Pub Date : 2022-04-01Epub Date: 2022-06-29DOI: 10.4103/2773-2398.348254
Kevin Pacheco-Barrios, Daniel Lima, Danielle Pimenta, Eric Slawka, Alba Navarro-Flores, Joao Parente, Ingrid Rebello-Sanchez, Alejandra Cardenas-Rojas, Paola Gonzalez-Mego, Luis Castelo-Branco, Felipe Fregni
Fibromyalgia (FM) is a common and refractory chronic pain condition with multiple clinical phenotypes. The current diagnosis is based on a syndrome identification which can be subjective and lead to under or over-diagnosis. Therefore, there is a need for objective biomarkers for diagnosis, phenotyping, and prognosis (treatment response and follow-up) in fibromyalgia. Potential biomarkers are measures of cortical excitability indexed by transcranial magnetic stimulation (TMS). However, no systematic analysis of current evidence has been performed to assess the role of TMS metrics as a fibromyalgia biomarker. Therefore, this study aims to evaluate evidence on corticospinal and intracortical motor excitability in fibromyalgia subjects and to assess the prognostic role of TMS metrics as response biomarkers in FM. We conducted systematic searches on PubMed/Medline, Embase, and Cochrane Central databases for observational studies and randomized controlled trials on fibromyalgia subjects that used TMS as an assessment. Three reviewers independently selected and extracted the data. Then, a random-effects model meta-analysis was performed to compare fibromyalgia and healthy controls in observational studies. Also, to compare active versus sham treatments, in randomized controlled trials. Correlations between changes in TMS metrics and clinical improvement were explored. The quality and evidence certainty were assessed following standardized approaches. We included 15 studies (696 participants, 474 FM subjects). The main findings were: (1) fibromyalgia subjects present less intracortical inhibition (mean difference (MD) = -0.40, 95% confidence interval (CI) -0.69 to -0.11) and higher resting motor thresholds (MD = 6.90 μV, 95% CI 4.16 to 9.63 μV) when compared to controls; (2) interventions such as exercise, pregabalin, and non-invasive brain stimulation increased intracortical inhibition (MD = 0.19, 95% CI 0.10 to 0.29) and cortical silent period (MD = 14.92 ms, 95% CI 4.86 to 24.98 ms), when compared to placebo or sham stimulation; (3) changes on intracortical excitability are correlated with clinical improvements - higher inhibition moderately correlates with less pain, depression, and pain catastrophizing; lower facilitation moderately correlates with less fatigue. Measures of intracortical inhibition and facilitation indexed by TMS are potential diagnostic and treatment response biomarkers for fibromyalgia subjects. The disruption in the intracortical inhibitory system in fibromyalgia also provides additional evidence that fibromyalgia has some neurophysiological characteristics of neuropathic pain. Treatments inducing an engagement of sensorimotor systems (e.g., exercise, motor imagery, and non-invasive brain stimulation) could restore the cortical inhibitory tonus in FM and induce clinical improvement.
