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A roadmap for research in post-stroke fatigue: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. 中风后疲劳研究路线图:第三次中风恢复和康复圆桌会议基于共识的核心建议。
Pub Date : 2024-01-01 Epub Date: 2023-10-14 DOI: 10.1177/15459683231209170
Coralie English, Dawn B Simpson, Sandra A Billinger, Leonid Churilov, Kirsten G Coupland, Avril Drummond, Annapoorna Kuppuswamy, Mansur A Kutlubaev, Anners Lerdal, Amreen Mahmood, G Lorimer Moseley, Quentin J Pittman, Ellyn A Riley, Brad A Sutherland, Connie Hy Wong, Dale Corbett, Gillian Mead

Rationale: Fatigue affects almost half of all people living with stroke. Stroke survivors rank understanding fatigue and how to reduce it as one of the highest research priorities.

Methods: We convened an interdisciplinary, international group of clinical and pre-clinical researchers and lived experience experts. We identified four priority areas: (1) best measurement tools for research, (2) clinical identification of fatigue and potentially modifiable causes, (3) promising interventions and recommendations for future trials, and (4) possible biological mechanisms of fatigue. Cross-cutting themes were aphasia and the voice of people with lived experience. Working parties were formed and structured consensus building processes were followed.

Results: We present 20 recommendations covering outcome measures for research, development, and testing of new interventions and priority areas for future research on the biology of post-stroke fatigue. We developed and recommend the use of the Stroke Fatigue Clinical Assessment Tool.

Conclusions: By synthesizing current knowledge in post-stroke fatigue across clinical and pre-clinical fields, our work provides a roadmap for future research into post-stroke fatigue.

理由:几乎一半的中风患者都患有疲劳。中风幸存者将理解疲劳以及如何减少疲劳列为最高研究重点之一。方法:我们召集了一个跨学科的国际临床和临床前研究人员和生活经验专家小组。我们确定了四个优先领域:(1)研究的最佳测量工具,(2)疲劳和潜在可改变原因的临床识别,(3)有希望的干预措施和未来试验的建议,以及(4)疲劳的可能生物学机制。跨领域的主题是失语症和有生活经验的人的声音。成立了工作组,并遵循了结构化的建立共识进程。结果:我们提出了20项建议,涵盖了新干预措施的研究、开发和测试的结果指标,以及未来卒中后疲劳生物学研究的优先领域。我们开发并推荐使用卒中后疲劳临床评估工具。结论:通过综合临床和临床前领域卒中后疲劳的现有知识,我们的工作为未来研究卒中后疲劳提供了路线图。
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引用次数: 0
Control intervention design for preclinical and clinical trials: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. 临床前和临床试验的对照干预设计:第三次中风康复圆桌会议提出的基于共识的核心建议。
Pub Date : 2024-01-01 Epub Date: 2023-10-14 DOI: 10.1177/15459683231209162
Kathryn S Hayward, Emily J Dalton, Jessica Barth, Marian Brady, Leora R Cherney, Leonid Churilov, Andrew N Clarkson, Jesse Dawson, Sean P Dukelow, Peter Feys, Maree Hackett, Steve R Zeiler, Catherine E Lang

Control comparator selection is a critical trial design issue. Preclinical and clinical investigators who are doing trials of stroke recovery and rehabilitation interventions must carefully consider the appropriateness and relevance of their chosen control comparator as the benefit of an experimental intervention is established relative to a comparator. Establishing a strong rationale for a selected comparator improves the integrity of the trial and validity of its findings. This Stroke Recovery and Rehabilitation Roundtable (SRRR) taskforce used a graph theory voting system to rank the importance and ease of addressing challenges during control comparator design. "Identifying appropriate type of control" was ranked easy to address and very important, "variability in usual care" was ranked hard to address and of low importance, and "understanding the content of the control and how it differs from the experimental intervention" was ranked very important but not easy to address. The CONtrol DeSIGN (CONSIGN) decision support tool was developed to address the identified challenges and enhance comparator selection, description, and reporting. CONSIGN is a web-based tool inclusive of seven steps that guide the user through control comparator design. The tool was refined through multiple rounds of pilot testing that included more than 130 people working in neurorehabilitation research. Four hypothetical exemplar trials, which span preclinical, mood, aphasia, and motor recovery, demonstrate how the tool can be applied in practice. Six consensus recommendations are defined that span research domains, professional disciplines, and international borders.

