Posts Tagged motor cortex

[ARTICLE] Vagus Nerve Stimulation Paired With Upper Limb Rehabilitation After Chronic Stroke – Full Text PDF

A Blinded Randomized Pilot Study

Background and Purpose

We assessed safety, feasibility, and potential effects of vagus nerve stimulation (VNS) paired with rehabilitation for improving arm function after chronic stroke.

Methods

We performed a randomized, multisite, double-blinded, sham-controlled pilot study. All participants were implanted with a VNS device and received 6-week in-clinic rehabilitation followed by a home exercise program. Randomization was to active VNS (n=8) or control VNS (n=9) paired with rehabilitation. Outcomes were assessed at days 1, 30, and 90 post-completion of in-clinic therapy.

Results

All participants completed the course of therapy. There were 3 serious adverse events related to surgery. Average FMA-UE scores increased 7.6 with active VNS and 5.3 points with control at day 1 post–in-clinic therapy (difference, 2.3 points; CI, −1.8 to 6.4; P=0.20). At day 90, mean scores increased 9.5 points from baseline with active VNS, and the control scores improved by 3.8 (difference, 5.7 points; CI, −1.4 to 11.5; P=0.055). The clinically meaningful response rate of FMA-UE at day 90 was 88% with active VNS and 33% with control VNS (P<0.05).

Conclusions

VNS paired with rehabilitation was acceptably safe and feasible in participants with upper limb motor deficit after chronic ischemic stroke. A pivotal study of this therapy is justified.

 

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[ARTICLE] Effects of 8-week sensory electrical stimulation combined with motor training on EEG-EMG coherence and motor function in individuals with stroke – Full Text

Abstract

The peripheral sensory system is critical to regulating motor plasticity and motor recovery. Peripheral electrical stimulation (ES) can generate constant and adequate sensory input to influence the excitability of the motor cortex. The aim of this proof of concept study was to assess whether ES prior to each hand function training session for eight weeks can better improve neuromuscular control and hand function in chronic stroke individuals and change electroencephalography-electromyography (EEG-EMG) coherence, as compared to the control (sham ES). We recruited twelve subjects and randomly assigned them into ES and control groups. Both groups received 20-minute hand function training twice a week, and the ES group received 40-minute ES on the median nerve of the affected side before each training session. The control group received sham ES. EEG, EMG and Fugl-Meyer Assessment (FMA) were collected at four different time points. The corticomuscular coherence (CMC) in the ES group at fourth weeks was significantly higher (p = 0.004) as compared to the control group. The notable increment of FMA at eight weeks and follow-up was found only in the ES group. The eight-week rehabilitation program that implemented peripheral ES sessions prior to function training has a potential to improve neuromuscular control and hand function in chronic stroke individuals.

Introduction

Stroke is one of the leading contributing factors to the loss of functional abilities and independence in daily life in adults1. The most common and widely observed impairment following stroke is motor impairment, which can be regarded as a loss or limitation of function in muscle control or movement25. Most stroke survivors later regain the ability to walk independently, but only fewer than 50% of them will have fully recovered upper extremity functions6,7. From a review focusing on motor recovery after stroke, it has been indicated that the recovery of both arm and hand function among subacute and chronic stroke survivors is limited in current neural rehabilitation settings4; therefore, additional management with activating plasticity before or during performing motor training is necessary for better motor recovery.

The fundamental principle of stroke rehabilitation is inducing brain plasticity by sensory or proprioceptive input in order to facilitate motor functions8,9. It has been demonstrated that strong sensory input can induce plastic changes in the motor cortex via direct or indirect pathways1017. In this case, electrical stimulation (ES) that provides steady and adequate somatosensory input can be an ideal method of stimulating the motor cortex.

