sensorimotor areas thought to relate to electrophysiological signatures of motor actions and motor learning. A sample of 16 stroke survivors with right hemisphere lesions (left hand motor impairment), received a maximum of 18–30 h of BCI intervention. Electroencephalograms were recorded during intervention sessions while outcome measures of motor function and capacity were assessed at baseline and completion of intervention. Greater desynchronization of Mu rhythm, during movements of the impaired hand compared to rest, were primarily localized to ipsilesional sensorimotor cortices (BA 1-7). In addition, increased Mu desynchronization in the ipsilesional primary motor cortex, Post vs. Pre BCI intervention, correlated significantly with improvements in hand function as assessed by grip force measurements. Moreover, the results show a significant change in the direction of causal information flow, as measured by iCoh, toward the ipsilesional motor (BA 4) and ipsilesional premotor cortices (BA 6) during BCI intervention. Significant iCoh increases from ipsilesional BA 4 to ipsilesional BA 6 were observed in both Mu [8–12 Hz] and Beta [18–26 Hz] frequency ranges. In summary, the present results are indicative of improvements in motor capacity and behavior, and they are consistent with the view that BCI-FES intervention improves functional motor capacity of the ipsilesional hemisphere and the impaired hand.

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 Altered functional connectivity differs in stroke survivors with impaired touch sensation following left and right hemisphere lesions

2018 ◽  
Vol 18 ◽  
pp. 342-355 ◽  
Author(s):  
Peter Goodin ◽  
Gemma Lamp ◽  
Rishma Vidyasagar ◽  
David McArdle ◽  
Rüdiger J. Seitz ◽  
...  
Keyword(s):  
Functional Connectivity ◽  
Right Hemisphere ◽  
Stroke Survivors ◽  
Touch Sensation ◽  
Left And Right

scholarly journals β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke

2020 ◽  
Vol 34 (5) ◽  
pp. 450-462 ◽  
Author(s):  
Chih-Wei Tang ◽  
Fu-Jung Hsiao ◽  
Po-Lei Lee ◽  
Yun-An Tsai ◽  
Ya-Fang Hsu ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Hand Movement ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Healthy Controls ◽  
Functional Changes ◽  
Post Stroke ◽  
Subacute Stroke

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.

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.

Abstract WP191: Ipsilesional Mu Sensorimotor Rhythms Track With Hand Function Recovery in Stroke Survivors

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Alexander B Remsik ◽  
Erik Bjorklund ◽  
Klevest Gjini ◽  
Leroy Williams ◽  
Peter L van Kan ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Source Localization ◽  
Right Hemisphere ◽  
Pearson Correlation ◽  
Solution Space ◽  
Hand Movements ◽  
Head Model ◽  
Mu Rhythm ◽  
Left Hand ◽  
Hand Grip

This research seeks to identify source localization of neuromechanical changes associated with gains in hand grip function following BCI intervention sessions for upper extremity motor recovery. Mu rhythm desynchronization (ERD) of contralateral brain motor areas is thought to occur during movement and changes in brain motor area ERD relate to changes in behavioral measures, hand grip function, with BCI intervention. N=16 right hemisphere survivors participated in 9-15 sessions with BCI. Participants executed hand movements in response to visual cues on a computer screen with the corresponding audio instructions (e.g., Left, Right, Rest). The sessions (i.e. pre and post BCI intervention) contained two runs, each consisting of 15 trials for rest, left hand, and right hand movements (i.e., 5 trials for each of the three conditions) presented in random order. Data from the pre and post conditions were then grand averaged. sLORETA estimates were calculated as follows: 1) Clean EEG data segmented (LEFT hand attempted movements and REST) separately for PRE and POST conditions. 2) Cross-spectra (MU[8-12 Hz]) were computed then averaged (i.e. 1 average per each subject separately for left, right and rest trials. 3) sLORETA of MU power estimates at 6239 cortical locations/voxels were obtained, normalized across subjects. In the sLORETA implementation, computations made in realistic head model using the MNI152 template, with 3D solution space restricted to cortical gray matter, as determined by the probabilistic Talairach atlas. The specific frequency band cross-spectra (frequency-domain) obtained from the average-reference potential data, were the inputs for source localization. 4) sLORETA estimates between the 2 conditions [Movement - Rest] were then calculated in cortical space. Pearson correlation of voxel-wise Mu ERD with the change in Hand Grip were calculated. A stronger Mu ERD in the ipsilesional primary motor cortical area (BA 4) at ‘post’ intervention (i.e., more negative values compared to ‘pre’) was associated with a greater change in hand grip (r=-0.435, p=0.046 [1-tailed]). Increases in functional recovery of the impaired upper extremity (Hand Grip) have a direct correlation with greater changes in Mu ERD of ipsilesional motor brain areas.

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

F1000Research ◽  
2016 ◽  
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 ◽  
Chronic Stroke ◽  
Blood Oxygenation ◽  
Robotic Arm ◽  
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 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:  CT00372411 & NCT00333983.