对照比较器的选择是一个关键的试验设计问题。进行中风恢复和康复干预试验的临床前和临床研究人员必须仔细考虑他们选择的对照对照品的适当性和相关性,因为实验干预的益处是相对于对照品确定的。为选定的比较者建立强有力的理由,可以提高试验的完整性和结果的有效性。该中风恢复和康复圆桌会议(SRRR)工作组使用图论投票系统对对照比较器设计过程中应对挑战的重要性和容易程度进行排名。“确定适当类型的控制”被列为容易解决且非常重要的问题,“日常护理的可变性”被列为由难以解决且重要性较低的问题,而“了解控制的内容及其与实验干预的区别”被列为了非常重要但不容易解决的问题。CONtrol DeSIGN(CONSIGN)决策支持工具的开发旨在解决已确定的挑战,并增强比较器的选择、描述和报告。CONSIGN是一个基于网络的工具,包括七个步骤,指导用户完成控制比较器的设计。该工具是通过多轮试点测试完善的,其中包括130多名从事神经康复研究的人员。四项假设的样本试验涵盖了临床前、情绪、失语症和运动恢复,展示了该工具如何在实践中应用。定义了六项共识建议,涵盖研究领域、专业学科和国际边界。
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引用次数: 0
A translational roadmap for transcranial magnetic and direct current stimulation in stroke rehabilitation: Consensus-based core recommendations from the third stroke recovery and rehabilitation roundtable. 脑卒中康复中经颅磁刺激和直流电刺激的转化路线图:第三次脑卒中康复圆桌会议提出的基于共识的核心建议。
Pub Date : 2024-01-01 Epub Date: 2023-10-14 DOI: 10.1177/15459683231209136
Jodi D Edwards, Adan Ulises Dominguez-Vargas, Charlotte Rosso, Meret Branscheidt, Lisa Sheehy, Fanny Quandt, Simon A Zamora, Melanie K Fleming, Valentina Azzollini, Ronan A Mooney, Charlotte J Stagg, Chiristian Gerloff, Simone Rossi, Leonardo G Cohen, Pablo Celnik, Michael A Nitsche, Cathrin M Buetefisch, Numa Dancause

Background and aims: The purpose of this Third Stroke Recovery and Rehabilitation Roundtable (SRRR3) was to develop consensus recommendations to address outstanding barriers for the translation of preclinical and clinical research using the non-invasive brain stimulation (NIBS) techniques Transcranial Magnetic Stimulation (TMS) and Transcranial Direct Current Stimulation (tDCS) and provide a roadmap for the integration of these techniques into clinical practice.

Methods: International NIBS and stroke recovery experts (N = 18) contributed to the consensus process. Using a nominal group technique, recommendations were reached via a five-stage process, involving a thematic survey, two priority ranking surveys, a literature review and an in-person meeting.

Results and conclusions: Results of our consensus process yielded five key evidence-based and feasibility barriers for the translation of preclinical and clinical NIBS research, which were formulated into five core consensus recommendations. Recommendations highlight an urgent need for (1) increased understanding of NIBS mechanisms, (2) improved methodological rigor in both preclinical and clinical NIBS studies, (3) standardization of outcome measures, (4) increased clinical relevance in preclinical animal models, and (5) greater optimization and individualization of NIBS protocols. To facilitate the implementation of these recommendations, the expert panel developed a new SRRR3 Unified NIBS Research Checklist. These recommendations represent a translational pathway for the use of NIBS in stroke rehabilitation research and practice.

