Neurorehabilitation and neural repair最新文献

Background: During post-stroke motor rehabilitation, patients often receive feedback from therapists or via rehabilitation technologies. Research suggests that feedback may benefit motor performance, skill acquisition, and action selection. However, there is no consensus on how extrinsic feedback should be implemented during stroke rehabilitation to best leverage specific neurobehavioral mechanisms to optimize recovery.

Objective: To identify the existing evidence and research gaps regarding the effects of extrinsic feedback on upper extremity motor function in stroke survivors, and to map the evidence onto neurobehavioral concepts of motor performance, motor learning, and action selection.

Methods: The MEDLINE, PsychInfo, EMBASE, and CINHAL databases were searched for relevant articles. A sequential screening process and data extraction were performed by 2 independent reviewers, and the results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines.

Results: A total of 29 studies were identified that met the criteria for inclusion. Beneficial effects of feedback were reported for clinical outcomes of rehabilitation interventions as well as motor performance, motor learning, and action selection post-stroke. Three studies showed that the addition of rewarding elements to positive performance feedback benefited learning or recovery.

Conclusions: Extrinsic feedback has the potential to improve outcomes of stroke rehabilitation through effects on motor performance, motor learning, or action selection. To understand how these specific neurobehavioral processes contribute to recovery, clinical trials should include more granular behavioral measures. Rewarding feedback may be particularly beneficial, but more research is needed regarding the specific implementation of feedback.

Visuospatial neglect (VSN) is a negative, strong, and independent predictor of poor outcome after stroke, and is associated with poorer upper limb (UL) motor recovery in terms of function or capacity (ie, in standardized, lab-based testing). Although the main aim of stroke rehabilitation is to re-establish optimal functioning in daily life, the impact of VSN on UL performance (ie, in unstructured, everyday environments) is largely unknown. In this proof of principle study, the impact of VSN on the strength of the association between UL motor function (Jamar Hand Dynamometer) and UL performance (Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale) was investigated in 65 (hyper)acute first-ever stroke patients. In a moderator analysis, the interaction term was negative and significant, showing that VSN suppresses the use of UL motor function in daily life (ie, performance). This finding suggests that, when considering UL performance in the (hyper)acute phase after stroke, interventions aimed to reduce deficits in both UL motor function and visuospatial function should already be started in the acute stroke unit setting.

Background: Stroke is a heterogeneous condition, making choice of treatment, and determination of how to structure rehabilitation outcomes difficult. Individualized goal-directed and repetitive physical practice is an important determinant of motor learning. Yet, many investigations of motor learning after stroke deliver task practice without consideration of individual capability of the learner.

Objective: We developed a gamified arm rehabilitation task for people with stroke that is personalized to individual capacity for paretic arm movement, provides a high dose of practice, progresses through increasingly difficulty levels that are dependent on the performance of the individual, and is practiced in an engaging environment. The objectives of the current study were to determine if 10 days of gamified, object intercept training using the paretic arm would improve arm movement speed and clinical outcome measures of impairment or function.

Methods: Individuals with chronic stroke and age-matched controls engaged in 10 days of gamified, skilled motor practice of a semi-immersive virtual reality-based intercept and release task. The paretic arm was assessed using the Fugl-Meyer Assessment (motor impairment) and Wolf Motor Function Test (motor function) before and after training.

Results: Both groups showed faster arm movement speed with practice; individuals with stroke demonstrated reduced paretic arm motor impairment and increased function after the intervention. Age and sex (for both groups), and time post-stroke were not related to changes in movement speed.

Conclusions: Findings indicate that gamified motor training positively affects paretic arm motor behavior in individuals with mild to severe chronic stroke.

Background: Mobility and cognitive impairment are prevalent and co-occurring in older adults with multiple sclerosis (OAMS), yet there is limited research concerning the role of disability status in the cognitive control of gait among OAMS.

Objective: We investigated the levels of prefrontal cortex (PFC) activation, using oxygenated hemoglobin (HbO₂), during cognitively-demanding tasks in OAMS with lower and higher disability using functional near-infrared spectroscopy (fNIRS) to: (1) identify PFC activation differences in single task walk and cognitively-demanding tasks in OAMS with different levels of disability; and (2) evaluate if disability may moderate practice-related changes in neural efficiency in OAMS.

Methods: We gathered data from OAMS with lower (n = 51, age = 65 ± 4 years) or higher disability (n = 48, age = 65 ± 5 years), using a cutoff of 3 or more, in the Patient Determined Disease Steps, for higher disability, under 3 different conditions (single-task walk, Single-Task-Alpha, and Dual-Task-Walk [DTW]) administered over 3 counterbalanced, repeated trials.

