Neurorehabilitation and neural repair最新文献

Introduction: Randomized Controlled Trials (RCTs) are essential to underpin the superiority of novel interventions affecting upper extremity capacity post-stroke. However, many RCTs are underpowered, due to heterogeneity in recovery. Prognostic targeting may help reduce sample sizes while maintaining sufficient power.

Objective: This study investigates the effects of prognostic targeting on the required sample size to achieve 70% to 90% power in early post-stroke RCTs with upper extremity capacity measured with the Action Research Arm Test (ARAT) as the outcome.

Patients and methods: Serial data from 4 prospective cohort studies (N = 372 stroke patients) were pooled, with assessments from week 1 to 6 months post-stroke. Using this dataset, we generated synthetic 6-month ARAT outcomes and analyzed data cross-sectionally and longitudinally, with and without prognostic targeting based on a pre-existing prognostic model predicting 6-month outcome. We then calculated power for different sample sizes and assessed trial efficiency, determined by the estimated sample size and inclusion rate.

Results: Prognostic targeting within 3 weeks post-stroke theoretically reduced the required sample size by up to 56% and improved trial efficiency by 40 to 45% for detecting a 6-point ARAT difference at 6 months. The targeted trials needed 220, 270, and 360 patients vs. 470, 560, and 820 in non-targeted trials for 70% to 90% power. Benefits persisted in longitudinal analyses.

Conclusion: This study demonstrates the benefits of prognostic targeting for improving power and efficiency in early post-stroke upper extremity trials using ARAT as outcome. We strongly recommend its use in future stroke rehabilitation and recovery studies.

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.

BackgroundSpoken language and environmental sounds hold rich and nuanced meaning for the listener, but depend on accurate hearing of the soundscape, including the timing, volume, and contrasts of its component pitches. Sensorineural hearing loss with aging degrades these properties, leading to progressive disability.ObjectivesThis case study and review describe my experience and behavioral accommodations to progressive bilateral hearing loss, limited compensation with hearing aids, and the stuttering evolution of gains after a unilateral cochlear implant (CI).ResultsDespite increasingly powerful hearing aids over 25 years, spoken phonemes and words became increasingly muffled, misheard, and often dissipated into ambient background noise. The cognitive effort to extract meaning and mask my disability grew exhausting. I gradually eliminated many of my usual family, medical career, and social roles. To try to recover some communication-dependent activities, I sought a bionic solution. A right-sided CI initially carried an ambiguous, fizzling code and unrecognizable synthetic voices. With 8 months of auditory rehabilitation, I better deciphered conversational speech and ambient sounds. By audiological testing, I improved from 10% hearing accuracy of single words to 65%, typical of post lingual adult users. Better hearing in ambient noise and for what had been excessively rapid speech evolved out to 18 months, allowing me to re-engage in many of my daily roles.ConclusionsHearing loss beyond the compensation of aids deeply challenges quality of life. Auditory rehabilitation after cochlear implantation engages neuroplasticity to re-establish functional communication.

Background: Action observation (AO) has emerged as a potentially powerful therapeutic tool to improve stroke rehabilitation. What remains unclear are the underlying visual attention mechanisms that inform gaze strategies during AO. Further, it is unclear whether visual attention is sustained during AO or influenced by the severity of residual functional impairments following stroke.

Objective: This study seeks to explore eye gaze patterns and vigilance during a single session of AO in stroke survivors with varying levels of impairment.

Methods: Twenty stroke survivors with upper limb impairment (Fugl-Meyer Scores ranging 23-54) engaged in AO by watching an actor performing a disc placement task (observation phase), followed by the participant performing the task (execution phase) with their more affected, then less affected limb. Gaze patterns during the observation phase were evaluated for areas of most prominent gaze and compared between varying levels of severity of residual limb impairment.

Results: Gaze during AO prior to movement on the more affected side is focused on hand and object while AO prior to movement on the less affected side is focused on the overall action in the video. These patterns are prevalent for all levels of severity.

Conclusions: This suggests that participants are developing gaze patterns in line with optimal approaches to encode action specifics, especially on the more affected side. This presents valuable understanding of perceptual patterns of AO that may be optimal for studies evaluating AO in stroke.

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.

The social life of locked-in syndrome (LIS) patients is significantly impacted by their difficulties to communicate. Consequently, researchers have started to explore how to decode intended speech from neural signals directly recorded from the cortex. The first studies in the late 2000s reported modest decoding accuracies. However, thanks to fast advances in machine learning, the most recent studies have reached decoding accuracies high enough to be optimistic about the clinical benefit of neural speech decoders in the near future. We first discuss the selection criteria for implanting a neural speech decoder in LIS patients, emphasizing the advantages and disadvantages associated with conditions such as brainstem stroke and amyotrophic lateral sclerosis. We examine the key design considerations for neural speech decoders, demonstrating how successful implantation requires careful optimization of multiple interrelated factors including language representation, cortical recording areas, neural features, training paradigms, and decoding algorithms. We then discuss current approaches and provide arguments for potential improvements in decoder design and implementation. Finally, we explore the crucial question of who should learn to use the neural speech decoder-the patient, the machine, or both. In conclusion, while neural speech decoders present promising avenues for improving communication for LIS patients, interdisciplinary efforts spanning neurorehabilitation, neuroscience, neuroengineering, and ethics are imperative to design future clinical trials.