背景和目的:第三次中风恢复和康复圆桌会议(SRRR3)的目的是制定共识建议,以解决使用非侵入性脑刺激(NIBS)技术经颅磁刺激(TMS)和经颅直流刺激(tDCS)进行临床前和临床研究转化的突出障碍,并提供将这些技术整合到临床实践中的路线图。方法:国际NIBS和脑卒中恢复专家(N = 18) 为协商一致进程作出了贡献。使用名义小组技术,通过五个阶段的过程达成建议,包括一次主题调查、两次优先排序调查、一次文献综述和一次面对面会议。结果和结论:我们的共识过程的结果为临床前和临床NIBS研究的翻译产生了五个关键的循证和可行性障碍,这些障碍被制定为五个核心共识建议。建议强调迫切需要:(1)加深对NIBS机制的理解,(2)提高临床前和临床NIBS研究的方法学严谨性,(3)结果测量的标准化,(4)增加临床前动物模型的临床相关性,以及(5)进一步优化和个性化NIBS方案。为了促进这些建议的实施,专家小组制定了一份新的SRRR3统一NIBS研究清单。这些建议为NIBS在中风康复研究和实践中的应用提供了一条转化途径。
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引用次数: 0
Mechanisms of Post-Stroke Fatigue: A Follow-Up From the Third Stroke Recovery and Rehabilitation Roundtable. 中风后疲劳的机制:第三届中风恢复与康复圆桌会议的后续活动。
Pub Date : 2024-01-01 Epub Date: 2023-12-29 DOI: 10.1177/15459683231219266
Annapoorna Kuppuswamy, Sandra Billinger, Kirsten G Coupland, Coralie English, Mansur A Kutlubaev, Lorimer Moseley, Quentin J Pittman, Dawn B Simpson, Brad A Sutherland, Connie Wong, Dale Corbett

Background: Post-stroke fatigue (PSF) is a significant and highly prevalent symptom, whose mechanisms are poorly understood. The third Stroke Recovery and Rehabilitation Roundtable paper on PSF focussed primarily on defining and measuring PSF while mechanisms were briefly discussed. This companion paper to the main paper is aimed at elaborating possible mechanisms of PSF.

Methods: This paper reviews the available evidence that potentially explains the pathophysiology of PSF and draws parallels from fatigue literature in other conditions. We start by proposing a case for phenotyping PSF based on structural, functional, and behavioral characteristics of PSF. This is followed by discussion of a potentially significant role of early inflammation in the development of fatigue, specifically the impact of low-grade inflammation and its long-term systemic effects resulting in PSF. Of the many neurotransmitter systems in the brain, the dopaminergic systems have the most evidence for a role in PSF, along with a role in sensorimotor processing. Sensorimotor neural network dynamics are compromised as highlighted by evidence from both neurostimulation and neuromodulation studies. The double-edged sword effect of exercise on PSF provides further insight into how PSF might emerge and the importance of carefully titrating interventional paradigms.

Conclusion: The paper concludes by synthesizing the presented evidence into a unifying model of fatigue which distinguishes between factors that pre-dispose, precipitate, and perpetuate PSF. This framework will help guide new research into the biological mechanisms of PSF which is a necessary prerequisite for developing treatments to mitigate the debilitating effects of post-stroke fatigue.

背景:脑卒中后疲劳(PSF)是一种严重且高发的症状,人们对其机制知之甚少。关于 PSF 的第三篇 "卒中恢复与康复圆桌会议 "论文主要关注 PSF 的定义和测量,同时简要讨论了 PSF 的机制。这篇主要论文的配套论文旨在阐述 PSF 的可能机制:本文回顾了可能解释 PSF 病理生理学的现有证据,并借鉴了其他情况下的疲劳文献。首先,我们根据 PSF 的结构、功能和行为特征,提出了 PSF 表型的案例。随后,我们讨论了早期炎症在疲劳发展过程中的潜在重要作用,特别是低度炎症的影响及其导致 PSF 的长期系统性影响。在大脑的众多神经递质系统中,多巴胺能系统在 PSF 中的作用以及在感觉运动处理中的作用证据最多。神经刺激和神经调控研究的证据表明,感觉运动神经网络的动力受到损害。运动对 PSF 的双刃剑效应进一步揭示了 PSF 是如何出现的,以及谨慎滴定干预范例的重要性:本文最后将所提供的证据归纳为一个统一的疲劳模型,该模型区分了导致 PSF 的前期因素、诱发因素和长期因素。这一框架将有助于指导对 PSF 生物机制的新研究,而这是开发治疗方法以减轻卒中后疲劳所造成的衰弱影响的必要前提。
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引用次数: 0
Standardized measurement of balance and mobility post-stroke: Consensus-based core recommendations from the third Stroke Recovery and Rehabilitation Roundtable. 中风后平衡和活动能力的标准化测量:第三次中风恢复和康复圆桌会议提出的基于共识的核心建议。
Pub Date : 2024-01-01 Epub Date: 2023-10-14 DOI: 10.1177/15459683231209154
Tamaya Van Criekinge, Charlotte Heremans, Jane Burridge, Judith E Deutsch, Ulrike Hammerbeck, Kristen Hollands, Suruliraj Karthikbabu, Jan Mehrholz, Jennifer L Moore, Nancy M Salbach, Jonas Schröder, Janne M Veerbeek, Vivian Weerdesteyn, Karen Borschmann, Leonid Churilov, Geert Verheyden, Gert Kwakkel

