Neurorehabilitation and neural repair最新文献

ObjectiveResearchers have focused on gamma rhythm stimulation, particularly at 40 Hz, to enhance endogenous gamma oscillations and improve cognitive function and outcomes in Alzheimer's disease (AD). However, some studies disputed these findings. This review aimed to systematically analyze recent randomized controlled trials on the effects of gamma stimulation on cognitive function in AD and to perform a meta-analysis to assess the efficacy, safety, and differences between brain and sensory stimulation.MethodsA systematic search was conducted in PubMed, Web of Science, Ovid-Embase, and Ovid-MEDLINE from their inception to April 2024. A meta-analysis was performed to evaluate adverse events and cognitive function assessed using AD Assessment Scale-Cognitive Subscale (ADAS-cog), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Face-Name Association Test (FNAT). Subgroup analyses were performed to explore the heterogeneity between the brain and sensory stimulation.ResultsEight studies involving 291 participants were included. Meta-analysis demonstrated a large benefit in cognitive function: FNAT (standardized mean difference [SMD] = 3.76; 95% confidence interval [CI] = 2.52-4.99; I² = 65%), MMSE (SMD = 3.09; 95% CI = 2.37-3.82; I² = 0%), ADAS-cog (SMD = -4.16; 95% CI = -6.60 to -2.62; I² = 0%), and MoCA (SMD = 2.17; 95% CI = -0.54 to 4.88; I² = 0%). There were no significant differences in adverse events between the intervention and sham groups (P = .06), suggesting the safety of gamma stimulation.ConclusionThis review highlights the safety and benefits of gamma stimulation for cognitive improvement in patients with AD, with sensory stimulation proving safe even in individuals with epilepsy.

BackgroundStroke is the leading cause of long-term disability, making the search for successful rehabilitation treatment one of the most important public health issues. A better understanding of the neural mechanisms underlying impairment and recovery is critical for optimizing treatments. Objective: We studied the longitudinal changes in brain oscillatory modes, linked to GABAergic system activity, and determined their importance for residual upper-limb motor functions and recovery.MethodsTranscranial Magnetic Stimulation (TMS) was combined with scalp Electroencephalography (EEG) to analyze TMS-induced brain oscillations in a cohort of 66 stroke patients in the acute (N = 60), early (N = 48), and late subacute stages (N = 37).ResultsA data-driven parallel factor analysis (PARAFAC) approach to tensor decomposition extracted brain oscillatory modes, which significantly evolved longitudinally across stroke stages (permutation tests, p_Bonf < 0.05). Notably, the observed decrease of the α-mode, known to be linked with GABAergic system activity, was mainly driven by the recovering patients and was supportive of stroke recovery at the group level (Bayesian Kendall correlation, moderate to strong statistical evidence).ConclusionsOverall, longitudinal evaluation of brain modes provides novel insights into functional reorganization of brain networks after a stroke. Notably, we propose that the observed α-mode decrease could correspond to a beneficial disinhibition toward the late subacute stage that fosters plasticity and facilitates recovery. These results confirm the relevance of future individual and direct monitoring of post-stroke modulations in inhibitory system activity, with the ultimate goal of designing electrophysiological biomarkers and refining therapies based on personalized neuromodulation.

BackgroundFunctional mobility is essential for maintaining independence and relies on both motor and cognitive processes. Although the impact of motor impairments on functional mobility in stroke survivors has been extensively studied, the influence of post-stroke cognitive impairments has been largely overlooked. The aim of the current study is 2-fold. First, to determine the impact of post-stroke cognitive impairments on functional mobility across a broad spectrum of tasks. Second, to determine if cognitive impairment has a differential impact on various forms of mobility.MethodForty individuals with stroke (20 cognitively normal and 20 cognitively impaired) and 30 healthy older adults participated in the study. Participants performed cognitive, motor, and mobility assessments. Cognitive tests included global and domain-specific assessments on an extensive neuropsychological battery. Motor tests included the Modified Rankin Scale and strength assessments. Functional mobility included the assessment of balance, overground walking, and driving in a simulator.ResultsFindings indicated that stroke survivors with cognitive impairment demonstrated significant deteriorations in functional mobility across multiple domains, compared to both cognitively normal stroke survivors and healthy older adults. Cognitive impairment significantly interferes with functional mobility, with driving showing greatest deterioration compared to balance and walking performance. Notably, this impact is independent of the level of disability and motor strength.ConclusionCognitive impairments in stroke survivors are associated with significant mobility disturbances, with the most pronounced deficits in driving performance. This study highlights the importance of including and prioritizing cognitive evaluation and intervention for enhancing functional mobility and independence in stroke survivors.

Background: After stroke, ankle proprioceptive deficits are common and do not typically correlate with ankle weakness. Some studies report that these deficits correlate with gait function, supporting the importance of somatosensory input for gait control. Others have not found a relationship, possibly due to use of coarse proprioception measures. Robotic assessments of proprioception offer improved consistency and sensitivity.

