Neurorehabilitation and neural repair最新文献

IntroductionFunctional electrical stimulation (FES) may enhance the impact of locomotor training on walking impairments following spinal cord injury (SCI).ObjectiveThis systematic review (PROSPERO: CRD42023435210) evaluated the therapeutic effectiveness of FES-assisted locomotor training (FALT) on improving walking speed and endurance for individuals with motor incomplete SCI (iSCI).MethodsDatabases (MEDLINE, EMBASE, CINAHL) were searched for interventional studies of FALT in iSCI that assessed the therapeutic effects on walking speed and/or endurance when the FES was not active. Study characteristics and findings were extracted, summarized, and narratively synthesized. Risk of bias was assessed using the Cochrane tools for interventional studies. Random effects meta-analyses were conducted to generate standardized pooled effect sizes for both outcomes.ResultsThirteen studies were identified: 4 randomized controlled trials (RCTs) and 9 pre-post tests. RCTs scored low (n = 1 study), intermediate (n = 1), and high (n = 2) on the RoB2, and all pre-post tests studies (n = 9) scored high on the ROBINS-I. Meta-analyses of 3 RCTs found that treadmill-based FALT was associated with a small, non-significant effect on walking speed (n = 76 participants; Hedge's g: -0.01; 95% CI: -0.46, 0.43; P = .96) and a small, non-significant effect on walking endurance (n = 71; Hedge's g: 0.20; 95% CI: -0.25, 0.65; P = .39) when compared to control conditions.DiscussionThis review did not find evidence that FALT improves walking speed or endurance for people with iSCI relative to other types of locomotor training. Future trials of FALT for SCI should aim to better standardize and report training dose and stimulation parameters to improve comparability.

Background: Clinical practice guidelines for walking recovery post-stroke recommend high aerobic intensity training, which usually involves walking at fast speeds. However, the acute effect of fast speeds on the neuromuscular control of walking is unclear.

Objectives: (1) Assess the criterion validity of the Dynamic Motor Control Index (WalkDMC) as a measure of coactivation post-stroke. (2) Assess acute speed-dependent coactivation post-stroke. (3) Assess how clinical characteristics shape the speed-dependent coactivation response. (4) Assess the relationship between heart rate and coactivation post-stroke. We hypothesized that WalkDMC is correlated with function and impairment measures. We also hypothesize that coactivation measured via the WalkDMC increases for speeds above or below self-selected speeds (SSS).

Methods: 32 chronic stroke survivors and 17 age and sex-matched controls walked at SSS, fast, and slow speeds. EMGs were measured bilaterally on 7 lower extremity muscles. We used non-negative matrix factorization to calculate WalkDMC. We used regression to assess the relationship between WalkDMC, speed, heart rate, and clinical outcomes.

Results: WalkDMC was correlated with clinical outcomes, supporting its criterion validity. We observed a quadratic relationship between speed and coactivation: for the paretic extremity, the predicted speed that would lead to the lowest coactivation was ~120% higher than SSS. Slow speeds consistently increased coactivation in controls and participants post-stroke. Coactivation in the paretic extremity was significantly predicted by speed, balance, and impairment.

Conclusions: Our results suggest that increased speeds lead to differential improvements in coactivation in the paretic and non-paretic extremities. These results may inform speed prescriptions for HIT interventions.

Background: People with stroke often have persistent balance impairments that have a profound impact on mobility and daily life independence. Several studies have been conducted to identify stroke-related deficits in neuromuscular responses to balance perturbations. Yet, the majority of these studies involved low-intensity, non-stepping perturbations, whereas falling typically occurs at high-intensity perturbations where stepping is a key saving strategy.

Objective: We aimed to identify deficits in muscle coordination patterns of reactive stepping in people with supratentorial stroke (PwS).

Methods: We included 32 PwS, who performed multidirectional stepping responses with their paretic and non-paretic leg. We determined step quality, and performed muscle synergy analysis to characterize stance- and swing-leg muscle coordination patterns.