Background: Mobility is a key priority for stroke survivors. Worldwide consensus of standardized outcome instruments for measuring mobility recovery after stroke is an essential milestone to optimize the quality of stroke rehabilitation and recovery studies and to enable data synthesis across trials.

Methods: Using a standardized methodology, which involved convening of 13 worldwide experts in the field of mobility rehabilitation, consensus was established through an a priori defined survey-based approach followed by group discussions. The group agreed on balance- and mobility-related definitions and recommended a core set of outcome measure instruments for lower extremity motor function, balance and mobility, biomechanical metrics, and technologies for measuring quality of movement.

Results: Selected measures included the Fugl-Meyer Motor Assessment lower extremity subscale for motor function, the Trunk Impairment Scale for sitting balance, and the Mini Balance Evaluation System Test (Mini-BESTest) and Berg Balance Scale (BBS) for standing balance. The group recommended the Functional Ambulation Category (FAC, 0-5) for walking independence, the 10-meter Walk Test (10 mWT) for walking speed, the 6-Minute Walk Test (6 MWT) for walking endurance, and the Dynamic Gait Index (DGI) for complex walking. An FAC score of less than three should be used to determine the need for an additional standing test (FAC < 3, add BBS to Mini-BESTest) or the feasibility to assess walking (FAC < 3, 10 mWT, 6 MWT, and DGI are "not testable"). In addition, recommendations are given for prioritized kinetic and kinematic metrics to be investigated that measure recovery of movement quality of standing balance and walking, as well as for assessment protocols and preferred equipment to be used.

Conclusions: The present recommendations of measures, metrics, technology, and protocols build on previous consensus meetings of the International Stroke Recovery and Rehabilitation Alliance to guide the research community to improve the validity and comparability between stroke recovery and rehabilitation studies as a prerequisite for building high-quality, standardized "big data" sets. Ultimately, these recommendations could lead to high-quality, participant-specific data sets to aid the progress toward precision medicine in stroke rehabilitation.

背景:流动性是中风幸存者的首要任务。衡量中风后活动能力恢复的标准化结果工具在全球范围内达成共识,这是优化中风康复和恢复研究质量以及实现试验数据综合的重要里程碑。方法:采用一种标准化方法,召集了13名世界各地的行动康复专家,通过事先定义的基于调查的方法,然后进行小组讨论,达成共识。该小组就平衡和运动相关的定义达成一致,并推荐了一套用于下肢运动功能、平衡和运动、生物力学指标和运动质量测量技术的核心结果测量仪器。结果:选择的测量方法包括Fugl-Meyer运动评估下肢运动功能分量表、躯干功能障碍量表、迷你平衡评估系统测试(Mini-BESTest)和伯格平衡量表(BBS)。该小组推荐了功能性步行类别(FAC,0-5)作为步行独立性,10米步行测试(10 mWT),6分钟步行测试(6 MWT)和用于复杂步行的动态步态指数(DGI)。FAC分数小于三分,应用于确定是否需要进行额外的站立测试(FAC 结论:目前的措施、指标、技术和方案建议建立在国际中风康复联盟先前的共识会议的基础上,以指导研究界提高中风康复和康复研究之间的有效性和可比性,作为建立高质量、标准化“大数据”集的先决条件。最终,这些建议可能会产生高质量的、针对参与者的数据集,以帮助中风康复中的精准医学取得进展。
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引用次数: 0
Applications of Repetitive Transcranial Magnetic Stimulation to Improve Upper Limb Motor Performance After Stroke: A Systematic Review. 重复性经颅磁刺激在改善中风后上肢运动性能中的应用:一项系统综述。
Pub Date : 2023-12-01 Epub Date: 2023-11-10 DOI: 10.1177/15459683231209722
Afifa Safdar, Marie-Claire Smith, Winston D Byblow, Cathy M Stinear