纤维肌痛(FM)是一种常见的难治性慢性疼痛,具有多种临床表型。目前的诊断是基于综合征的识别,这可能是主观的,并导致诊断不足或过度。因此,纤维肌痛的诊断、表型和预后(治疗反应和随访)需要客观的生物标志物。潜在的生物标志物是经颅磁刺激(TMS)索引的皮质兴奋性的测量。然而,目前还没有对现有证据进行系统分析,以评估经颅磁刺激指标作为纤维肌痛生物标志物的作用。因此,本研究旨在评估纤维肌痛受试者皮质脊髓和皮质内运动兴奋性的证据,并评估经颅磁刺激指标作为FM反应生物标志物的预后作用。我们对PubMed/Medline、Embase和Cochrane Central数据库进行了系统的检索,以获取观察性研究和随机对照试验,这些研究使用经颅电刺激作为评估纤维肌痛的对象。三位审稿人独立选择和提取数据。然后,进行随机效应模型荟萃分析,比较观察性研究中的纤维肌痛和健康对照。同时,在随机对照试验中,比较积极治疗和虚假治疗。探讨经颅磁刺激指标变化与临床改善之间的相关性。采用标准化方法评估质量和证据确定性。我们纳入了15项研究(696名参与者,474名FM受试者)。主要发现有:(1)与对照组相比,纤维肌痛症患者表现出较少的皮质内抑制(平均差值(MD) = -0.40, 95%可信区间(CI) -0.69 ~ -0.11)和较高的静息运动阈值(MD = 6.90 μV, 95% CI 4.16 ~ 9.63 μV);(2)与安慰剂或假刺激相比,运动、普瑞巴林和非侵入性脑刺激等干预措施增加了皮质内抑制(MD = 0.19, 95% CI 0.10至0.29)和皮质沉默期(MD = 14.92 ms, 95% CI 4.86至24.98 ms);(3)皮质内兴奋性的变化与临床改善相关,较高的抑制程度与疼痛、抑郁和疼痛灾难化的减少中度相关;较低的促进与较少的疲劳适度相关。经颅磁刺激诱发的皮质内抑制和促进指标是纤维肌痛患者潜在的诊断和治疗反应的生物标志物。纤维肌痛皮层内抑制系统的破坏也为纤维肌痛具有神经性疼痛的一些神经生理特征提供了额外的证据。诱导感觉运动系统参与的治疗(例如,锻炼,运动意象和非侵入性脑刺激)可以恢复FM的皮质抑制性张力并诱导临床改善。
{"title":"Motor cortex inhibition as a fibromyalgia biomarker: a meta-analysis of transcranial magnetic stimulation studies.","authors":"Kevin Pacheco-Barrios, Daniel Lima, Danielle Pimenta, Eric Slawka, Alba Navarro-Flores, Joao Parente, Ingrid Rebello-Sanchez, Alejandra Cardenas-Rojas, Paola Gonzalez-Mego, Luis Castelo-Branco, Felipe Fregni","doi":"10.4103/2773-2398.348254","DOIUrl":"https://doi.org/10.4103/2773-2398.348254","url":null,"abstract":"<p><p>Fibromyalgia (FM) is a common and refractory chronic pain condition with multiple clinical phenotypes. The current diagnosis is based on a syndrome identification which can be subjective and lead to under or over-diagnosis. Therefore, there is a need for objective biomarkers for diagnosis, phenotyping, and prognosis (treatment response and follow-up) in fibromyalgia. Potential biomarkers are measures of cortical excitability indexed by transcranial magnetic stimulation (TMS). However, no systematic analysis of current evidence has been performed to assess the role of TMS metrics as a fibromyalgia biomarker. Therefore, this study aims to evaluate evidence on corticospinal and intracortical motor excitability in fibromyalgia subjects and to assess the prognostic role of TMS metrics as response biomarkers in FM. We conducted systematic searches on PubMed/Medline, Embase, and Cochrane Central databases for observational studies and randomized controlled trials on fibromyalgia subjects that used TMS as an assessment. Three reviewers independently selected and extracted the data. Then, a random-effects model meta-analysis was performed to compare fibromyalgia and healthy controls in observational studies. Also, to compare active versus sham treatments, in randomized controlled trials. Correlations between changes in TMS metrics and clinical improvement were explored. The quality and evidence certainty were assessed following standardized approaches. We included 15 studies (696 participants, 474 FM subjects). The main findings were: (1) fibromyalgia subjects present less intracortical inhibition (mean difference (MD) = -0.40, 95% confidence interval (CI) -0.69 to -0.11) and higher resting motor thresholds (MD = 6.90 μV, 95% CI 4.16 to 9.63 μV) when compared to controls; (2) interventions such as exercise, pregabalin, and non-invasive brain stimulation increased intracortical inhibition (MD = 0.19, 95% CI 0.10 to 0.29) and cortical silent period (MD = 14.92 ms, 95% CI 4.86 to 24.98 ms), when compared to placebo or sham stimulation; (3) changes on intracortical excitability are correlated with clinical improvements - higher inhibition moderately correlates with less pain, depression, and pain catastrophizing; lower facilitation moderately correlates with less fatigue. Measures of intracortical inhibition and facilitation indexed by TMS are potential diagnostic and treatment response biomarkers for fibromyalgia subjects. The disruption in the intracortical inhibitory system in fibromyalgia also provides additional evidence that fibromyalgia has some neurophysiological characteristics of neuropathic pain. Treatments inducing an engagement of sensorimotor systems (e.g., exercise, motor imagery, and non-invasive brain stimulation) could restore the cortical inhibitory tonus in FM and induce clinical improvement.</p>","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/89/nihms-1820039.PMC9282159.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40601244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.4103/2773-2398.348253
Xin Gao, Robert Clarke, Dingguo Zhang