Results: We observed smaller leg angles in PwS in lateral, posterolateral and posterior directions, particularly with the paretic leg. Muscle synergy analysis yielded a set of 5 synergies in both groups for the swing VAF_Paretic = 0.84 ± 0.02, VAF_Non-Paretic = 0.84 ± 0.02) and stance leg VAF_Paretic = 0.85 ± 0.02, VAF_Non-Paretic = 0.84 ± 0.02). Three synergies were less frequently represented during paretic step execution. In addition, for the synergy with prominent gluteus medius involvement, underrepresentation was associated with lower Fugl-Meyer lower-extremity scores.

Conclusions: The finding of deficient synergy structure and activation during reactive stepping complements and extends insights into balance related impairments after stroke. As the key next step, the methodology presented here allows identifying whether training-induced gains in reactive step quality are related to optimization of pre-existing coordination patterns, or whether some degree of behavioral restitution (i.e., return to "normal" coordination patterns) may still be possible.

ObjectiveResearchers have focused on gamma rhythm stimulation, particularly at 40 Hz, to enhance endogenous gamma oscillations and improve cognitive function and outcomes in Alzheimer's disease (AD). However, some studies disputed these findings. This review aimed to systematically analyze recent randomized controlled trials on the effects of gamma stimulation on cognitive function in AD and to perform a meta-analysis to assess the efficacy, safety, and differences between brain and sensory stimulation.MethodsA systematic search was conducted in PubMed, Web of Science, Ovid-Embase, and Ovid-MEDLINE from their inception to April 2024. A meta-analysis was performed to evaluate adverse events and cognitive function assessed using AD Assessment Scale-Cognitive Subscale (ADAS-cog), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Face-Name Association Test (FNAT). Subgroup analyses were performed to explore the heterogeneity between the brain and sensory stimulation.ResultsEight studies involving 291 participants were included. Meta-analysis demonstrated a large benefit in cognitive function: FNAT (standardized mean difference [SMD] = 3.76; 95% confidence interval [CI] = 2.52-4.99; I² = 65%), MMSE (SMD = 3.09; 95% CI = 2.37-3.82; I² = 0%), ADAS-cog (SMD = -4.16; 95% CI = -6.60 to -2.62; I² = 0%), and MoCA (SMD = 2.17; 95% CI = -0.54 to 4.88; I² = 0%). There were no significant differences in adverse events between the intervention and sham groups (P = .06), suggesting the safety of gamma stimulation.ConclusionThis review highlights the safety and benefits of gamma stimulation for cognitive improvement in patients with AD, with sensory stimulation proving safe even in individuals with epilepsy.

Background: After stroke, ankle proprioceptive deficits are common and do not typically correlate with ankle weakness. Some studies report that these deficits correlate with gait function, supporting the importance of somatosensory input for gait control. Others have not found a relationship, possibly due to use of coarse proprioception measures. Robotic assessments of proprioception offer improved consistency and sensitivity.

Objective: To establish relationships between ankle proprioception, gait function, and ankle motor in stroke survivors.

Methods: We studied 39 individuals in the chronic phase of stroke using 2 robotic tests, Crisscross and Joint Position Reproduction (JPR), to quantify ankle proprioception. We examined associations of these measures with gait speed (10-meter walk test) and gait endurance (6-minute walk test). We also analyzed correlations with lower extremity motor impairment, including robotic measures of ankle strength (MVC) and active range of motion (AROM), and the lower extremity Fugl-Meyer exam (LEFM).

Results: Impaired ankle proprioception was present in 87% of participants. Crisscross error weakly correlated with the 10mWT gait speed (ρ = -0.20, P = 0.23) and 6MWT distance (ρ = -0.28, P = .089). JPR error weakly correlated with 10mWT gait speed (ρ = -0.29, P = .092) and significantly correlated with 6MWT distance (ρ = -0.34, P = .04). No significant correlations were observed between ankle proprioceptive error and MVC, AROM, or LEFM (P > 0.2).