Objective: To establish relationships between ankle proprioception, gait function, and ankle motor in stroke survivors.

Methods: We studied 39 individuals in the chronic phase of stroke using 2 robotic tests, Crisscross and Joint Position Reproduction (JPR), to quantify ankle proprioception. We examined associations of these measures with gait speed (10-meter walk test) and gait endurance (6-minute walk test). We also analyzed correlations with lower extremity motor impairment, including robotic measures of ankle strength (MVC) and active range of motion (AROM), and the lower extremity Fugl-Meyer exam (LEFM).

Results: Impaired ankle proprioception was present in 87% of participants. Crisscross error weakly correlated with the 10mWT gait speed (ρ = -0.20, P = 0.23) and 6MWT distance (ρ = -0.28, P = .089). JPR error weakly correlated with 10mWT gait speed (ρ = -0.29, P = .092) and significantly correlated with 6MWT distance (ρ = -0.34, P = .04). No significant correlations were observed between ankle proprioceptive error and MVC, AROM, or LEFM (P > 0.2).

Conclusion: These results confirm the presence of a weak relationship between ankle proprioception and gait after stroke that is independent of several common measures of motor impairment.

Objective: Investigating structural changes in the cervical spinal cord and brain in children with complete thoracolumbar spinal cord injury (TLSCI) and their correlation with clinical function may provide objective imaging indicators for functional evaluation.

Methods: Twenty-one children with complete TLSCI and twenty-one typically developing (TD) children were enrolled in this study. All participants underwent whole-brain and upper cervical spinal cord sagittal 3D T1-weighted and whole-brain axial diffusion tensor imaging scans using a 3.0T MRI scanner. Utilizing the Spinal Cord Toolbox, cervical spinal cord morphological parameters were obtained. Brain structure changes were analyzed with voxel-based morphometry (VBM) and voxel-based analysis (VBA).

Results: Compared to TD children, children with TLSCI showed significant reductions in the CSA (P = .011) and APW (P = .002) at the C2/3 level, as well as significant atrophy in the gray matter volume (GMV) of the left thalamus (P = .026), and bilateral paracentral lobule (PCL, P = .002). There was a significant positive correlation (r = 0.540, P = .017) between GMV of bilateral PCL and sensory scores. The VBA results showed a significant increase in fractional anisotropy values in the right posterior limb of the internal capsule, posterior thalamic radiation, and superior longitudinal fasciculus (SLF, P = .045), the mean diffusivity value of the right SLF was significantly decreased (P = .049) in children with TLSCI.

Conclusions: In children with complete TLSCI, specific structural changes in the cervical spinal cord and brain were observed. A significant correlation between GMV of bilateral PCL and sensory scores may provide imaging biomarkers for assessing neurologic function and therapeutic efficacy (Ethics No: [2020] 003).

BackgroundThe effectiveness of non-invasive neuromodulation to improve social cognition (SC) in neurological disorders remains unclear. However, repetitive transcranial magnetic stimulation (rTMS) shows promise for treating cognitive abnormalities by promoting neuroplasticity.ObjectiveIn this randomized, double-blind, sham-controlled study, we investigated the effects of high-frequency rTMS on the medial prefrontal cortex (mPFC) and right temporal parietal junction (rTPJ) in patients with mild cognitive impairment (MCI) to enhance SC abilities and other cognitive and functional abilities related to the stimulated network, and their maintenance effects post-treatment.MethodsTwenty-four MCI patients were assigned to 2 groups: a Real-Real group (RR-Gr) that received 4 weeks of rTMS, and a Sham-Real group (SR-Gr) that received 2 weeks of sham stimulation followed by 2 weeks of real rTMS. All subjects underwent cognitive/functional assessments at baseline, week 2, and week 4 of the treatment, and 8 weeks post-intervention (12 weeks).ResultsAfter 2 weeks of treatment, the RR-Gr improved in empathy performance (P < .001), emotion-recognition (P < .001), social-behavior (SB) (P = .04), and executive function (P = .014). Following 4 weeks of rTMS, emotion-recognition improved further, and the benefits persisted at follow-up observation (all Ps < .001). In RR-Gr, patients with higher education exhibited more significant improvements in SB abilities (P = .032). Both groups also improved attention, mobility, and quality of life over time (P range :<.001-.02).ConclusionsExcitatory rTMS treatment targeting 2 key social brain regions (mPFC and rTPJ) shows promise as a sustained intervention to improve SC and associated cognitive functions in the MCI population.Trial registrationClinicalTrials.gov ID: NCT04490616.