Stroke is a significant cause of disability in both developing and developed countries. This can cause a severe financial burden on families and society. With the development of robotics and brain-computer interfaces (BCIs), robotic exoskeletons and BCIs have received increasing clinical attention on stroke rehabilitation. Electroencephalography (EEG) is a method of recording brain signals non-invasively, which can be used as a BCI to control exoskeletons. This review focuses on rehabilitation systems of EEG-controlled upper limb exoskeletons, including the newest research progress and clinical evaluation in recent years. From the review, we find EEG-controlled exoskeletons can positively contribute to stroke rehabilitation. However, there are some issues that should be well investigated. More efforts are needed on EEG signal decoding algorithms such as deep learning methods in the clinical context. Practical applications must also bridge the gap between offline experiment and online control. In addition, this review also discusses the impact and significance of shared control, virtual reality/augmented reality, and other ways of human-computer interaction to improve EEG-controlled exoskeletons.
{"title":"A review on electroencephalography (EEG)-controlled upper limb exoskeletons towards stroke rehabilitation","authors":"Xin Gao, Robert Clarke, Dingguo Zhang","doi":"10.4103/2773-2398.348253","DOIUrl":"https://doi.org/10.4103/2773-2398.348253","url":null,"abstract":"Stroke is a significant cause of disability in both developing and developed countries. This can cause a severe financial burden on families and society. With the development of robotics and brain-computer interfaces (BCIs), robotic exoskeletons and BCIs have received increasing clinical attention on stroke rehabilitation. Electroencephalography (EEG) is a method of recording brain signals non-invasively, which can be used as a BCI to control exoskeletons. This review focuses on rehabilitation systems of EEG-controlled upper limb exoskeletons, including the newest research progress and clinical evaluation in recent years. From the review, we find EEG-controlled exoskeletons can positively contribute to stroke rehabilitation. However, there are some issues that should be well investigated. More efforts are needed on EEG signal decoding algorithms such as deep learning methods in the clinical context. Practical applications must also bridge the gap between offline experiment and online control. In addition, this review also discusses the impact and significance of shared control, virtual reality/augmented reality, and other ways of human-computer interaction to improve EEG-controlled exoskeletons.","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74686319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.4103/2773-2398.348257
Huiwen Mao, Yan Li
Effective treatments for patients in a persistent vegetative state due to traumatic brain injury (TBI) are currently unavailable. The purpose of this study was to investigate the therapeutic use of sensitive sensory stimulation for patients in persistent vegetative state following TBI. This case report discussed a 36-year-old male patient who experienced TBI 75 days prior to admission. Upon hospital admission, the patient was unconscious, could automatically open his eyes, but could not avoid light, trace motions, or execute commands. He was placed on a nasal feeding diet, exhibited urinary and fecal incontinence and developed postoperative urinary retention and a pulmonary infection. He showed no mobility of the upper and lower extremities with hypomyotonia. Medications for nerve repair, regaining consciousness, preventing seizure, resolving phlegm, and protecting the stomach were administered. The activity of the extremities was improved by exercise therapies and low or medium-frequency electric stimulation, bladder and bowel function was improved by acupuncture and abdominal massage, and consciousness recovery was promoted by acupuncture and hyperbaric oxygen therapy. Five months following admission, the patient regained consciousness with improved bladder and bowel function. Electroencephalogram indicated that brain function had significantly improved. Auditory evoked potentials and somatosensory evoked potentials suggested that sensation conduction pathways had improved significantly. Sensitive sensory stimulation in combination with routine rehabilitation treatment can effectively cause the regain of consciousness in patients with persistent vegetative state following TBI and improve activities of daily living and the function of the sensation conduction pathways..