Conclusion: These results confirm the presence of a weak relationship between ankle proprioception and gait after stroke that is independent of several common measures of motor impairment.

BackgroundStroke is the leading cause of long-term disability, making the search for successful rehabilitation treatment one of the most important public health issues. A better understanding of the neural mechanisms underlying impairment and recovery is critical for optimizing treatments. Objective: We studied the longitudinal changes in brain oscillatory modes, linked to GABAergic system activity, and determined their importance for residual upper-limb motor functions and recovery.MethodsTranscranial Magnetic Stimulation (TMS) was combined with scalp Electroencephalography (EEG) to analyze TMS-induced brain oscillations in a cohort of 66 stroke patients in the acute (N = 60), early (N = 48), and late subacute stages (N = 37).ResultsA data-driven parallel factor analysis (PARAFAC) approach to tensor decomposition extracted brain oscillatory modes, which significantly evolved longitudinally across stroke stages (permutation tests, p_Bonf < 0.05). Notably, the observed decrease of the α-mode, known to be linked with GABAergic system activity, was mainly driven by the recovering patients and was supportive of stroke recovery at the group level (Bayesian Kendall correlation, moderate to strong statistical evidence).ConclusionsOverall, longitudinal evaluation of brain modes provides novel insights into functional reorganization of brain networks after a stroke. Notably, we propose that the observed α-mode decrease could correspond to a beneficial disinhibition toward the late subacute stage that fosters plasticity and facilitates recovery. These results confirm the relevance of future individual and direct monitoring of post-stroke modulations in inhibitory system activity, with the ultimate goal of designing electrophysiological biomarkers and refining therapies based on personalized neuromodulation.

BackgroundFunctional mobility is essential for maintaining independence and relies on both motor and cognitive processes. Although the impact of motor impairments on functional mobility in stroke survivors has been extensively studied, the influence of post-stroke cognitive impairments has been largely overlooked. The aim of the current study is 2-fold. First, to determine the impact of post-stroke cognitive impairments on functional mobility across a broad spectrum of tasks. Second, to determine if cognitive impairment has a differential impact on various forms of mobility.MethodForty individuals with stroke (20 cognitively normal and 20 cognitively impaired) and 30 healthy older adults participated in the study. Participants performed cognitive, motor, and mobility assessments. Cognitive tests included global and domain-specific assessments on an extensive neuropsychological battery. Motor tests included the Modified Rankin Scale and strength assessments. Functional mobility included the assessment of balance, overground walking, and driving in a simulator.ResultsFindings indicated that stroke survivors with cognitive impairment demonstrated significant deteriorations in functional mobility across multiple domains, compared to both cognitively normal stroke survivors and healthy older adults. Cognitive impairment significantly interferes with functional mobility, with driving showing greatest deterioration compared to balance and walking performance. Notably, this impact is independent of the level of disability and motor strength.ConclusionCognitive impairments in stroke survivors are associated with significant mobility disturbances, with the most pronounced deficits in driving performance. This study highlights the importance of including and prioritizing cognitive evaluation and intervention for enhancing functional mobility and independence in stroke survivors.

Objective: Investigating structural changes in the cervical spinal cord and brain in children with complete thoracolumbar spinal cord injury (TLSCI) and their correlation with clinical function may provide objective imaging indicators for functional evaluation.

Methods: Twenty-one children with complete TLSCI and twenty-one typically developing (TD) children were enrolled in this study. All participants underwent whole-brain and upper cervical spinal cord sagittal 3D T1-weighted and whole-brain axial diffusion tensor imaging scans using a 3.0T MRI scanner. Utilizing the Spinal Cord Toolbox, cervical spinal cord morphological parameters were obtained. Brain structure changes were analyzed with voxel-based morphometry (VBM) and voxel-based analysis (VBA).