Recent studies using functional magnetic resonance imaging (fMRI) or transcranial magnetic stimulation (TMS) suggest that ES on peripheral nerves can increase motor-evoked potential (MEP)1820, increase the active voxel count in the corresponding motor cortex13, and increase blood-oxygen-level dependent (BOLD) signals in fMRI, suggesting peripheral ES induced higher excitability and activation level of cortical neurons21. Since the expansion of the motor cortical area or increase in the excitability of neural circuits is associated with learning new motor skills2226, clinicians should take advantage and assist patients with stroke on motor tasks training during this period of time. Celnik and colleagues27found that the hand function of chronic stroke subjects improved immediately after two-hour peripheral nerve stimulation combined with functional training, and the effect lasted for one day. Based on previous studies, the ES that increases corticomuscular excitability may turn out to be an ideal intervention added prior to traditional motor training to “activate” the neural circuit, so that patients may get the most out of the training. According to a recent study that applied single session peripheral ES on post-stroke individuals, the corticomuscular coherence (CMC), which is the synchronization level between EEG and EMG, increased significantly and was accompanied by improvement in the steadiness of force output28.

To our knowledge, however, there is no study investigating the long-term effect of ES combined with functional training on both motor performance and cortical excitability. We targeted the median nerve because its distribution covered the dorsal side of index, middle, and half of ring finger and the palmar side of the first three fingers and half of the ring finger. Besides, median nerve is in charge of the flexion of the first three fingers, which combined they accounts for most of the functional tasks of hand. Therefore, the purpose of this pilot study was to preliminarily evaluate the effect of eight-week ES-combined hand functional training among chronic stroke patients based on CMC and motor performance. We followed up for four weeks after the intervention ceased and examined the lasting effect. We hypothesized that those who received intervention with ES would have better hand function and higher CMC than those who received intervention with sham ES. We also hypothesized that the effect would last for at least four weeks during our follow-up.[…]

 

Continue —>  Effects of 8-week sensory electrical stimulation combined with motor training on EEG-EMG coherence and motor function in individuals with stroke

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[Abstract] Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke

Background. Motor training alone or combined with transcranial direct current stimulation (tDCS) positioned over the motor cortex (M1) improves motor function in chronic stroke. Currently, understanding of how tDCS influences the process of motor skill learning after stroke is lacking.

Objective. To assess the effects of tDCS on the stages of motor skill learning and on generalization to untrained motor function.

Methods. In this randomized, sham-controlled, blinded study of 56 mildly impaired chronic stroke patients, tDCS (anode over the ipsilesional M1 and cathode on the contralesional forehead) was applied during 5 days of training on an unfamiliar, challenging fine motor skill task (sequential visual isometric pinch force task). We assessed online and offline learning during the training period and retention over the following 4 months. We additionally assessed the generalization to untrained tasks.

Results. With training alone (sham tDCS group), patients acquired a novel motor skill. This skill improved online, remained stable during the offline periods and was largely retained at follow-up. When tDCS was added to training (real tDCS group), motor skill significantly increased relative to sham, mostly in the online stage. Long-term retention was not affected by tDCS. Training effects generalized to untrained tasks, but those performance gains were not enhanced further by tDCS.

Conclusions. Training of an unfamiliar skill task represents a strategy to improve fine motor function in chronic stroke. tDCS augments motor skill learning, but its additive effect is restricted to the trained skill.

 

via Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke – Manuela Hamoudi, Heidi M. Schambra, Brita Fritsch, Annika Schoechlin-Marx, Cornelius Weiller, Leonardo G. Cohen, Janine Reis, 2018

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[Abstract] Long-lasting effects of transcranial static magnetic field stimulation on motor cortex excitability

Abstract

Background

Transcranial static magnetic field stimulation (tSMS) was recently added to the family of inhibitory non-invasive brain stimulation techniques. However, the application of tSMS for 10–20 min over the motor cortex (M1) induces only short-lasting effects that revert within few minutes.

Objective

We examined whether increasing the duration of tSMS to 30 min leads to long-lasting changes in cortical excitability, which is critical for translating tSMS toward clinical applications.

Methods

The study comprised 5 experiments in 45 healthy subjects. We assessed the impact of 30-min-tSMS over M1 on corticospinal excitability, as measured by the amplitude of motor evoked potentials (MEPs) and resting motor thresholds (RMTs) to single-pulse transcranial magnetic stimulation (TMS) (experiments 1–2). We then assessed the impact of 30-min-tSMS on intracortical excitability, as measured by short-interval intracortical facilitation (SICF) and short-interval intracortical inhibition (SICI) using paired-pulse TMS protocols (experiments 2–4). We finally assessed the impact of 10-min-tSMS on SICF and SICI.