Background: Noninvasive brain stimulation (NIBS) is a promising technique for improving upper limb motor performance post-stroke. Its application has been guided by the interhemispheric competition model and typically involves suppression of contralesional motor cortex. However, the bimodal balance recovery model prompts a more tailored application of NIBS based on ipsilesional corticomotor function.

Objective: To review and assess the application of repetitive transcranial magnetic stimulation (rTMS) protocols that aimed to improve upper limb motor performance after stroke.

Methods: A PubMed search was conducted for studies published between 1st January 2005 and 1st November 2022 using rTMS to improve upper limb motor performance of human adults after stroke. Studies were grouped according to whether facilitatory or suppressive rTMS was applied to the contralesional hemisphere.

Results: Of the 492 studies identified, 70 were included in this review. Only 2 studies did not conform to the interhemispheric competition model, and facilitated the contralesional hemisphere. Only 21 out of 70 (30%) studies reported motor evoked potential (MEP) status as a biomarker of ipsilesional corticomotor function. Around half of the studies (37/70, 53%) checked whether rTMS had the expected effect by measuring corticomotor excitability (CME) after application.

Conclusion: The interhemispheric competition model dominates the application of rTMS post-stroke. The majority of recent and current studies do not consider bimodal balance recovery model for the application of rTMS. Evaluating CME after the application rTMS could confirm that the intervention had the intended neurophysiological effect. Future studies could select patients and apply rTMS protocols based on ipsilesional MEP status.

背景:无创脑刺激(NIBS)是一种很有前途的改善脑卒中后上肢运动性能的技术。它的应用受到半球间竞争模型的指导,通常涉及抑制对侧运动皮层。然而,双峰平衡恢复模型促使基于同侧皮质运动功能的NIBS的更具针对性的应用。目的:回顾和评估旨在改善中风后上肢运动性能的重复性经颅磁刺激(rTMS)方案的应用。方法:PubMed检索2005年1月1日至2022年11月1日期间发表的研究,使用rTMS改善成人中风后上肢运动性能。根据对侧半球应用促进性或抑制性rTMS对研究进行分组。结果:在确定的492项研究中,70项纳入本综述。只有2项研究不符合半球间竞争模型,并促进了对侧半球的竞争。70项研究中只有21项(30%)报告了运动诱发电位(MEP)状态作为同侧皮质运动功能的生物标志物。大约一半的研究(37/70,53%)通过测量应用后的皮质运动兴奋性(CME)来检查rTMS是否具有预期效果。结论:脑卒中后rTMS的应用以半球间竞争模式为主。最近和当前的大多数研究都没有考虑用于rTMS应用的双峰平衡恢复模型。应用rTMS后评估CME可以证实干预具有预期的神经生理学效果。未来的研究可以根据同侧MEP状态选择患者并应用rTMS方案。
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引用次数: 0
Access to Rehabilitation After Hospitalization for Traumatic Brain Injury: A National Longitudinal Cohort Study in Sweden. 创伤性脑损伤住院后的康复:瑞典的一项全国纵向队列研究。
Pub Date : 2023-12-01 Epub Date: 2023-11-12 DOI: 10.1177/15459683231209315
Andrea Klang, Yasmina Molero, Paul Lichtenstein, Henrik Larsson, Brian Matthew D'Onofrio, Niklas Marklund, Christian Oldenburg, Elham Rostami

Background: Rehabilitation is suggested to improve outcomes following traumatic brain injury (TBI), however, the extent of access to rehabilitation among TBI patients remains unclear.

Objective: To examine the level of access to rehabilitation after TBI, and its association with health and sociodemographic factors.

