[Abstract +References] Reorganization of Bioelectrical Activity in the Neocortex after Stroke by Rehabilitation Using a Brain–Computer Interface Controlling a Wrist Exoskeleton

The process of the functional rearrangement of the motor cortex of the brain after stroke is due to neuroplasticity, and this underlies motor recovery. Functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) are currently recognized as the most informative methods for studying these processes. The course of the neuroplastic process can be evaluated from the power levels of EEG rhythms during imagination of movements in the paralyzed arm in right-handed patients after stroke in the left hemisphere monitored at different times – before and after courses of neurorehabilitation using a brain–computer interface controlling a wrist exoskeleton. Powerful excitatory interactions in the primary motor cortex and frontoparietal areas in the lesioned and “intact” hemispheres are initially seen, and these probably reflect reorganization of neural networks. Rehabilitation courses were followed by restoration of bioelectrical activity in the primary motor cortex due to recovery of efficient connections with the premotor and superior parietal zones and decreases in the pathological influences of the contralateral hemisphere.

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[VIDEO] Mirror Box Therapy & NEUROPLASTICITY Following Stroke – YouTube

Δημοσιεύτηκε στις 9 Ιουν 2015

Mirror box therapy can be utilized in conjunction with other therapies to help stroke patients retrain their brain, regain function and improve their overall quality of life. When a stroke patient puts his weakened hand in the mirror box, and moves his strong hand, the mirror provides a reflection of the stronger hand, thus giving the illusion that movement is occurring in the hand affected by the stroke. This activates mirror neurons in the premotor cortex of the brain. In other words, the mirror tricks the mind and the weak hand into working better. Studies have shown that patients who have used Mirror Box Therapy show an improvement in motor function and in the rewiring of the brain.

Neuroplasticity refers to the potential of the brain to reorganize by creating new neural pathways to adapt. This reorganization allows for positive functional improvements after a stroke. The brain is more flexible than we’ve ever thought before and it is constantly optimizing itself. It has the potential to reorganize itself by transferring cognitive abilities from one area to another. After a stroke, for instance, your brain can reorganize itself to move functions to undamaged areas. Mirror Box Therapy takes advantage of this potential.

[Abstract] “How Did I Make It?”: Uncertainty about Own Motor Performance after Inhibition of the Premotor Cortex – Journal of Cognitive Neuroscience.

Abstract

Optimal motor performance requires the monitoring of sensorimotor input to ensure that the motor output matches current intentions. The brain is thought to be equipped with a “comparator” system, which monitors and detects the congruence between intended and actual movement; results of such a comparison can reach awareness.

This study explored in healthy participants whether the cathodal transcranial direct current stimulation (tDCS) of the right premotor cortex (PM) and right posterior parietal cortex (PPC) can disrupt performance monitoring in a skilled motor task.

Before and after tDCS, participants underwent a two-digit sequence motor task; in post-tDCS session, single-pulse TMS (sTMS) was applied to the right motor cortex, contralateral to the performing hand, with the aim of interfering with motor execution. Then, participants rated on a five-item questionnaire their performance at the motor task. Cathodal tDCS of PM (but not sham or PPC tDCS) impaired the participants’ ability to evaluate their motor performance reliably, making them unconfident about their judgments. Congruently with the worsened motor performance induced by sTMS, participants reported to have committed more errors after sham and PPC tDCS; such a correlation was not significant after PM tDCS.

In line with current computational and neuropsychological models of motor control and awareness, the present results show that a mechanism in the PM monitors and compare intended versus actual movements, evaluating their congruence. Cathodal tDCS of the PM impairs the activity of such a “comparator,” disrupting self-confidence about own motor performance.

Source: MIT Press Journals – Journal of Cognitive Neuroscience – Early Access – Abstract

[ARTICLE] Stimulation targeting higher motor areas in stroke rehabilitation: A proof-of-concept, randomized, double-blinded placebo-controlled study of effectiveness and underlying mechanisms

Abstract

Purpose: To demonstrate, in a proof-of-concept study, whether potentiating ipsilesional higher motor areas (premotor cortex and supplementary motor area) augments and accelerates recovery associated with constraint induced movement.

Methods: In a randomized, double-blinded pilot clinical study, 12 patients with chronic stroke were assigned to receive anodal transcranial direct current stimulation (tDCS) (n = 6) or sham (n = 6) to the ipsilesional higher motor areas during constraint-induced movement therapy. We assessed functional and neurophysiologic outcomes before and after 5 weeks of therapy.

Results: Only patients receiving tDCS demonstrated gains in function and dexterity. Gains were accompanied by an increase in excitability of the contralesional rather than the ipsilesional hemisphere.

Conclusions: Our proof-of-concept study provides early evidence that stimulating higher motor areas can help recruit the contralesional hemisphere in an adaptive role in cases of greater ipsilesional injury. Whether this early evidence of promise translates to remarkable gains in functional recovery compared to existing approaches of stimulation remains to be confirmed in large-scale clinical studies that can reasonably dissociate stimulation of higher motor areas from that of the traditional primary motor cortices.

Source: Stimulation targeting higher motor areas in stroke rehabilitation: A proof-of-concept, randomized, double-blinded placebo-controlled study of effectiveness and underlying mechanisms – IOS Press