Results

30-min-tSMS decreased MEP amplitude compared to sham for at least 30 min after the end of the stimulation. This long-lasting effect was associated with increased SICF and reduced SICI. 10-min-tSMS –previously reported to induce a short-lasting decrease in MEP amplitude– produced the opposite changes in intracortical excitability, decreasing SICF while increasing SICI.

Conclusions

These results suggest a dissociation of intracortical changes in the consolidation from short-lasting to long-lasting decrease of corticospinal excitability induced by tSMS. The long-lasting effects of 30-min-tSMS open the way to the translation of this simple, portable and low-cost technique toward clinical trials.

via Long-lasting effects of transcranial static magnetic field stimulation on motor cortex excitability – Brain Stimulation: Basic, Translational, and Clinical Research in Neuromodulation

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[BLOG] The Importance of Cortical Plasticity in Stroke Rehabilitation – Saebo

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Those who have survived a stroke may experience neurological damage that leads to deficiencies in their sensory and motor systems, such as limited use in their hands and/or arms. This damage also affects the sensory communication to the brain and impairs the ability to touch, feel, or be aware of joint movement. The combination of motor and sensory impairments significantly impacts stroke patients’ capacity to perform daily activities.

The Motor Cortex

Located in the frontal lobe of the brain is the area known as the motor cortex. There are three areas that comprise this important part of the cerebellum: the primary motor cortex, the premotor cortex, and the supplementary motor area. The motor cortex controls the higher levels of movement, such as voluntary action. When the neurons experience electrical stimulation in this part of the brain, associated body parts move. It is a complex process that involves making decisions and coordinating movements appropriately to perform an intended action.

How Strokes Affect the Motor Cortex

Human body with a head ache of the brain with a migrain and stroke accident caused by poor circulation representing neurology with heart blood health problems.

When the motor cortex becomes damaged from head injuries, including strokes or other accidents, it affects the ability of the brain to control the body’s movement.

The brain is divided into two halves, the right and the left hemispheres. Each hemisphere controls the voluntary movement of the half of the body opposite it, which is known as crossed control (e.g., the right half of the brain controls the left side of the body). Because of this, when one hemisphere of the brain experiences damage, the movement of the opposite side of the body is affected. When the damage is severe enough to completely destroy the system, paralysis occurs.

Any damage impacts a person’s ability to control movement. For example, when a patient whose motor cortex is injured from a stroke tries to hold an object, the communication between the brain and rest of the body is delayed. This might cause the patient to have unsteady hands, stop prior to the target, move past it, or simply move too late.

Physical Conditions Resulting From Stroke

Common physical conditions after a stroke include:

  • Weakness, paralysis, and problems with balance or coordination
  • Pain, numbness, or burning and tingling sensations
  • Fatigue
  • Inattention to one side of the body, also known as neglect. In extreme cases, the patient may not be aware of their arm or leg
  • Urinary or bowel incontinence
  • Speech problems or difficulty understanding speech, reading, or writing
  • Difficulty swallowing
  • Memory problems, poor attention span, or difficulty solving problems
  • Visual problems
  • Depression, anxiety, or mood swings with emotional outbursts
  • Difficulty recognizing limitations caused by the stroke

How the Motor Cortex is Repaired

How the motor cortex is repaired

Damage to the brain does not have to be permanent; the brain has the capability to repair itself thanks to cortical plasticity (neuroplasticity). Upon experiencing damage or injury, the brain builds new neural connections using cues from the environment and individual experiences.

Neuroplasticity and Neurorehabilitation

A certain amount of neuroplasticity occurs throughout a person’s life, as it is part of learning to respond to a particular activity or behavior. This can be seen in brain scans  when a person learns a new motor skill and corresponding regions in larger cortical territories light up.

Neurorehabilitation has been shown to support the brain’s efforts to rebuild and reprogram itself. It requires task-orientated arm training and extensive practice to re-teach the brain. The surrounding tissue that remains healthy takes over some of the work of the damaged tissue. By conducting task training, this healthy tissue is stimulated, which facilitates the building of new connections between the healthy, intact neurons.