BackgroundShort-term maintenance of phonological information is critical for language production and comprehension, and is often impaired in stroke survivors with aphasia.ObjectiveIn this pilot study, we investigated whether brain oscillatory activity underlying phonological short-term memory (pSTM) can be influenced by transcranial alternating current stimulation (tACS) in stroke survivors with aphasia (SWA).MethodsIn a within-subject, single-blinded, sham-controlled study, 13 SWA received theta-tACS (4-7 Hz) targeting left temporoparietal and inferior frontal regions across 3 tACS conditions (in-phase, anti-phase, and sham; 20 minutes each). Participants completed an adaptive delayed match-to-sample task with spoken consonant-vowel strings (2-8 syllables) before, during, and after stimulation. The primary outcome was change in pSTM capacity (ie, number of syllables maintained over a 5-second delay), estimated using a linear interpolation approach. We hypothesized that in-phase tACS would enhance, and anti-phase tACS would disrupt, pSTM capacity relative to sham.ResultsLME analyses reveal significant interactions between tACS condition and block (F(4, 91.9) = 2.65, P = .038), and post-hoc estimated marginal means comparisons show increased pSTM capacity during in-phase tACS versus sham (estimate = 0.71, t(92) = 2.26, P = .040) and anti-phase (estimate = 0.75, t(92) = 2.44, P = .040) conditions, only during the stimulation period. Differences between anti-phase and sham-tACS were not significant (estimate = -0.04, P = .901). Individual response to tACS was variable, with only 60% of SWA responding.ConclusionsThis study supports in-phase theta-tACS positively impacts pSTM. Larger studies are needed to confirm these findings and evaluate lasting effects to increase clinical relevance.

Background: Respiratory dysfunction is common after stroke and may negatively affect functional recovery. Inspiratory muscle training (IMT) has been proposed to enhance diaphragmatic function and activity performance in this population.

Objective: To investigate the effects of IMT on diaphragm function and activity performance in patients with subacute ischemic stroke. Methods: In this randomized controlled, single-blind trial, 26 patients with subacute ischemic stroke (>1 month post-onset) were randomly allocated to an intervention group (IG, n = 13) or control group (CG, n = 13). Both groups received standard neurorehabilitation, aerobic training, and the Active Cycle of Breathing Technique (ACBT). The IG additionally underwent IMT, 5 days per week for 6 weeks (30 sessions). Assessments included maximal inspiratory and expiratory pressures (MIP, MEP), diaphragmatic thickness (Ti, Te) and excursion via ultrasonography, 6-minute walk test (6MWT), and Canadian Occupational Performance Measure (COPM).

Results: Twenty-two participants completed the study (IG = 11; CG = 11). Significant within-group improvements were observed in both groups for MIP, MEP, Ti, TF, excursion, 6MWT, and COPM scores (P < .05). Between-group analyses showed significantly greater improvements in the IG for ΔMIP (P < .001), ΔMEP (P = .003), affected-side ΔTi (P = .007), ΔTF (P = .008), and Δexcursion (P = .005). No significant differences were found for 6MWT and COPM (P > .05).

Conclusions: IMT effectively improves respiratory muscle strength, diaphragmatic thickness, and excursion in subacute ischemic stroke and may be a valuable addition to post-stroke rehabilitation programs.

Registration: URL: https://www.

Clinicaltrials: gov; Unique identifier: NCT06210516.

Background and aim: Unilateral spatial neglect (UN) impairs patients' ability to detect and respond to stimuli on the contralesional side, severely limiting functional recovery after right-hemispheric stroke. Neck muscle vibration (NMV) has been shown to be a bottom-up, proprioceptive intervention to modulate spatial neglect. Although preliminary studies found promising effects, the isolated efficacy of NMV for neglect rehabilitation has not yet been tested in a randomized, blinded controlled trial. This study aimed to evaluate whether NMV alone improves neglect symptoms and activities of daily living (ADL).

Methods: Twenty patients with right-hemispheric stroke and UN were randomly assigned to receive either active or placebo NMV (combined, but not simultaneously with computer-based training) over 2 weeks (5 sessions/week, 20 minutes/day). In the computer training, the placebo NMV group completed neglect-specific modules (standard neglect therapy [SNT], e.g., visual exploration training), while the active NMV group performed only general cognitive tasks unrelated to neglect. This allowed the isolated effect of NMV to be examined. Assessments included standard neglect diagnostics (e.g., Letter Cancellation), the Free Exploration Test (FET), and 2 ADL-based measures (NET, CBS), conducted before, immediately after, and (NMV group only) 1 month post-treatment.

Results: The active NMV group showed significant improvements in 3 of 4 standard neglect tests, exploration behavior (FET), and ADL performance, with effects remaining stable at 1-month follow-up. The SNT group with placebo NMV showed comparable gains in ADL outcomes but improved in 1 standard neglect test only. Between-group analyses revealed no statistically significant differences, suggesting similar efficacy of both interventions.

Conclusion: NMV alone yields clinically meaningful and lasting improvements in neglect symptoms and ADL, comparable to SNT. Its passive nature makes it a promising tool, particularly for early rehabilitation.