Results: OAMS who had a lower disability level exhibited decreased PFC activation levels during Single-Task-Walk (STW) and larger increases in PFC activation levels, when going from STW to a cognitively-demanding task, such as a DTW, than those with higher disability. OAMS with a lower disability level exhibited greater declines in PFC activation levels with additional within session practice than those with a higher disability level.

Conclusions: These findings suggest that disability moderates brain adaptability to cognitively-demanding tasks and demonstrate the potential for fNIRS-derived outcome measures to complement neurorehabilitation outcomes.

Background: In recent decades, there has been a widespread adoption of digital devices among the non-disabled population. The pervasive integration of digital devices has revolutionized how the majority of the population manages daily activities. Most of us now depend on digital platforms and services to conduct activities across the domains of communication, finance, healthcare, and work. However, a clear disparity exists for people who live with severe quadriplegia, who largely lack access to tools that would enable them to perform daily tasks digitally and communicate effectively with their environment.

Objectives: The purpose of this piece is to (i) highlight the unmet needs of people with severe quadriplegia (including cases for medical necessity and perspectives from the community), (ii) present the current landscape of assistive technology for people with severe quadriplegia, (iii) make the case for implantable BCIs (how they address needs and why they are a good solution relative to other assistive technologies), and (iv) present future directions.

Results: There are technologies that are currently available to this population, but these technologies are certainly not usable with the same level of ease, efficiency, or autonomy as what has been designed for the non-disabled community. This hinders the ability of people with severe quadriplegia to achieve digital autonomy, perpetuating social isolation and limiting the expression of needs, opinions, and preferences.

Conclusion: Most importantly, the gap in digital equality fundamentally undermines the basic human rights of people with severe quadriplegia.

Background: We previously demonstrated that deep brain stimulation (DBS) of lateral cerebellar nucleus (LCN) can enhance motor recovery and functional reorganization of perilesional cortex in rodent models of stroke or TBI.

Objective: Considering the treatment-related neuroplasticity observed at the perilesional cortex, we hypothesize that chronic LCN DBS-enhanced motor recovery observed will carry-over even after DBS has been deactivated.

Methods: Here, we directly tested the enduring effects of LCN DBS in male Long Evans rats that underwent controlled cortical impact (CCI) injury targeting sensorimotor cortex opposite their dominant forepaw followed by unilateral implantation of a macroelectrode into the LCN opposite the lesion. Animals were randomized to DBS or sham treatment for 4 weeks during which the motor performance were characterize by behavioral metrics. After 4 weeks, stimulation was turned off, with assessments continuing for an additional 2 weeks. Afterward, all animals were euthanized, and tissue was harvested for further analyses.

Results: Treated animals showed significantly greater motor improvement across all behavioral metrics relative to untreated animals during the 4-week treatment, with functional gains persisting across 2-week post-treatment. This motor recovery was associated with the increase in CaMKIIα and BDNF positive cell density across perilesional cortex in treated animals.

Conclusions: LCN DBS enhanced post-TBI motor recovery, the effect of which was persisted up to 2 weeks beyond stimulation offset. Such evidence should be considered in relation to future translational efforts as, unlike typical DBS applications, treatment may only need to be provided until such time as a new function plateau is achieved.

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.

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: Investigating brain activation during motor imagery (MI) tasks in people with multiple sclerosis (pwMS) can increase the knowledge of the neural mechanisms underlying motor dysfunction in MS and, hopefully, aid in developing improved rehabilitation strategies.

Objective: To investigate brain activation in the supplementary motor area and premotor cortex via functional near-infrared spectroscopy (fNIRS) during a hand manipulation task, and comparing MI with actual practice (AP) in pwMS.

Methods: Each subject completed a sequence of 4 consecutive manual dexterity trials wearing an fNIRS device. The tasks included the following conditions: AP dominant hand, MI dominant hand, AP non-dominant hand, and MI non-dominant hand.

Results: Twenty pwMS (mean Expanded Disability Status Scale = 4.75 [3.0-6.5]) and 20 healthy controls (HC) participated in the study. According to the fNIRS timeline course, a similar increase (compared with baseline) was observed in the relative oxygenated hemoglobin (HbO) concentration during the MI and AP tasks, which was immediately followed by a decrease (for either hand) in the pwMS and the HC groups. A difference in the relative HbO concentration between the HC and pwMS was detected solely when the 2 groups mentally replicated the manual dexterity task movements in the MI condition (dominant hand). The increase was higher in the HC group (P = .030).

Conclusions: Despite exhibiting manual dexterity difficulties, pwMS demonstrated comparable neural activation patterns as the HCs during MI tasks in regions associated with motor planning and complex movement control, thus, suggesting that deficits in manual dexterity among pwMS may not solely originate from impairments in the motor planning processes.