For these changes to occur in the motor cortex, it is important to conduct skill-dependent activities rather than use-dependent. For an activity to be considered skill-dependent, it requires a challenge rather than simple repetition. Training using tasks that require problem solving, or some other meaningful challenge, has greater success. Neural remodeling might occur anytime during the weeks to months after an injury, based on the experiences of an individual.

How Quickly Do Changes in the Motor Cortex Begin?

The old saying, “if you don’t use it, you lose it,” is very apt for the motor cortex. Upon immobilization of a limb, there is a window of just nine days before the potential for recovery decreases. After not using the affected limb, the tissue around the cortical lesion or other damage in the brain starts to experience problems, which leads to further loss of function.

Thus, the sooner a patient begins therapy, the better. Starting a program with occupational therapists that stimulates and retrains the limb as soon as five days after the injury has the potential to minimize cortical loss and enhance the brain’s reorganizing capabilities. The brain constantly conducts neuroplastic changes through a variety of mechanisms, such as motor learning and peripheral deafferentation. Most likely, this plasticity leads to spontaneous recovery. However, it is best to stimulate reorganization in the damaged hemisphere to increase chances of recovery.

Effective Ways to Retrain Limb Use

Effective Ways to Retrain Limb Use

There are several factors that affect stroke recovery: the amount of brain damage, the location of the damage, and the presence of healthy areas of the brain. Less damage tends to correspond with less disability, which translates to the greatest chance for recovery. And rehabilitation plays an important role in healing.

You will typically be in stage 1 or 2 of stroke recovery right after a stroke.

Treatments for Stage 1 of Stroke Recovery

For stage 1, follow the exercises and treatments laid out here. Treatments include:

  • supporting affected limbs
  • passive range of motion
  • muscle facilitation
  • movement exercises
  • mirror-box therapy
  • mental visualization

Treatments for Stage 2 of Stroke Recovery

For stage 2, follow exercises and treatments laid out here. Treatments include:

Exercises Based on Stroke Severity

It is important to remember that motor cortex deficits will differ depending on how severe the stroke is. For the patient with severe motor, sensory, and functional deficits, ensure that the arm and hand are in the proper position, mobile, and comfortable with no pain. There should be support during rest, and the upper limb should be handled carefully during the activities. Then, practice self range-of-motion exercises. You can use some of the same means of external support for the upper limb from stages 1 or 2.

For patients with moderate impairments who demonstrate high motivation and potential for functional motor gains, it is important to use repetitive, novel tasks that truly challenge the person. This helps to build the necessary neural networks to increase functional ability. Motor-learning training using imagery is very beneficial as well.

Rehabilitation is Key to Recovery

Stroke recovery is possible for many occupational therapists’ patients. Although it ultimately depends on the severity of the brain injury and the area affected, rehabilitation plays a key role in chances of success. Starting as soon as possible is key, since after nine days any repair becomes increasingly difficult. During rehab, a therapist may recommend products such as the SaeboGlove and other items that are made to improve motor functions.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

via The Importance of Cortical Plasticity in Stroke Rehabilitation

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[WEB SITE] Brain-Machine Interface Shows Potential for Hand Paralysis – Rehab Managment

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The use of a brain-machine interface shows potential for helping to restore function in stroke patients with hand paralysis, according to a study of healthy adults published in the Journal of Neuroscience.

According to the study, researchers note that the brain-machine interface, which is designed to combine brain stimulation with a robotic device that controls hand movement, increases the output of pathways connecting the brain and spinal cord.

Researchers Alireza Gharabaghi and colleagues asked participants to imagine opening their hand without actually making any movement while their hand was placed in a device that passively opened and closed their fingers as it received the necessary input from their brain activity. Stimulating the hand area of the motor cortex at the same time, but not after, the robotic device initiated hand movement increased the strength of the neural signal, most likely by harnessing the processing power of additional neurons in the corticospinal tract, explains a media release from the Society for Neuroscience.

However, the signal decreased when participants were not required to imagine moving their hand. Delivering brain stimulation and robotic motor feedback simultaneously during rehabilitation may therefore be beneficial for patients who have lost voluntary muscle control, the release continues.