{"title":"Sensitive sensory stimulation for the arousal treatment of a persistent vegetative state following traumatic brain injury: a care-compliant case report","authors":"Huiwen Mao, Yan Li","doi":"10.4103/2773-2398.348257","DOIUrl":"https://doi.org/10.4103/2773-2398.348257","url":null,"abstract":"Effective treatments for patients in a persistent vegetative state due to traumatic brain injury (TBI) are currently unavailable. The purpose of this study was to investigate the therapeutic use of sensitive sensory stimulation for patients in persistent vegetative state following TBI. This case report discussed a 36-year-old male patient who experienced TBI 75 days prior to admission. Upon hospital admission, the patient was unconscious, could automatically open his eyes, but could not avoid light, trace motions, or execute commands. He was placed on a nasal feeding diet, exhibited urinary and fecal incontinence and developed postoperative urinary retention and a pulmonary infection. He showed no mobility of the upper and lower extremities with hypomyotonia. Medications for nerve repair, regaining consciousness, preventing seizure, resolving phlegm, and protecting the stomach were administered. The activity of the extremities was improved by exercise therapies and low or medium-frequency electric stimulation, bladder and bowel function was improved by acupuncture and abdominal massage, and consciousness recovery was promoted by acupuncture and hyperbaric oxygen therapy. Five months following admission, the patient regained consciousness with improved bladder and bowel function. Electroencephalogram indicated that brain function had significantly improved. Auditory evoked potentials and somatosensory evoked potentials suggested that sensation conduction pathways had improved significantly. Sensitive sensory stimulation in combination with routine rehabilitation treatment can effectively cause the regain of consciousness in patients with persistent vegetative state following TBI and improve activities of daily living and the function of the sensation conduction pathways..","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74424707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.4103/2773-2398.348252
Brittany D. Morris, John Wong
Disorders of consciousness (DoC) including the vegetative state, now known as unresponsive wakefulness syndrome, and the minimally conscious state lead to profound disability among affected individuals while placing a major burden on health care facilities, the economy, and society. Efficacious treatment strategies are necessary to alleviate these strains, but standardized, evidence-based protocols for the treatment of DoC are lacking. Progress towards this end remains difficult when considering the current dearth of comprehensive scoping review articles to organize and present the existing literature. The present scoping review seeks to fill this gap while presenting an up-to-date comprehensive compilation of current treatment strategies and their efficacy for vegetative state/unresponsive wakefulness syndrome, and minimally conscious state. To accomplish this, an examination of the existing literature between 2011 and 2021 was conducted using the PubMed database to compile and present current treatment strategies and their efficacy amongst patients in vegetative state/unresponsive wakefulness syndrome and minimally conscious state. Of the 112 articles collected, 32 reported successful treatment, 69 reported some incremental benefits of treatment, and 11 identified no benefit of treatment. Overall, sensory stimulation, transcranial direct current stimulation, transcranial magnetic stimulation, spinal cord stimulation, vagus nerve stimulation, rehabilitation programs, cranioplasty, and pharmacological treatments with zolpidem, amantadine, baclofen, midazolam, and clonazepam dose reduction coupled with neurorehabilitation were associated with successful treatment of DoC. Given the personal, societal, and economic burden associated with DoC, further research is warranted to determine and protocolize evidence-based strategies for effective treatment of those with DoC.