Method: We conducted a longitudinal cohort study using Swedish nationwide healthcare and sociodemographic registers. We identified 15 880 TBI patients ≥18 years hospitalized ≥3 days from 2008 to 2012 who were stratified into 3 severity groups; grade I (n = 1366; most severe), grade II (n = 5228), and grade III (n = 9268; least severe). We examined registered contacts with specialized rehabilitation or geriatric care (for patients ≥65 years) during the hospital stay, and/or within 1 year post-discharge. We performed a generalized linear model analysis to estimate the risk ratio (RR) for receiving specialized rehabilitation or geriatric care after a TBI based on sociodemographic and health factors.

Results: Among TBI patients, 46/35% (grade I), 14/40% (grade II), and 5/18% (grade III) received specialized rehabilitation or geriatric care, respectively. Being currently employed or studying was positively associated (RR 1.7, 2.3), while living outside of a city area was negatively associated (RR 0.36, 0.79) with receiving specialized rehabilitation or geriatric care. Older age and a prior substance use disorder were negatively associated with receiving specialized rehabilitation (RR 0.51 and 0.81).

Conclusion: Our results suggest insufficient and unequal access to rehabilitation for TBI patients, highlighting the importance of organizing and standardizing post-TBI rehabilitation to meet the needs of patients, regardless of their age, socioeconomic status, or living area.

背景:康复被认为可以改善创伤性脑损伤(TBI)后的预后,然而,TBI患者获得康复的程度仍不清楚。目的:探讨脑外伤后康复的可及性及其与健康和社会人口因素的关系。方法:我们使用瑞典全国医疗保健和社会人口统计登记册进行了一项纵向队列研究。从2008年到2012年,我们确定了15880例≥18年住院≥3天的TBI患者,他们被分为3个严重程度组;一级(n = 1366;最严重),II级(n = 5228)和III级(n = 9268;最严重的)。我们检查了住院期间和/或出院后1年内与专业康复或老年护理(≥65岁的患者)的登记接触者。我们进行了广义线性模型分析,以估计基于社会人口统计学和健康因素的TBI后接受专门康复或老年护理的风险比(RR)。结果:在TBI患者中,分别有46/35% (I级)、14/40% (II级)和5/18% (III级)接受了专科康复或老年护理。目前就业或学习与接受专门康复或老年护理呈正相关(RR为1.7,2.3),而居住在城市以外地区与接受专门康复或老年护理呈正相关(RR为0.36,0.79)。年龄较大和既往物质使用障碍与接受专门康复呈负相关(RR分别为0.51和0.81)。结论:我们的研究结果表明,TBI患者的康复机会不足且不平等,突出了组织和规范TBI后康复以满足患者需求的重要性,无论其年龄,社会经济地位或生活区域如何。
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引用次数: 0
Macrostructural Cerebellar Neuroplasticity Correlates With Motor Recovery After Stroke. 脑卒中后大脑宏观结构的神经可塑性与运动恢复相关。
Pub Date : 2023-12-01 Epub Date: 2023-10-26 DOI: 10.1177/15459683231207356
Takashi Hanakawa, Fujiko Hotta, Tatsuhiro Nakamura, Keiichiro Shindo, Naoko Ushiba, Masaki Hirosawa, Yutaka Yamazaki, Yoshinao Moriyama, Syota Takagi, Katsuhiro Mizuno, Meigen Liu

Background: Motor recovery varies across post-stroke individuals, some of whom require a better rehabilitation strategy. We hypothesized that macrostructural neuroplasticity of the motor control network including the cerebellum might underlie individual differences in motor recovery. Objectives. To gain insight into the macrostructural neuroplasticity after stroke, we examined 52 post-stroke individuals using both the Fugl-Meyer assessment and structural magnetic resonance imaging.

Methods: We performed voxel-based lesion symptom mapping and cross-sectional voxel-based morphometry to correlate the motor scores with the lesion location and the gray matter volume (GMV), respectively. Longitudinal data were available at ~8 and/or 15 weeks after admission from 43 individuals with supratentorial lesions. We performed a longitudinal VBM analysis followed by a multiple regression analysis to correlate between the changes of the motor assessment scores and those of GMV overtime.