[Source(s): Society for Neuroscience]

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[ARTICLE] Non-Invasive Brain Stimulation to Enhance Upper Limb Motor Practice Poststroke: A Model for Selection of Cortical Site – Full Text

Motor practice is an essential part of upper limb motor recovery following stroke. To be effective, it must be intensive with a high number of repetitions. Despite the time and effort required, gains made from practice alone are often relatively limited, and substantial residual impairment remains. Using non-invasive brain stimulation to modulate cortical excitability prior to practice could enhance the effects of practice and provide greater returns on the investment of time and effort. However, determining which cortical area to target is not trivial. The implications of relevant conceptual frameworks such as Interhemispheric Competition and Bimodal Balance Recovery are discussed. In addition, we introduce the STAC (Structural reserve, Task Attributes, Connectivity) framework, which incorporates patient-, site-, and task-specific factors. An example is provided of how this framework can assist in selecting a cortical region to target for priming prior to reaching practice poststroke. We suggest that this expanded patient-, site-, and task-specific approach provides a useful model for guiding the development of more successful approaches to neuromodulation for enhancing motor recovery after stroke.

Poststroke Arm Impairment

Upper limb motor impairment following stroke is highly prevalent and often persists even after intensive rehabilitation efforts (14). It is also one of the most disabling of stroke sequela, limiting functional independence and precluding return to work and other roles (5).

Upper extremity motor control relies heavily on input transmitted via the corticospinal tract (CST). The CST descends through the posterior limb of the internal capsule, an area vulnerable to middle cerebral artery stroke and in which CST fibers are densely packed. Thus, even a small lesion in this location can have devastating effects on motor function (69). A loss of voluntary wrist and finger extension is particularly common and appears to be related to the extent of CST damage (10). There is also evidence that those who retain wrist extension and have considerable CST sparing are more likely to be responsive to existing therapies (7811).

However, even individuals who lack voluntary wrist and finger extension often retain some ability to move the shoulder and elbow. Unfortunately, only a few stereotyped movement patterns can be performed and these are often not functional. The combination of shoulder flexion with elbow extension that is required for most functional reaching tasks, for example, is frequently lost. Nevertheless, previous studies have demonstrated that reaching practice with trunk restraint can improve unconstrained reaching ability, even in patients who lack wrist and finger extension (1215). Still, a great deal of time and effort is required and the improvements are relatively small.

Non-Invasive Brain Stimulation

Non-invasive brain stimulation offers a potential method of enhancing the effects of practice and thus giving patients greater returns on their investment of time and effort. Approaches to non-invasive brain stimulation are rapidly expanding but generally fall into two major categories: transcranial magnetic stimulation (TMS) and transcranial electrical stimulation [TES; see Ref. (16) for overview of non-invasive techniques for neuromodulation]. These modalities are applied to the scalp overlying a specific cortical area that is being targeted. The level of spatial specificity varies depending on many factors including the modality used (TMS is generally more precise than TES), the stimulation intensity (higher intensity results in a more widespread effect), and the architecture of the underlying tissue. The excitability of the underlying pool of neurons can be modulated by varying stimulation parameters such as the frequency and temporal pattern of the stimuli. Therefore, stimulation can be used to temporarily inhibit or facilitate the underlying cortical area for a sustained period of time after the stimulation ends (usually 20–40 min). In this way, non-invasive brain stimulation could be used to “prime” relevant cortical areas before a bout of practice, potentially enhancing the effects of practice. However, there is little guidance for how such cortical sites might be selected and in which direction (inhibition or facilitation) their activity should be modulated. Conceptual models that could offer such guidance are considered below.

Mechanistic Models to Guide Neuromodulation

Continue —> Frontiers | Non-Invasive Brain Stimulation to Enhance Upper Limb Motor Practice Poststroke: A Model for Selection of Cortical Site | Neurology

Figure 1. On randomly delivered trials, transcranial magnetic stimulation (TMS) perturbation was applied just after a “Go” cue. The effect of this pre-movement perturbation on the speed of the subsequent reaching movement is expressed relative to that in trials with no TMS perturbation. The amount of slowing due to TMS perturbation of the lesioned vs. non-lesioned hemispheres is shown for patients with good structural reserve (left) and patients with poor structural reserve (right).