{"title":"A scoping review of treatments for the vegetative and minimally conscious states","authors":"Brittany D. Morris, John Wong","doi":"10.4103/2773-2398.348252","DOIUrl":"https://doi.org/10.4103/2773-2398.348252","url":null,"abstract":"Disorders of consciousness (DoC) including the vegetative state, now known as unresponsive wakefulness syndrome, and the minimally conscious state lead to profound disability among affected individuals while placing a major burden on health care facilities, the economy, and society. Efficacious treatment strategies are necessary to alleviate these strains, but standardized, evidence-based protocols for the treatment of DoC are lacking. Progress towards this end remains difficult when considering the current dearth of comprehensive scoping review articles to organize and present the existing literature. The present scoping review seeks to fill this gap while presenting an up-to-date comprehensive compilation of current treatment strategies and their efficacy for vegetative state/unresponsive wakefulness syndrome, and minimally conscious state. To accomplish this, an examination of the existing literature between 2011 and 2021 was conducted using the PubMed database to compile and present current treatment strategies and their efficacy amongst patients in vegetative state/unresponsive wakefulness syndrome and minimally conscious state. Of the 112 articles collected, 32 reported successful treatment, 69 reported some incremental benefits of treatment, and 11 identified no benefit of treatment. Overall, sensory stimulation, transcranial direct current stimulation, transcranial magnetic stimulation, spinal cord stimulation, vagus nerve stimulation, rehabilitation programs, cranioplasty, and pharmacological treatments with zolpidem, amantadine, baclofen, midazolam, and clonazepam dose reduction coupled with neurorehabilitation were associated with successful treatment of DoC. Given the personal, societal, and economic burden associated with DoC, further research is warranted to determine and protocolize evidence-based strategies for effective treatment of those with DoC.","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78070028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
According to previous case reports, trigeminal nerve stimulation (TNS) can be successfully used to wake a non-responsive unconscious patient. However, no studies have comprehensively investigated the effect of TNS on patients with disorders of consciousness (DOC). Therefore, the present study aimed to assess the safety and efficacy of TNS in DOC patients recruited at the First Affiliated Hospital of Nanchang University. We used Coma Recovery Scale-Revised (CRS-R) scores to assess patients at baseline and after 1–4 weeks of TNS. The patients were further followed up for 4 weeks after the last stimulation to evaluate the safety of the procedure. The participant group comprised 21 DOC patients with an acquired brain injury who were more than 3 months post-injury. The participants were 44.29 ± 12.55 years old and 5.52 ± 1.83 months post-DOC onset, and included 12 patients who were in a vegetative state or had unresponsive wakefulness syndrome and 9 patients who were in a minimally conscious state. Compared with CRS-R scores at baseline, those at weeks 4 and 8 showed no significant improvements in any of the DOC patients. Nonetheless, CRS-R scores improved throughout the study period in 8 out of the 21 DOC patients. Among those with improved scores, two patients in a minimally conscious state had improved CRS-R scores at week 4, while five had improved scores at 4 weeks later. Only one patient with vegetative state/unresponsive wakefulness syndrome had recovered to a minimally conscious state at week 4. Importantly, no obvious treatment-related adverse events were considered to be related to TNS. Taken together, these data provide early evidence that TNS may be an effective and safe approach for promoting the recovery of consciousness in patients with neurological disorders.
{"title":"Trigeminal nerve stimulation for disorders of consciousness: evidence from 21 cases","authors":"Xiao-yang Dong, Yunliang Tang, Long-Jun Fang, Zhen Feng","doi":"10.4103/2773-2398.348256","DOIUrl":"https://doi.org/10.4103/2773-2398.348256","url":null,"abstract":"According to previous case reports, trigeminal nerve stimulation (TNS) can be successfully used to wake a non-responsive unconscious patient. However, no studies have comprehensively investigated the effect of TNS on patients with disorders of consciousness (DOC). Therefore, the present study aimed to assess the safety and efficacy of TNS in DOC patients recruited at the First Affiliated Hospital of Nanchang University. We used Coma Recovery Scale-Revised (CRS-R) scores to assess patients at baseline and after 1–4 weeks of TNS. The patients were further followed up for 4 weeks after the last stimulation to evaluate the safety of the procedure. The participant group comprised 21 DOC patients with an acquired brain injury who were more than 3 months post-injury. The participants were 44.29 ± 12.55 years old and 5.52 ± 1.83 months post-DOC onset, and included 12 patients who were in a vegetative state or had unresponsive wakefulness syndrome and 9 patients