Results: We found a cross-sectional correlation of residual motor functioning with GMV in the ipsilesional cerebellum and contralesional parietal cortex. Longitudinally, we found increases in GMV in the ipsilesional supplementary motor area, and the ipsilesional superior and inferior cerebellar zones, along with a GMV decrease in the ipsilesional thalamus. The motor recovery was correlated with the GMV changes in the superior and inferior cerebellar zones. The regaining of upper-limb motor functioning was correlated with the GMV changes of both superior and inferior cerebellum while that of lower-limb motor functioning with the GMV increase of the inferior cerebellum only.

Conclusions: The present findings support the hypothesis that macrostructural cerebellar neuroplasticity is correlated with individual differences in motor recovery after stroke.

背景:脑卒中后的运动恢复各不相同,其中一些人需要更好的康复策略。我们假设,包括小脑在内的运动控制网络的宏观结构神经可塑性可能是运动恢复个体差异的基础。目标。为了深入了解卒中后的宏观结构神经可塑性,我们使用Fugl-Meyer评估和结构磁共振成像对52名卒中后个体进行了检查。方法:我们进行了基于体素的病变症状映射和基于横截面体素的形态测量,以分别将运动评分与病变位置和灰质体积(GMV)相关联。纵向数据可在~8和/或15 43例幕上病变患者入院后数周。我们进行了纵向VBM分析,然后进行了多元回归分析,以将运动评估分数的变化与GMV超时的变化相关联。结果:我们发现同侧小脑和对侧顶叶皮层的残余运动功能与GMV存在横断面相关性。从纵向上看,我们发现同侧补充运动区、同侧小脑上下区的GMV增加,同侧丘脑的GMV降低。运动恢复与小脑上下区的GMV变化相关。上肢运动功能的恢复与上小脑和下小脑的GMV变化相关,而下肢运动功能的重建仅与下小脑GMV的增加相关。结论:目前的研究结果支持了一种假说,即巨大结构的小脑神经可塑性与中风后运动恢复的个体差异相关。
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引用次数: 0
Multi-Site Identification and Generalization of Clusters of Walking Behaviors in Individuals With Chronic Stroke and Neurotypical Controls. 慢性脑卒中和神经正常对照患者步行行为群的多位点识别和归纳。
Pub Date : 2023-12-01 Epub Date: 2023-11-17 DOI: 10.1177/15459683231212864
Natalia Sánchez, Nicolas Schweighofer, Sara J Mulroy, Ryan T Roemmich, Trisha M Kesar, Gelsy Torres-Oviedo, Beth E Fisher, James M Finley, Carolee J Winstein

Background: Walking patterns in stroke survivors are highly heterogeneous, which poses a challenge in systematizing treatment prescriptions for walking rehabilitation interventions.

Objectives: We used bilateral spatiotemporal and force data during walking to create a multi-site research sample to: (1) identify clusters of walking behaviors in people post-stroke and neurotypical controls and (2) determine the generalizability of these walking clusters across different research sites. We hypothesized that participants post-stroke will have different walking impairments resulting in different clusters of walking behaviors, which are also different from control participants.

Methods: We gathered data from 81 post-stroke participants across 4 research sites and collected data from 31 control participants. Using sparse K-means clustering, we identified walking clusters based on 17 spatiotemporal and force variables. We analyzed the biomechanical features within each cluster to characterize cluster-specific walking behaviors. We also assessed the generalizability of the clusters using a leave-one-out approach.

Results: We identified 4 stroke clusters: a fast and asymmetric cluster, a moderate speed and asymmetric cluster, a slow cluster with frontal plane force asymmetries, and a slow and symmetric cluster. We also identified a moderate speed and symmetric gait cluster composed of controls and participants post-stroke. The moderate speed and asymmetric stroke cluster did not generalize across sites.

Conclusions: Although post-stroke walking patterns are heterogenous, these patterns can be systematically classified into distinct clusters based on spatiotemporal and force data. Future interventions could target the key features that characterize each cluster to increase the efficacy of interventions to improve mobility in people post-stroke.