Abstract P219: Somatosensory Impairments at Baseline Limit Motor Recovery in Stroke Survivors Using a BCI

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Alexander B Remsik ◽  
Shawna Gloe ◽  
Leroy Williams ◽  
PETER L VAN KAN ◽  
Veena A Nair ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Brain Injuries ◽  
Somatosensory System ◽  
Motor Recovery ◽  
Stroke Survivors ◽  
Motor Rehabilitation ◽  
Recovery Potential ◽  
System Integrity ◽  
Upper Extremity Rehabilitation

Objective: This study is part of a clinical trial designed to test the efficacy of an EEG-based BCI intervention for upper extremity motor rehabilitation in stroke survivors. The analyses presented here focus on the effectiveness of BCI intervention as a function of somatosensory integrity. Introduction: Human motor control requires integration of sensory and motor signals in the generation of motor commands. Stroke lesions often result in sensorimotor impairments and survivors may require rehabilitation to regain motor function and capacity. Stroke affects individuals differentially, based on a range of factors, including, but not limited to, lesion location and volume. Such factors may restrain recovery potential. Hypothesis: We tested the hypothesis that stroke survivors with measurable somatosensory impairments realize the same amount of motor recovery as those participants without somatosensory impairments. Methods: N= 23 stroke survivors participated in up to 30 hours of BCI intervention (13.8 ±1.3, mean + SD) for upper extremity rehabilitation, as measured by the ARAT. Participants were grouped post-hoc on presence or absence of somatosensory impairments, as measured by the NIHSS subdomains of Sensory (i.e. cutaneous), and Motor Arm (i.e. proprioceptive) and their group means compared. Results: The hypothesis was not confirmed. Mean ARAT scores at completion and follow up differed between groups (Cutaneous loss: ARAT mean change at completion: 0.9 ± 2.23, p= 0.234; ARAT mean change at follow-up: 1.20 ± 2.860, p = 0.217), (No Cutaneous loss: ARAT mean change at completion: 2.15 ± 6.34, p= 0.244; ARAT mean change at follow-up: 4.39 ± 6.41, p= 0.0297) (Proprioceptive loss: ARAT mean change at completion: 0.867 ± 3.66, p= 0.375, ARAT mean change at follow-up: 2.47 ± 5.38, p= 0.097), (No Proprioceptive loss: ARAT mean change at completion: 3 ± 6.80, p= 0.252, ARAT mean change at follow-up: 4 ± 5.42, p= 0.075). Conclusions: These results suggest that BCI intervention is more effective at delivering motor improvements in participants with less somatosensory impairments. These results are consistent with the view that somatosensory system integrity may be key to BCI motor rehabilitation of brain injuries following stroke.

scholarly journals Efficacy of functional magnetic stimulation in improving upper extremity function after stroke: a randomized, single-blind, controlled study

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092788
Author(s):  
Xiaowei Chen ◽  
Xuncan Liu ◽  
Yinxing Cui ◽  
Guoxing Xu ◽  
Lu Liu ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Upper Extremity ◽  
Motor Function ◽  
Magnetic Stimulation ◽  
Primary Motor Cortex ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Controlled Study ◽  
Extremity Function ◽  
Upper Extremity Function

Objective To clarify the efficacy of functional magnetic stimulation (FMS) in improving hemiplegic upper extremity function in patients with sub-acute stroke. Methods In this randomized controlled trial, 40 sub-acute stroke patients with hemiplegia were recruited from inpatient wards in the Department of Rehabilitation and randomly assigned to two groups. In the FMS group, magnetic stimulation was applied to extensor muscle groups of the affected upper extremity. In the low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) group, stimulation was applied to the contralesional primary motor cortex. All patients received occupational therapy. Hand and upper extremity motor function was evaluated using the Fugl–Meyer Assessment for upper extremity (FMA-UE), and the Barthel Index (BI) evaluated daily living abilities. Results The FMA-UE and BI scores were significantly increased in both groups following stimulation. Furthermore, a significant between-group difference was observed in both FMA-UE and BI scores after 2 weeks of therapy. In the FMS group, 6 of 19 patients regained wrist and finger extension abilities, but only 2 patients regained equivalent motor skills in the LF-rTMS group Conclusions FMS improves paretic upper extremity function and leads to better recovery of motor activity than LF-rTMS. FMS may be a novel modality to improve motor function.

scholarly journals Functional Deficits in the Less-Impaired Arm of Stroke Survivors Depend on Hemisphere of Damage and Extent of Paretic Arm Impairment

2019 ◽  
Vol 34 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Candice Maenza ◽  
David C. Good ◽  
Carolee J. Winstein ◽  
David A. Wagstaff ◽  
Robert L. Sainburg
Keyword(s):  
Grip Strength ◽  
Motor Function ◽  
Right Hemisphere ◽  
Functional Performance ◽  
Hand Function ◽  
Motor Impairment ◽  
Functional Independence ◽  
Motor Deficit ◽  
Motor Deficits ◽  
Stroke Survivors

Background. Previous research has detailed the hemisphere dependence and specific kinematic deficits observed for the less-affected arm of patients with unilateral stroke. Objective. We now examine whether functional motor deficits in the less-affected arm, measured by standardized clinical measures of motor function, also depend on the hemisphere that was damaged and on the severity of contralesional impairment. Methods. We recruited 48 left-hemisphere-damaged (LHD) participants, 62 right-hemisphere-damaged participants, and 54 age-matched control participants. Measures of motor function included the following: (1) Jebsen-Taylor Hand Function Test (JHFT), (2) Grooved Pegboard Test (GPT), and (3) grip strength. We measured the extent of contralesional arm impairment with the upper-extremity component of the Fugl-Meyer (UEFM) assessment of motor impairment. Results. Ipsilesional limb functional performance deficits (JHFT) varied with both the damaged hemisphere and severity of contralesional arm impairment, with the most severe deficits expressed in LHD participants with severe contralesional impairment (UEFM). GPT and grip strength varied with severity of contralesional impairment but not with hemisphere. Conclusions. Stroke survivors with the most severe paretic arm impairment, who must rely on their ipsilesional arm for performing daily activities, have the greatest motor deficit in the less-affected arm. We recommend remediation of this arm to improve functional independence in this group of stroke patients.

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