who were in a minimally conscious state. Compared with CRS-R scores at baseline, those at weeks 4 and 8 showed no significant improvements in any of the DOC patients. Nonetheless, CRS-R scores improved throughout the study period in 8 out of the 21 DOC patients. Among those with improved scores, two patients in a minimally conscious state had improved CRS-R scores at week 4, while five had improved scores at 4 weeks later. Only one patient with vegetative state/unresponsive wakefulness syndrome had recovered to a minimally conscious state at week 4. Importantly, no obvious treatment-related adverse events were considered to be related to TNS. Taken together, these data provide early evidence that TNS may be an effective and safe approach for promoting the recovery of consciousness in patients with neurological disorders.","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81159701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01DOI: 10.4103/2773-2398.348255
Xia Shen, Jia Hu, Margaret Y. Mak
Exercise training is often prescribed as an adjunct to medication to improve postural instability in individuals with Parkinson’s disease. As the association between exercise dose and the corresponding effects on postural stability has not been established in this population, we aimed to explore this topic in the present study. This is an exploratory study conducted in the Gait and Balance Laboratory at the Hong Kong Polytechnic University in a period from June 2011 to June 2013. Eligible participants with Parkinson’s disease (n = 51) were randomly assigned to either a balance and gait training group or a strength training group. The 12-week training period included two 4-week phases of physiotherapist-supervised laboratory-based training separated by a 4-week phase of self-supervised home-based training. Blinded testers examined postural stability using the limit of stability test, single-leg-stance test, walking test, and the activities-specific balance confidence scale, at baseline and after each training phase. Baseline evaluations revealed no significant difference between the balance and gait training and strength training groups. In the balance and gait training group, the first 4-week training phase led to significant improvement in most measures of balance and gait performance (P < 0.025), and the 12-week training phase yielded further improvements in gait velocity and activities-specific balance confidence scale score. In the strength training group, the first 4-week training phase led to significant improvement in the endpoint excursion in the limit of stability test and gait velocity, and the 12-week training phase resulted in an improvement in the single-leg-stance time and stride length in the walking test. All improvements occurred during the laboratory-based training sessions. Therefore, in individuals with Parkinson’s disease, a 4-week period of balance and gait training could improve postural stability, whereas longer durations of strength training are required to gain comparable improvements.
{"title":"Dose-response characteristics of exercise training in individuals with Parkinson's disease: an exploratory study","authors":"Xia Shen, Jia Hu, Margaret Y. Mak","doi":"10.4103/2773-2398.348255","DOIUrl":"https://doi.org/10.4103/2773-2398.348255","url":null,"abstract":"Exercise training is often prescribed as an adjunct to medication to improve postural instability in individuals with Parkinson’s disease. As the association between exercise dose and the corresponding effects on postural stability has not been established in this population, we aimed to explore this topic in the present study. This is an exploratory study conducted in the Gait and Balance Laboratory at the Hong Kong Polytechnic University in a period from June 2011 to June 2013. Eligible participants with Parkinson’s disease (n = 51) were randomly assigned to either a balance and gait training group or a strength training group. The 12-week training period included two 4-week phases of physiotherapist-supervised laboratory-based training separated by a 4-week phase of self-supervised home-based training. Blinded testers examined postural stability using the limit of stability test, single-leg-stance test, walking test, and the activities-specific balance confidence scale, at baseline and after each training phase. Baseline evaluations revealed no significant difference between the balance and gait training and strength training groups. In the balance and gait training group, the first 4-week training phase led to significant improvement in most measures of balance and gait performance (P < 0.025), and the 12-week training phase yielded further improvements in gait velocity and activities-specific balance confidence scale score. In the strength training group, the first 4-week training phase led to significant improvement in the endpoint excursion in the limit of stability test and gait velocity, and the 12-week training phase resulted in an improvement in the single-leg-stance time and stride length in the walking test. All improvements occurred during the laboratory-based training sessions. Therefore, in individuals with Parkinson’s disease, a 4-week period of balance and gait training could improve postural stability, whereas longer durations of strength training are required to gain comparable improvements.","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90916044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/2773-2398.340138
