Neurorehabilitation and neural repair最新文献

Background: After a central nervous system lesion, the ability to control muscle activation and relaxation in specific joint ranges may be impaired. The underlying mechanism of this sensorimotor impairment is related to a decreased ability to regulate the tonic stretch reflex threshold (TSRT) through descending and peripheral control processes. In dynamics, the reflex threshold and its velocity-sensitivity (μ) describe how movement in specific upper limb (UL) joint ranges is impaired after stroke.

Objective: To examine the relationships between measures of elbow flexor impairment using TSRT and μ, and clinical scores of spasticity and motor function. We hypothesized that TSRT and μ would be related to clinical spasticity and motor impairment scores in patients with acute and chronic stroke.

Methods: TSRT, μ, and clinical data of the resistance to passive movement (Modified Ashworth Scale) and UL motor function (Fugl-Meyer Assessment [FMA]) were collected from 120 patients. Relationships between variables were determined using simple correlations and multiple regression analysis.

Results: TSRT and μ explained 72.0% of the variance in the FMA of the Upper Extremity [FMA-UE] describing only in-synergy and out-of-synergy movements and reflex function. TSRT explained 68.7% of the variance in the total score of the FMA-UE.

Conclusions: This study shows for the first time, a significant relationship between deficits in TSRT regulation and μ with UL motor impairment after stroke. TSRT and μ may be valuable clinical biomarkers of sensorimotor impairment for monitoring spontaneous or treatment-induced motor recovery.

Background: Early identification of potential deficits is of utmost importance as early diagnosis and early treatment has been shown to be crucial to reduce disease activity and disease impact-leading to the notion of "Time matters" in multiple sclerosis (MS).

Objective: The aim of the present study was to compare physical-, cognitive-, and patient-reported outcomes in early phase MS patients with matched healthy controls (HC).

Methods: This cross-sectional study included 84 patients early in the disease course of MS (≤2 years from diagnosis) and 84 age- and sex-matched HC. All participants underwent a comprehensive test battery including physical-, cognitive-, and patient-reported outcomes.

Results: Relative deficits for patients with MS compared to HC corresponded to 7% to 35% in walking capacity (Timed 25-Foot Walk Test, 6 Spot Step Test, 6 Minute Walk Test), 5% for upper limb function (9 Hole Peg Test), 27% for aerobic capacity (maximal oxygen uptake), 17% to 38% for physical activity level (Baecke Sport Index and accelerometer counts/minute), 68% for fatigability (Walking Fatigability Index), 150% for fatigue (Modified Fatigue Impact Scale), 4% to 20% for cognitive function (Symbol Digit Modalities Test, Paced Auditory Serial Addition Test, and Selective Reminding Test), and lastly, 7% to 8% for quality of life (Short Form-36 health survey). Only the Symbol Digit Modalities Test and Selective Reminding Test Delayed did not differ between groups, statistically.

Conclusion: Early phase MS patients present substantial deficits in physical-, cognitive-, and patient-reported outcomes compared to HC. These early impairments highlight the importance of early initiatives aimed at preserving and/or building of reserve capacity.

Background: Dual-task capacity, which might be impaired poststroke, is needed for daily functions. Therefore, dual-task capacity should be assessed during rehabilitation. The Dual Overload Interference Test (DO-IT) is a new upper extremity (UE) protocol for assessment, combining The Box and Block Test with the Counting Backwards Test.

Objectives: To validate DO-IT by comparing between (1) young and older healthy, (2) stroke and healthy participants. Additionally, to correlate DO-IT with (3) walking-cognitive dual-task assessment (healthy), and (4) standardized cognitive and EF assessments (stroke).

Methods: A cross-sectional study included younger and older community-dwelling healthy individuals (N = 32), and younger and older individuals with stroke (N = 83). DO-IT was administered to all participants. The #blocks transferred (motor) and #correct numbers counted (cognitive) were recorded for single and dual conditions. The walking-cognitive dual-task test was administered to the healthy participants. Motor and cognitive costs were calculated as the difference between single and dual tasks. The Montreal Cognitive Assessment test (MoCA) and the Color Trail Test (CTT) assessed cognition post stroke.

Results: Older healthy adults had significantly lower dual-task motor capacity compared to younger adults (median [interquartile range] blocks: older 26 [21-38], younger 46 [38-52], P < .01). Participants with stroke showed higher motor costs than healthy participants. Dual-task costs correlated between DO-IT to walking-cognitive (motor; r = .37-.41, cognitive; r = .41-.47, P < .05). DO-IT motor cost negatively correlated with MoCA (r = -.27, P < .05), and DO-IT motor performance correlated with MoCA/CTT-AB (r = .29-.60, P < .05).