背景:脑卒中幸存者的行走模式是高度异质性的,这对行走康复干预的系统化治疗处方提出了挑战。目的:我们使用行走时的双侧时空和力量数据创建了一个多站点的研究样本:(1)识别卒中后和神经正常对照人群的行走行为集群;(2)确定这些行走集群在不同研究站点的普遍性。我们假设卒中后的参与者会有不同的行走障碍,导致不同的行走行为群,这也与对照组的参与者不同。方法:我们收集了来自4个研究站点的81名卒中后参与者的数据,并收集了31名对照参与者的数据。采用稀疏k均值聚类方法,基于17个时空和力变量对行走类进行识别。我们分析了每个集群内的生物力学特征,以表征集群特定的行走行为。我们还使用留一方法评估了集群的可泛化性。结果:我们确定了4个卒中集群:快速且不对称的卒中集群、中速且不对称的卒中集群、具有正面力不对称的慢速卒中集群和缓慢且对称的卒中集群。我们还确定了一个由对照组和参与者组成的中等速度和对称步态集群。中等速度和不对称卒中集群没有在各个部位普遍存在。结论:脑卒中后行走模式虽然具有异质性,但基于时空和力数据,这些模式可以系统地划分为不同的集群。未来的干预措施可以针对每个集群的关键特征,以提高干预措施的有效性,改善中风后患者的行动能力。
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引用次数: 0
The Evolution of Hand Proprioceptive and Motor Impairments in the Sub-Acute Phase After Stroke. 脑卒中亚急性期手部本体感觉和运动功能障碍的演变。
Pub Date : 2023-12-01 Epub Date: 2023-11-13 DOI: 10.1177/15459683231207355
Monika Zbytniewska-Mégret, Christian Salzmann, Christoph M Kanzler, Thomas Hassa, Roger Gassert, Olivier Lambercy, Joachim Liepert

Background: Hand proprioception is essential for fine movements and therefore many activities of daily living. Although frequently impaired after stroke, it is unclear how hand proprioception evolves in the sub-acute phase and whether it follows a similar pattern of changes as motor impairments.

Objective: This work investigates whether there is a corresponding pattern of changes over time in hand proprioception and motor function as comprehensively quantified by a combination of robotic, clinical, and neurophysiological assessments.

Methods: Finger proprioception (position sense) and motor function (force, velocity, range of motion) were evaluated using robotic assessments at baseline (<3 months after stroke) and up to 4 weeks later (discharge). Clinical assessments (among others, Box & Block Test [BBT]) as well as Somatosensory/Motor Evoked Potentials (SSEP/MEP) were additionally performed.

Results: Complete datasets from 45 participants post-stroke were obtained. For 42% of all study participants proprioception and motor function had a dissociated pattern of changes (only 1 function considerably improved). This dissociation was either due to the absence of a measurable impairment in 1 modality at baseline, or due to a severe lesion of central somatosensory or motor tracts (absent SSEP/MEP). Better baseline BBT correlated with proprioceptive gains, while proprioceptive impairment at baseline did not correlate with change in BBT.

Conclusions: Proprioception and motor function frequently followed a dissociated pattern of changes in sub-acute stroke. This highlights the importance of monitoring both functions, which could help to further personalize therapies.

背景:手部本体感觉是精细运动和许多日常生活活动所必需的。虽然在中风后经常受损,但目前尚不清楚手本体感觉在亚急性期是如何演变的,以及它是否遵循与运动损伤相似的变化模式。目的:本研究通过机器人、临床和神经生理评估的综合量化,探讨了手本体感觉和运动功能是否存在相应的随时间变化模式。方法:在基线时使用机器人评估评估手指本体感觉(位置感)和运动功能(力、速度、运动范围)(结果:获得45名参与者中风后的完整数据集)。42%的研究参与者本体感觉和运动功能有分离的改变模式(只有一个功能有明显改善)。这种分离要么是由于基线时1个模态没有可测量的损伤,要么是由于中枢性体感觉束或运动束的严重损伤(缺乏SSEP/MEP)。基线时更好的BBT与本体感觉的增加相关,而基线时本体感觉的损伤与BBT的变化无关。结论:在亚急性脑卒中中,本体感觉和运动功能经常发生分离性改变。这突出了监测这两种功能的重要性,这可能有助于进一步个性化治疗。
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引用次数: 1
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Neurorehabilitation and neural repair
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