{"title":"Welcome to Brain Network and Modulation","authors":"","doi":"10.4103/2773-2398.340138","DOIUrl":"https://doi.org/10.4103/2773-2398.340138","url":null,"abstract":"","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85299848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/2773-2398.340142
Jing-Jing Zhang, Yan Chen, Lingsong Wu, Fang Gao, Yan Li, Bing-Chen An
Urinary retention is a serious complication of spinal cord injury. This study examined whether repetitive functional magnetic stimulation (rFMS) applied over the sacral nerve root affected bladder function or mood in patients with urinary retention after spinal cord injury. This single-center, case-control study included 32 patients with detrusor flaccid neurogenic bladder after spinal cord injury, who were randomly assigned to rFMS (n = 11), electroacupuncture pudinal nerve stimulation (EAPNS; n = 11), and control groups (n = 10). All groups received routine bladder function training. The S3 sacral nerve was stimulated at a frequency of 5 Hz, once per day for 4 consecutive weeks in the rFMS group. Electroacupuncture stimulation of the pudendal nerve was performed once daily for 4 weeks in the EAPNS group. The control group received bladder function retraining alone. After the 4-week treatment, there were significant improvements in all three groups (P < 0.05). Primary bladder sensation, maximum bladder volume, maximum bladder pressure, and residual urine were significantly higher in the rFMS group than in the other two groups (P < 0.05). Primary bladder sensation, maximum bladder volume, residual urine, and urinary leukocyte count were significantly different between the EAPNS and control groups (P < 0.05). The rFMS group had significantly lower scores in the self-rated anxiety scale and self-rated depression scale compared with those of the other two groups. The quality of life score significantly increased in all three groups. rFMS is conducive to the recovery of neurogenic function in patients with urinary retention. This study provides a scientific basis for the clinical application and promotion of rFMS.
{"title":"Clinical effect of repetitive functional magnetic stimulation of sacral nerve roots on urinary retention after spinal cord injury: a case-control study","authors":"Jing-Jing Zhang, Yan Chen, Lingsong Wu, Fang Gao, Yan Li, Bing-Chen An","doi":"10.4103/2773-2398.340142","DOIUrl":"https://doi.org/10.4103/2773-2398.340142","url":null,"abstract":"Urinary retention is a serious complication of spinal cord injury. This study examined whether repetitive functional magnetic stimulation (rFMS) applied over the sacral nerve root affected bladder function or mood in patients with urinary retention after spinal cord injury. This single-center, case-control study included 32 patients with detrusor flaccid neurogenic bladder after spinal cord injury, who were randomly assigned to rFMS (n = 11), electroacupuncture pudinal nerve stimulation (EAPNS; n = 11), and control groups (n = 10). All groups received routine bladder function training. The S3 sacral nerve was stimulated at a frequency of 5 Hz, once per day for 4 consecutive weeks in the rFMS group. Electroacupuncture stimulation of the pudendal nerve was performed once daily for 4 weeks in the EAPNS group. The control group received bladder function retraining alone. After the 4-week treatment, there were significant improvements in all three groups (P < 0.05). Primary bladder sensation, maximum bladder volume, maximum bladder pressure, and residual urine were significantly higher in the rFMS group than in the other two groups (P < 0.05). Primary bladder sensation, maximum bladder volume, residual urine, and urinary leukocyte count were significantly different between the EAPNS and control groups (P < 0.05). The rFMS group had significantly lower scores in the self-rated anxiety scale and self-rated depression scale compared with those of the other two groups. The quality of life score significantly increased in all three groups. rFMS is conducive to the recovery of neurogenic function in patients with urinary retention. This study provides a scientific basis for the clinical application and promotion of rFMS.","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89804026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/2773-2398.340139
Yan-fei Li
Stroke patients require rehabilitation programs to improve their functioning and quality of life. Proprioceptive neuromuscular facilitation is a widely used rehabilitation technique in clinical facilities. However, previous studies have not completely clarified its effectiveness. This study aimed to evaluate the effectiveness of proprioceptive neuromuscular facilitation in improving balance and mobility in stroke patients through clinical research and literature review. Our findings show that proprioceptive neuromuscular facilitation techniques effectively improve balance and mobility in stroke patients. However, there is little evidence supporting its superiority over the other rehabilitation methods.
