Neurorehabilitation and neural repair最新文献

Background: Upper limb activity following stroke is low, which may limit recovery. We investigated whether a virtually-delivered upper limb program, that included a wearable device with reach-to-grasp feedback, would increase upper limb activity after stroke.

Methods: This was a parallel-group, assessor-blinded, randomized control trial conducted at 6 sites across 5 provinces of the CanStroke Recovery Trials Platform between 2020 to 2022. Participants (n = 73) were community-living, less than 1 year post stroke, and had residual arm movement and upper limb use limitations. Participants were randomized via a central web-based randomization service to receive a virtually delivered program (Virtual Arm Boot Camp [V-ABC], n = 36) or waitlist control (n = 37) receiving usual care. V-ABC consisted of a home exercise program, feedback from a wrist-worn device to monitor reach-to-grasp counts, and 6 virtual sessions with a trained therapist over 3 weeks. The primary outcome was the average daily reach-to-grasp counts over 3 days at 4 weeks post baseline assessment. Secondary outcomes included upper limb function, self-reported use, and quality of life. Within-subject changes between pre, post treatment, and 2 months follow up for all participants were also examined as a tertiary analysis.

Results: The V-ABC group demonstrated greater average daily reach-to-grasp counts (primary outcome) at 4 weeks compared to control (mean difference = 368, 95% confidence interval = 6-730, P = .046).

Conclusions: This study provided evidence that a virtually delivered upper limb program that consists of exercise, feedback from a wearable device, and therapist support can increase real-world upper limb activity following stroke.

Clinical trial registration: NCT04232163.

Background: Although various repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS) protocols are used, their comparative effectiveness for treating poststroke hemineglect remains unassessed.

Objective: To investigate rTMS and TBS effects on clinical outcomes in poststroke hemineglect through a systematic review and network meta-analysis.

Methods: We searched PubMed, EMBASE, and Cochrane Library databases up to March 7, 2024, for trials on rTMS or TBS in poststroke hemineglect. Included studies involved rTMS or TBS with different protocols, sham, or no stimulation, assessing hemineglect severity or impact. The quality of the included studies was evaluated using the PEDro scale. The network meta-analysis was performed using ShinyNMA (version 1.01).

Results: We analyzed 13 studies with 309 participants. All studies included participants who had experienced right hemisphere stroke. All included studies had a fair to good quality based on PEDro score evaluation. Protocols included continuous TBS (cTBS), high-frequency rTMS (HF-rTMS), and low-frequency rTMS (LF-rTMS) targeting both contralesional and lesional sites. HF-rTMS on the lesional site significantly improved short-term results on the line bisection test and Catherine Bergego Scale; LF-rTMS on the contralesional site improved short-term line bisection; and cTBS on the contralesional site improved long-term line bisection. No severe adverse events or significant inconsistencies were reported.

Conclusions: Our findings indicate that HF-rTMS targeting the lesional site is the preferred therapeutic approach for the short-term management of poststroke hemineglect. LF-rTMS directed at the contralesional site is a practical alternative. Moreover, cTBS targeting the contralesional site is a viable option because of its long-term effect.

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.

Purpose: Exercise reduces cognitive deficits in traumatic brain injury (TBI), but early post-trauma exercise is often discouraged due to potential harm. The purpose was to evaluate the interaction between pre- and post-injury physical exercise on cognition, neuronal survival and inflammation.

Methods: Rats were either sham-operated and kept sedentary (Sham) or subjected to controlled cortical impact injury and then distributed into sedentary (Tbi), pre-injury exercise (Pre-Tbi), post-injury exercise with early (24 hours, Tbi-early) or late (6 days, Tbi-late) onset, and a combination of pre- and post-injury exercise with early (Pre-Tbi-early) or late (Pre-Tbi-late) onset. Object recognition memory, hippocampal volume, neuronal survival (NeuN⁺) in the hippocampus and perirhinal cortex, and microglial activity (Iba-1) in the hippocampus were evaluated.