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[ARTICLE] Effect of tDCS stimulation of motor cortex and cerebellum on EEG classification of motor imagery and sensorimotor band power – Full Text

Abstract

Background

Transcranial direct current stimulation (tDCS) is a technique for brain modulation that has potential to be used in motor neurorehabilitation. Considering that the cerebellum and motor cortex exert influence on the motor network, their stimulation could enhance motor functions, such as motor imagery, and be utilized for brain-computer interfaces (BCIs) during motor neurorehabilitation.

Methods

A new tDCS montage that influences cerebellum and either right-hand or feet motor area is proposed and validated with a simulation of electric field. The effect of current density (0, 0.02, 0.04 or 0.06 mA/cm2) on electroencephalographic (EEG) classification into rest or right-hand/feet motor imagery was evaluated on 5 healthy volunteers for different stimulation modalities: 1) 10-minutes anodal tDCS before EEG acquisition over right-hand or 2) feet motor cortical area, and 3) 4-seconds anodal tDCS during EEG acquisition either on right-hand or feet cortical areas before each time right-hand or feet motor imagery is performed. For each subject and tDCS modality, analysis of variance and Tukey-Kramer multiple comparisons tests (p <0.001) are used to detect significant differences between classification accuracies that are obtained with different current densities. For tDCS modalities that improved accuracy, t-tests (p <0.05) are used to compare μ and βband power when a specific current density is provided against the case of supplying no stimulation.

Results

The proposed montage improved the classification of right-hand motor imagery for 4 out of 5 subjects when the highest current was applied for 10 minutes over the right-hand motor area. Although EEG band power changes could not be related directly to classification improvement, tDCS appears to affect variably different motor areas on μ and/or β band.

Conclusions

The proposed montage seems capable of enhancing right-hand motor imagery detection when the right-hand motor area is stimulated. Future research should be focused on applying higher currents over the feet motor cortex, which is deeper in the brain compared to the hand motor cortex, since it may allow observation of effects due to tDCS. Also, strategies for improving analysis of EEG respect to accuracy changes should be implemented.

Background

Transcranial direct current stimulation (tDCS) is a noninvasive technique for brain stimulation where direct current is supplied through two or more electrodes in order to modulate temporally brain excitability [12]. This technique has shown potential to improve motor performance and motor learning [345]. Hence, it could be applied in motor neurorehabilitacion [1]. However, tDCS effects vary depending on several factors, such as the size or position of the stimulation electrodes and the current intensity that is applied [6] or the mental state of the user [7]. Therefore, it should be considered that outcomes of tDCS studies are the result of different affected brain networks that may be involved in attention and movements, among other processes.

Volitional locomotion requires automatic control of movement while the cerebral cortex provides commands that are transmitted by neural projections toward the brainstem and the spinal cord. This control involves predictive motor operations that link activity from the cerebral cortex, cerebellum, basal ganglia and brainstem in order to modify actions at the spinal cord level [8]. In general, this set of structures can be considered to form a motor network that allow voluntary movement.

Different parts of the cerebral cortex participate in the performance of self-initiated movement, like the supplementary motor (SMA), the primary motor (M1) and premotor (PM) areas. It is known that M1 is activated during motor execution. Excitatory effects of M1 have been studied with anodal stimulation [6], finding that activation of this region is related to higher motor evoked potentials (MEPs) and an increment of force movement on its associated body part area [910]. Moreover, M1 seems to be critical in the early phase of consolidation of motor skills during procedural motor learning [11], i.e., the implicit skill acquisition through the repeated practice of a task [12].

In addition, the SMA and PM influence M1 in order to program opportune precise motor commands when movement pattern is modified intentionally, based on information from temporoparietal cortices regarding to the body’s state [8]. The SMA contributes in the generation of anticipatory postural adjustments [13]. Consequently, its facilitatory stimulation seems to increase anticipatory postural adjustments amplitudes, to reduce the time required to perform movements during the learning task of sequential movements, and to produce early initiation of motor responses [141516]. These studies suggest the possibility of using SMA excitation during treatments for motor disorders, since hemiparesis after stroke involves the impairment of anticipatory motor control at the affected limb [17]. In addition, some studies propose the participation of the SMA in motor memory and both implicit and explicit motor learning [18192021], i.e, when new information is acquired without intending to do so and when acquisition of skill is conscious [22], respectively. Complimentary to the role of SMA, the PM is crucial for sensory-guided movement initiation and the consolidation of motor sequence learning during sleep [823], while its facilitation with anodal tDCS seems to enhance the excitability from the ipsilateral M1 [24], which may be useful for treatment of PM disorders.