Conclusions: UE-Cognitive dual-task capacity is affected post-stroke. DO-IT shows potential for use in stroke rehabilitation and its validity should be further researched.

Background: Deficits in dual-tasks (DT) are frequently observed post-concussion (ie, mild Traumatic Brain Injury). However, traditional DT may not be relevant to daily life. Walking while talking elicits DT costs in healthy adults and is part of daily life.

Objective: We investigated the effect of concussion on walking with extemporaneous speech and explored relationships between DT and acute symptoms.

Methods: Participants with recent concussion (<14 days post-injury) and controls completed 3 tasks: single-task gait without speaking (ST_G), single-task speaking without walking (ST_S), and walking while speaking (DT). Silent pauses in speech audio reflected cognitive performance, and gait was quantified using inertial sensors. We used linear mixed models to compare groups and conditions and explored associations with self-reported symptoms.

Results: Both concussion (n = 19) and control (n = 18) groups exhibited longer speech pauses (P < .001), slower walking speeds (P < .001), and slower cadence (P < .001) during the DT compared to ST conditions. There were no group differences or interactions for speech pauses (P > .424). The concussion group slowed down more during DT than the control group (group × task P = .032). Vestibular symptoms strongly associated with ST speech pause duration (ρ = .72), ST gait speed (ρ = -.75), and DT gait speed (ρ = -.78).

Conclusions: Extemporaneous speech is well-practiced but challenging to complete while walking post-concussion. Strong associations between DT outcomes and vestibular-related symptoms suggest DT deficits vary with post-concussion symptomology. DT deficits may be deleterious to daily tasks post-concussion.

Background: High intensity interval training (HIIT) is a mode of aerobic exercise that can increase neurotrophin concentration, improve cardiovascular health, and enhance recovery post-stroke. However, HIIT is not commonly prescribed in stroke rehabilitation. Exploring the clinical utility of, and barriers and facilitators to, HIIT is necessary to optimize clinical use.

Objective: To identify perceptions of HIIT from people with stroke and health professionals working in stroke rehabilitation.

Methods: People with stroke and health professionals in Australia were invited to participate in an online questionnaire. Participants were further invited to complete a one-on-one semi-structured interview. A Framework Analysis approach was applied to identify key themes.

Results: Twenty-six people with stroke (mean ± standard deviation = 49.2 ± 60.6 months post-stroke, 57.7% female) and 37 health professionals (2 medical and 35 allied health) completed questionnaires. Ten people with stroke (5 female) and 8 allied health professionals completed an interview. Aerobic exercise was not considered a priority after stroke, though participants were interested in HIIT. People with stroke reported a lack of understanding of the benefits of HIIT and use of the term "high intensity" as barriers to participation. Facilitators included education about safety of HIIT and referral to health professionals. Health professionals reported a lack of knowledge of HIIT prescription parameters and participant motivation as barriers to prescription. Facilitators included education of HIIT prescription and benefits and appropriate screening prior to commencement.

Conclusions: People with stroke and health professionals are interested in HIIT after stroke. Increasing knowledge and confidence to participate in, and prescribe HIIT, may increase clinical use.

Background: Axial symptoms in Parkinson's disease (PD) often respond poorly to pharmacological treatment. We evaluated whether combining repetitive transcranial magnetic stimulation (rTMS) and repetitive spinal magnetic stimulation (rSMS) is more effective than rTMS alone in improving axial and other motor disabilities in PD.

Methods: A total of 42 PD patients with axial symptoms were randomly allocated to 2 experimental intervention groups: Group I received active rTMS + active rSMS (2000 pulses; 20 Hz; 80% resting motor threshold for each motor area "M1" + 1500 pulses rSMS 10 Hz, at 50% of maximal stimulator output). Group II received active rTMS + sham rSMS with the same number of pulses. Both groups received 10 sessions (5 consecutive days/week for 2 weeks). Assessments using Freezing of Gait Questionnaire, walking speed, Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts II and III, and Parkinson's Disease Questionaire-39 (PDQ-39) were performed at baseline (T0), end of sessions (T1), and 1 month later (T2).

Results: At T0, Group II showed higher walking speed. At T1 and T2, Group I demonstrated significantly greater improvements in MDS-UPDRS parts II, III, and sub-items of part III. Group I showed stronger improvement in TUG-T and average fast velocity immediately post-intervention, but this effect diminished after 1 month. PDQ-39 scores for leisure activity and walking problems were significantly higher in group I.