{"title":"Effectiveness of proprioceptive neuromuscular facilitation techniques in improving balance in poststroke patients: a systematic review","authors":"Yan-fei Li","doi":"10.4103/2773-2398.340139","DOIUrl":"https://doi.org/10.4103/2773-2398.340139","url":null,"abstract":"Stroke patients require rehabilitation programs to improve their functioning and quality of life. Proprioceptive neuromuscular facilitation is a widely used rehabilitation technique in clinical facilities. However, previous studies have not completely clarified its effectiveness. This study aimed to evaluate the effectiveness of proprioceptive neuromuscular facilitation in improving balance and mobility in stroke patients through clinical research and literature review. Our findings show that proprioceptive neuromuscular facilitation techniques effectively improve balance and mobility in stroke patients. However, there is little evidence supporting its superiority over the other rehabilitation methods.","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82217269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.4103/2773-2398.340143
Xiao-Yan Li, Chuang Zhao, Ye-Ran Mao, Ruochen Du, Zhidan Liu
The traditional Chinese herb, Moschus (also called She Xiang in Chinese), is used to accelerate the rehabilitation of Bell’s palsy (BP) through acupoint sticking therapy in China. However, the mechanism of its effect is not clear. In this study, we explored the pharmacological mechanism using bioinformatics analysis. We identified 59 active ingredients in Moschus using the Traditional Chinese Medicine Integrated Database, including 17-beta-estradiol, testosterone, and 2,6-decamethylene pyridine. In total, 837 differently expressed genes were identified in blood of BP patients by RNA sequencing. Finally, 33 proteins were identified with overlapping predictions by the Comparative Toxicogenomics Database and Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine. Proteins of interest were closely associated with 406 Gene Ontology biological processes and 4 pathways. The hub proteins in the protein–protein interaction network were FOS, JUN, proopiomelanocortin, and G protein-coupled estrogen receptor 1. A pharmacology network was constructed with 15 active components of Moschus, 33 protein targets and four pathways. The docking model of androst-4-ene-3,17-dione and FOS-JUN complexes was predicted and constructed. The results indicated testosterone as an effective component of Moschus that may enhance BP rehabilitation by targeting FUN and the mitogen-activated protein kinase and cyclic adenosine monophosphate signaling pathways, and that docking of androst-4-ene-3,17-dione and FOS-JUN complexes might play a critical role. The findings provide a direction for future research to verify the key targets of Moschus in the treatment of BP and an application prospect in the field of facial nerve rehabilitation.
{"title":"A network pharmacology analysis to identify active components and targets of Moschus in treatment and rehabilitation of Bell’s palsy","authors":"Xiao-Yan Li, Chuang Zhao, Ye-Ran Mao, Ruochen Du, Zhidan Liu","doi":"10.4103/2773-2398.340143","DOIUrl":"https://doi.org/10.4103/2773-2398.340143","url":null,"abstract":"The traditional Chinese herb, Moschus (also called She Xiang in Chinese), is used to accelerate the rehabilitation of Bell’s palsy (BP) through acupoint sticking therapy in China. However, the mechanism of its effect is not clear. In this study, we explored the pharmacological mechanism using bioinformatics analysis. We identified 59 active ingredients in Moschus using the Traditional Chinese Medicine Integrated Database, including 17-beta-estradiol, testosterone, and 2,6-decamethylene pyridine. In total, 837 differently expressed genes were identified in blood of BP patients by RNA sequencing. Finally, 33 proteins were identified with overlapping predictions by the Comparative Toxicogenomics Database and Bioinformatics Analysis Tool for Molecular Mechanism of Traditional Chinese Medicine. Proteins of interest were closely associated with 406 Gene Ontology biological processes and 4 pathways. The hub proteins in the protein–protein interaction network were FOS, JUN, proopiomelanocortin, and G protein-coupled estrogen receptor 1. A pharmacology network was constructed with 15 active components of Moschus, 33 protein targets and four pathways. The docking model of androst-4-ene-3,17-dione and FOS-JUN complexes was predicted and constructed. The results indicated testosterone as an effective component of Moschus that may enhance BP rehabilitation by targeting FUN and the mitogen-activated protein kinase and cyclic adenosine monophosphate signaling pathways, and that docking of androst-4-ene-3,17-dione and FOS-JUN complexes might play a critical role. The findings provide a direction for future research to verify the key targets of Moschus in the treatment of BP and an application prospect in the field of facial nerve rehabilitation.","PeriodicalId":93737,"journal":{"name":"Brain network and modulation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90587946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}