As previously mentioned, the cerebellum is also involved in locomotion through the regulation of motor processes by influencing the cerebral cortex, among other neural structures. During adaptive control of movement, as in the gait process, it seems that loops that interconnect reciprocally motor cortical areas to the basal ganglia and cerebellum allow predictive control of locomotion and they exhibit correlation with movement parameters [825]. Regarding to studies about cerebellar stimulation, there is still not enough knowledge about the effects of tDCS on different neuronal populations and the afferent pathways, so results are variable among studies and their interpretation is more complex than for cerebral tDCS [26]. Furthermore, the topographical motor organization of the cerebellum is not clear yet [27]. Nevertheless, most studies base their experimental procedure on the existence of decussating cerebello-cerebral connections, even if there are also ipsilateral cerebello-cerebral tracts or inter-hemispheric cerebellar connections [28]. Hence, a cerebellar hemisphere is stimulated to affect cerebellar brain inhibition (CBI), which refers to the inherent suppression of cerebellum over the contralateral M1 [29]. For example, the supply of anodal and cathodal stimulation over the right cerebellum in [30] resulted in incremental and decremental CBI on the left M1, respectively. In contrast, there are some studies that suggest this expectation may be not always appropriate. In [31] it was shown that inhibitory transcranial magnetic stimulation (a stimulation technique that provides magnetic field pulses on the brain [32]) over the lateral right cerebellum led to procedural learning decrement for tasks performed with either the right or left hand, whereas inhibition of lateral left cerebellar hemisphere decreased learning only with the left hand. In addition, results from [33] showed that cathodal cerebellar tDCS worsened locomotor adaptation ipsilaterally. These two studies may provide a reference for using cerebellar inhibition for avoiding undesired brain activity changes during motor rehabilitation, such as compensatory movement habits that might contribute to maladaptative plasticity and hamper the goal of achieving a normal movement pattern [34]. […]

Continue —> Effect of tDCS stimulation of motor cortex and cerebellum on EEG classification of motor imagery and sensorimotor band power | Journal of NeuroEngineering and Rehabilitation | Full Text

Fig. 1 tDCS montage. Scheme of tDCS electrodes position in reference to EEG electrodes and inion (left), and placement of tDCS electrodes on the EEG cap (right). Electrodes 1,2 and 3 are highlighted in red, green and blue, respectively

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[ARTICLE] Neuroplastic Changes Following Brain Ischemia and their Contribution to Stroke Recovery: Novel Approaches in Neurorehabilitation – Full Text

Ischemic damage to the brain triggers substantial reorganization of spared areas and pathways, which is associated with limited, spontaneous restoration of function. A better understanding of this plastic remodeling is crucial to develop more effective strategies for stroke rehabilitation. In this review article, we discuss advances in the comprehension of post-stroke network reorganization in patients and animal models. We first focus on rodent studies that have shed light on the mechanisms underlying neuronal remodeling in the perilesional area and contralesional hemisphere after motor cortex infarcts. Analysis of electrophysiological data has demonstrated brain-wide alterations in functional connectivity in both hemispheres, well beyond the infarcted area. We then illustrate the potential use of non-invasive brain stimulation (NIBS) techniques to boost recovery. We finally discuss rehabilitative protocols based on robotic devices as a tool to promote endogenous plasticity and functional restoration.