Conclusions: These findings indicate that combining rTMS and rSMS for 10 sessions is more effective than rTMS alone in managing PD's motor and axial symptoms. The effect size of the outcome is large enough to be of significance in clinical practice.

Trial registration: The study was registered prospectively on 26/12/2021 at the clinicaltrial.gov website with the registration ID: NCT05271513, https://clinicaltrials.gov/study/NCT05271513.

Background: The prognosis of prolonged disorders of consciousness (pDoC) in children has consistently posed a formidable challenge in clinical decision-making.

Objective: This study aimed to develop a machine learning (ML) model based on conventional structural magnetic resonance imaging (csMRI) to predict outcomes in children with pDoC.

Methods: A total of 196 children with pDoC were included in this study. Based on the consciousness states 1 year after brain injury, the children were categorized into either the favorable prognosis group or the poor prognosis group. They were then randomly assigned to the training set (n = 138) or the test set (n = 58). Semi-quantitative visual assessments of brain csMRI were conducted and Least Absolute Shrinkage and Selection Operator regression was used to identify significant features predicting outcomes. Based on the selected features, support vector machine (SVM), random forests (RF), and logistic regression (LR) were used to develop csMRI, clinical, and csMRI-clinical-merge models, respectively. Finally, the performances of all models were evaluated.

Results: Seven csMRI features and 4 clinical features were identified as important predictors of consciousness recovery. All models achieved satisfactory prognostic performances (all areas under the curve [AUCs] >0.70). Notably, the csMRI model developed using the SVM exhibited the best performance, with an AUC, accuracy, sensitivity, and specificity of 0.851, 0.845, 0.844, and 0.846, respectively.

Conclusions: A csMRI-based prediction model for the prognosis of children with pDoC was developed, showing potential to predict recovery of consciousness 1 year after brain injury and is worth popularizing in clinical practice.

Background: The congruence or discordance between actual and perceived balance ability has been proposed to be linked to functional outcomes such as falls. However, gaps remain in our ability to quantify discordance, and its relationship to relevant outcomes.

Objective: To investigate a novel quantification of concordance/discordance between balance performance and perception and determine the relationship to falls among people with Parkinson's disease (PwPD).

Methods: Data from 244 PwPD were aggregated from 5 previously conducted studies. Variables extracted included age, sex, Activities-Specific Balance Confidence scale (ABC; perceived balance), Timed Up and Go (TUG; balance performance), Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III scores, and retrospective falls (6- or 12-month). Data validation between studies was established. Discordance was quantified as the difference between an individual's predicted ABC, based upon their TUG score, to their reported ABC.

Results: Two methods for calculating discordance were tested: simple linear regression and segmented regression. As there were no differences between the bootstrap distributions of both approaches (P = .520), simple linear regression was utilized for the subsequent logistic regression model. Discordance was the only statistically significant predictor of fall status (OR = 0.98, P = .003), after controlling for age, MDS-UPDRS part III, sex, and TUG. The inclusion of discordance in the logistic regression model boosted the predictive accuracy by 58%.

Conclusions: Discordance between actual and perceived balance was uniquely related to retrospective fall history among PwPD. Clinicians and researchers should consider discordance between actual and perceived balance as a potentially modifiable target to minimize falls.

Background: Stroke is one of the leading causes of chronic disability worldwide. Sensorimotor recovery relies on principles of motor learning for the improvement of movement and sensorimotor function after stroke. Motor learning engages several cognitive processes to effectively learn and retain new motor skills. However, cognitive impairments are common and often coexist with motor impairments after stroke. The specific relationships between poststroke cognitive impairments and motor learning have not been determined.

Objectives: To summarize the existing evidence related to cognitive impairments and motor learning after stroke. Specific goals were to determine: (1) how motor learning is studied in individuals with poststroke cognitive impairments; (2) how cognitive impairments are assessed; (3) which cognitive domains impact motor learning.

Results: Over 400 studies were screened for specific inclusion criteria and 19 studies that related poststroke cognitive impairments to motor learning were included. Studies used a wide variety of experimental designs, sample sizes, and measures for cognitive evaluation. Cognitive impairments impacting motor improvement and learning capacity after stroke were reported in all but 4 studies. The most common domains impacting motor learning were attention, executive function, and memory.

Conclusion: Detailed cognitive assessments, retention testing, and a combination of clinical and kinematic outcomes are recommended for future studies. The presence of specific cognitive impairments measured with sensitive instruments should be considered when designing effective training interventions for patients with stroke to maximize sensorimotor recovery.