Results: Compared to TD children, children with TLSCI showed significant reductions in the CSA (P = .011) and APW (P = .002) at the C2/3 level, as well as significant atrophy in the gray matter volume (GMV) of the left thalamus (P = .026), and bilateral paracentral lobule (PCL, P = .002). There was a significant positive correlation (r = 0.540, P = .017) between GMV of bilateral PCL and sensory scores. The VBA results showed a significant increase in fractional anisotropy values in the right posterior limb of the internal capsule, posterior thalamic radiation, and superior longitudinal fasciculus (SLF, P = .045), the mean diffusivity value of the right SLF was significantly decreased (P = .049) in children with TLSCI.

Conclusions: In children with complete TLSCI, specific structural changes in the cervical spinal cord and brain were observed. A significant correlation between GMV of bilateral PCL and sensory scores may provide imaging biomarkers for assessing neurologic function and therapeutic efficacy (Ethics No: [2020] 003).

BackgroundThe effectiveness of non-invasive neuromodulation to improve social cognition (SC) in neurological disorders remains unclear. However, repetitive transcranial magnetic stimulation (rTMS) shows promise for treating cognitive abnormalities by promoting neuroplasticity.ObjectiveIn this randomized, double-blind, sham-controlled study, we investigated the effects of high-frequency rTMS on the medial prefrontal cortex (mPFC) and right temporal parietal junction (rTPJ) in patients with mild cognitive impairment (MCI) to enhance SC abilities and other cognitive and functional abilities related to the stimulated network, and their maintenance effects post-treatment.MethodsTwenty-four MCI patients were assigned to 2 groups: a Real-Real group (RR-Gr) that received 4 weeks of rTMS, and a Sham-Real group (SR-Gr) that received 2 weeks of sham stimulation followed by 2 weeks of real rTMS. All subjects underwent cognitive/functional assessments at baseline, week 2, and week 4 of the treatment, and 8 weeks post-intervention (12 weeks).ResultsAfter 2 weeks of treatment, the RR-Gr improved in empathy performance (P < .001), emotion-recognition (P < .001), social-behavior (SB) (P = .04), and executive function (P = .014). Following 4 weeks of rTMS, emotion-recognition improved further, and the benefits persisted at follow-up observation (all Ps < .001). In RR-Gr, patients with higher education exhibited more significant improvements in SB abilities (P = .032). Both groups also improved attention, mobility, and quality of life over time (P range :<.001-.02).ConclusionsExcitatory rTMS treatment targeting 2 key social brain regions (mPFC and rTPJ) shows promise as a sustained intervention to improve SC and associated cognitive functions in the MCI population.Trial registrationClinicalTrials.gov ID: NCT04490616.

Background: Gait impairment in Parkinson's disease (PD) occurs early and pharmaceutical interventions do not fully restore this function. Visual cueing has been shown to improve gait and alleviate freezing of gait (FOG) in PD. Technological development of digital laser shoe visual cues now allows for visual cues to be used continuously when walking. This study aimed to investigate the effects of laser shoe visual cueing on gait in people with PD across different disease severity (i.e., Hoehn & Yahr [H&Y] stages I-III) and FOG status.

Methods: Eighty people with PD (H&YI = 20, H&YII = 30 [15 FOG, 15 noFOG], H&YIII = 30 [15 FOG, 15 noFOG]) walked a 10 m straight path (back and forth) self-paced for 80 seconds without and then with laser shoe cues (participants were allowed 1-2 walks to familiarize with the cues). Inertial sensors were used to measure gait metrics. Laser cue line was set to usual step length for individuals based on their usual walk data from the inertial sensors.

Results: Laser shoe cueing did not improve gait in PD regardless of disease severity or FOG status. Across all groups, participants decreased gait speed (P < .001), cadence (P < .001), arm range of motion (P < .005), and increased stride time, double support time (P < .001), elevation at midswing (P < .001), and gait variability (P < .001) with the laser shoes compared to usual walking.

Conclusion: Digital laser shoe visual cues do not improve gait in people with PD across disease severity or FOG status. Further investigation is required to examine different cue settings or exposure periods.