Introduction

Following an ischemic insult within the motor cortex, one or more body parts contralateral to the infarct result impaired or paretic. The degree of the motor impairment depends on many factors, such as the extent of the infarct, the identity of the damaged region(s) and the effectiveness of the early medical care. Substantial functional recovery can occur in the first weeks after stroke, mainly due to spontaneous mechanisms (Kwakkel et al., 2004; Cramer, 2008; Darling et al., 2011; Ward, 2011; Grefkes and Fink, 2014). About 26% of stroke survivors are able to carry on everyday activities (Activity of Daily Living or ADLs, i.e., eating, drinking, walking, dressing, bathing, cooking, writing) without any help, but another 26% is forced to shelter in a nursing home (Carmichael, 2005). Impairments of upper and lower limbs are particularly disabling as they impact on the degree of independence in ADLs. Overall, a significant percentage of the patients exhibit persistent disability following ischemic attacks. Therefore, it is critical to increase our knowledge of post-stroke neuroplasticity for implementing novel rehabilitative strategies. In this review we summarize data about plastic reorganizations after injury, both in the ipsilesional and contralesional hemisphere. We also describe non-invasive brain stimulation (NIBS) techniques and robotic devices for stimulating functional recovery in humans and rodent stroke models.

Neuroplasticity After Stroke

The term brain plasticity defines all the modifications in the organization of neural components occurring in the central nervous system during the entire life span of an individual (Sale et al., 2009). Such changes are thought to be highly involved in mechanisms of aging, adaptation to environment and learning. Moreover, neuronal plastic phenomena are likely to be at the basis of adaptive modifications in response to anatomical or functional deficit or brain damage (Nudo, 2006). Ischemic damage causes a dramatic alteration of the entire complex neural network within the affected area. It has been amply demonstrated, by many studies, that the cerebral cortex exhibits spontaneous phenomena of brain plasticity in response to damage (Gerloff et al., 2006; Nudo, 2007). The destruction of neural networks indeed stimulates a reorganization of the connections and this rewiring is highly sensitive to the experience following the damage (Stroemer et al., 1993; Li and Carmichael, 2006). Such plastic phenomena involve particularly the perilesional tissue in the injured hemisphere, but also the contralateral hemisphere, subcortical and spinal regions.

Continue —> Frontiers | Neuroplastic Changes Following Brain Ischemia and their Contribution to Stroke Recovery: Novel Approaches in Neurorehabilitation | Frontiers in Cellular Neuroscience

Figure 3. Example of a novel robotic system that integrates functional grasping, active reaching arm training and bimanual tasks. An example of a novel robotic system that integrates functional grasping, active reaching arm training and bimanual tasks, consisting of: (i) Virtual Reality: software applications composed of rehabilitative and evaluation tasks; (ii) TrackHold: robotic device to support the weight of the user’s limb during tasks execution; (iii) Robotic Hand Exos: active hand exoskeleton to assist grasping tasks; and (iv) Handgrip sensors to support the bilateral grasping training and evaluation (modified from Sgherri et al., 2017).

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[Abstract] Strength of ~20-Hz Rebound and Motor Recovery After Stroke.

Background. Stroke is a major cause of disability worldwide, and effective rehabilitation is crucial to regain skills for independent living. Recently, novel therapeutic approaches manipulating the excitatory-inhibitory balance of the motor cortex have been introduced to boost recovery after stroke. However, stroke-induced neurophysiological changes of the motor cortex may vary despite of similar clinical symptoms. Therefore, better understanding of excitability changes after stroke is essential when developing and targeting novel therapeutic approaches.

Objective and Methods. We identified recovery-related alterations in motor cortex excitability after stroke using magnetoencephalography. Dynamics (suppression and rebound) of the ~20-Hz motor cortex rhythm were monitored during passive movement of the index finger in 23 stroke patients with upper limb paresis at acute phase, 1 month, and 1 year after stroke.

Results. After stroke, the strength of the ~20-Hz rebound to stimulation of both impaired and healthy hand was decreased with respect to the controls in the affected (AH) and unaffected (UH) hemispheres, and increased during recovery. Importantly, the rebound strength was lower than that of the controls in the AH and UH also to healthy-hand stimulation despite of intact afferent input. In the AH, the rebound strength to impaired-hand stimulation correlated with hand motor recovery.

Conclusions. Motor cortex excitability is increased bilaterally after stroke and decreases concomitantly with recovery. Motor cortex excitability changes are related to both alterations in local excitatory-inhibitory circuits and changes in afferent input. Fluent sensorimotor integration, which is closely coupled with excitability changes, seems to be a key factor for motor recovery.

Source: Strength of ~20-Hz Rebound and Motor Recovery After Stroke – Feb 04, 2017

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