Results: All exercise conditions, except TBI-early, attenuated the significant memory impairment at 24-hour retention caused by TBI. Additionally, Pre-TBI-early treatment led to memory improvement at 3-hour retention. Pre-TBI reduced neuronal death and microglial activation in the hippocampus. TBI-late, but not TBI-early, mitigated hippocampal volume loss, loss of mature neurons in the hippocampus, and inflammation. Combining pre-injury and early-onset exercise reduced memory deficits but did not affect neuronal death or microglial activation. Combining pre-injury and late-onset exercise had a similar memory-enhancing effect than late post-injury treatment alone, albeit with reduced effects on neuronal density and neuroinflammation.

Conclusions: Pre-TBI physical exercise reduces the necessary onset delay of post-TBI exercise to obtain cognitive benefits, yet the exact mechanisms underlying this reduction require further research.

Background: The use of prediction tools in stroke rehabilitation research and clinical practice is increasing, but it is not clear whether these prediction tools out-perform clinician predictions.

Objective: This study aimed to compare physiotherapist predictions for independent walking with the Time to Walking Independently after STroke (TWIST) prediction tool.

Methods: Adults with new lower limb weakness and unable to walk independently (Functional Ambulation Category [FAC] < 4) were recruited. At 1 week post-stroke, the treating physiotherapist was asked to predict whether their patient would achieve independent walking by 4, 6, 9, 12, 16, or 26 weeks, or remain dependent. Predictions were also made using the TWIST prediction tool, but not shared. Binary logistic regressions were conducted with the time independent walking was achieved as the dependent variable and independent variables were the physiotherapist and TWIST predictions.

Results: Ninety-one participants were included (median age 71 years, 36 [40%] female). Most participants (67 [74%]) were non-ambulatory (FAC = 0) at 1-week post-stroke. Thirty-seven physiotherapists were recruited. Physiotherapists made accurate predictions for time taken to achieve independent walking for 39 participants (43%). Prediction accuracy was not related to physiotherapist confidence or years of stroke-specific experience. TWIST out-performed physiotherapist predictions (Physiotherapists 76%-77%, TWIST 86%-88% accurate) for participants who achieved independent walking by 4, 6, and 9 weeks post-stroke. Accuracy of physiotherapist and TWIST predictions was similar for 16 and 26 weeks post-stroke.

Conclusions: The TWIST prediction tool is more accurate than physiotherapists at predicting whether a patient will achieve independent walking by 4, 6, or 9 weeks post-stroke, but not for 16 or 26 weeks post-stroke. TWIST may be useful to inform early rehabilitation and discharge planning. Clinical Trial Registration-URL: www.anzctr.org.au Unique Identifier: ACTRN12617001434381.

Background and objective: The biomarkers of hand function may differ based on level of motor impairment after stroke. The objective of this study was to determine the relationship between resting state functional connectivity (RsFC) and unimanual contralesional hand function after stroke and whether brain-behavior relationships differ based on level of grasp function.

Methods: Sixty-two individuals with chronic, left-hemisphere stroke were separated into three functional levels based on Box and Blocks Test performance with the contralesional hand: Low (moved 0 blocks), Moderate (moved >0% but <90% of blocks relative to the ipsilesional hand), and High (moved ≥90% of blocks relative to the ipsilesional hand).

Results: RsFC in the ipsilesional and interhemispheric motor networks was reduced in the Low group compared to the Moderate and High groups. While interhemispheric RsFC correlated with hand function (grip strength and Stroke Impact Scale Hand) across the sample, contralesional RsFC correlated with hand function in the Low group and no measures of connectivity correlated with hand function in the Moderate and High groups. Linear regression modeling found that contralesional RsFC significantly predicted hand function in the Low group, while no measure correlated with hand function in the High group. Corticospinal tract integrity was the only predictor of hand function for the Moderate group and in an analysis across the entire sample.

Conclusions: Differences in brain-hand function relationships based on level of motor impairment may have implications for predictive models of treatment response and the development of intervention protocols aimed at improving hand function after stroke.