Background: Gait impairment in Parkinson's disease (PD) occurs early and pharmaceutical interventions do not fully restore this function. Visual cueing has been shown to improve gait and alleviate freezing of gait (FOG) in PD. Technological development of digital laser shoe visual cues now allows for visual cues to be used continuously when walking. This study aimed to investigate the effects of laser shoe visual cueing on gait in people with PD across different disease severity (i.e., Hoehn & Yahr [H&Y] stages I-III) and FOG status.

Methods: Eighty people with PD (H&YI = 20, H&YII = 30 [15 FOG, 15 noFOG], H&YIII = 30 [15 FOG, 15 noFOG]) walked a 10 m straight path (back and forth) self-paced for 80 seconds without and then with laser shoe cues (participants were allowed 1-2 walks to familiarize with the cues). Inertial sensors were used to measure gait metrics. Laser cue line was set to usual step length for individuals based on their usual walk data from the inertial sensors.

Results: Laser shoe cueing did not improve gait in PD regardless of disease severity or FOG status. Across all groups, participants decreased gait speed (P < .001), cadence (P < .001), arm range of motion (P < .005), and increased stride time, double support time (P < .001), elevation at midswing (P < .001), and gait variability (P < .001) with the laser shoes compared to usual walking.

Conclusion: Digital laser shoe visual cues do not improve gait in people with PD across disease severity or FOG status. Further investigation is required to examine different cue settings or exposure periods.

BackgroundFollowing stroke, brain networks can be described by strength of local connections (clustering coefficient [Cw]) and strength of global interconnections (path length [Lw]) between nodes, and their balance (Small-worldness [Sw]). Objective. To identify electroencephalography (EEG) networks predicting clinical evolution in stroke through a multicenter cross-sectional study.MethodsWe consecutively recruited 87 anterior circulation ischemic stroke patients. We obtained resting-state EEG (31 electrodes, 10-10 system) within 24 hours from stroke (T0) and at discharge from stroke unit (4-10 days after stroke; T1). EEG data were elaborated with EEGLAB and Lagged Linear Coherence among cortical sources of EEG signals was analyzed using eLORETA. We performed a multiple linear regression with National Institutes of Health Stroke Scale (NIHSS) at T0 and T1 as dependent variables and Cw, Lw, and Sw of delta, theta, and alpha networks as independent variables.ResultsWe found a negative association between alpha1 Sw and NIHSS at T0 (β = -.232, P = .04) meaning that the lower is alpha efficiency the higher is clinical severity and a positive association between delta Sw and NIHSS at T1 (β = .423, P < .001) meaning that the higher is delta efficiency the higher is clinical severity. We found positive association between delta Sw at T0 and NIHSS at T1 (β = .259, P = .02), meaning that the higher is delta efficiency in the hyperacute phase the higher is clinical severity at T1.ConclusionsA higher delta Sw within 24 hours after stroke is associated to higher NIHSS within 10 days. Delta brain network rearrangement in the hyperacute phase is a potential neurophysiological measure to be integrated in multi-modal prognostic models.

BackgroundProprioception is critical for daily activities and is often impaired after stroke. Recent studies have highlighted the prevalence of proprioceptive impairments of the upper limb in stroke; however, few studies have examined the relationship between proprioceptive impairments and motor function.ObjectiveWe examined how proprioceptive detection thresholds (movement discrimination thresholds [MDTs]) relate to existing assessments of upper limb proprioceptive, motor, and clinical function after stroke.MethodsStroke (N = 39) and control participants (N = 39) completed 5 tasks using the Kinarm Exoskeleton Lab: (1) MDT-a single-arm proprioceptive task assessing movement detection threshold, (2) Position Matching-a bilateral matching task assessing static limb position sense, (3) Kinesthetic Matching-a bilateral matching task assessing sense of limb motion, (4) Visually Guided Reaching-a task assessing upper limb motor control, and (5) Reaching without Vision-a task assessing upper limb motor control with increased reliance on proprioceptive feedback.ResultsStroke participants were significantly impaired on all robotic tasks compared to controls. We found that MDT was correlated with bilateral matching robotic tasks of proprioception, including Position Matching (ρ = .64, P < .001) and Kinesthetic Matching (ρ = .56, P < .001). However, MDT was not significantly correlated with robotic tasks of motor control or clinical measures.ConclusionsMDT, a single-arm measure that reduces motor requirements in proprioceptive testing, was significantly correlated to existing robotic measures of proprioception. MDT is capable of measuring impairments in perception that may be independent from impairments in action-based motor function.

Background and PurposeParkinson's impairs movement control and proprioception. This pilot randomized controlled trial investigated whether anodal transcranial direct current stimulation (a-tDCS) combined with proprioceptive exercises improves these functions in people with Parkinson's.MethodsTwenty-four people with Parkinson's were randomly assigned (1:1) to either active a-tDCS (2mA, 20 minutes, 3 sessions/week for 2 weeks) or sham stimulation, followed by standardized proprioceptive training. The primary outcome was ankle joint proprioceptive acuity. Secondary outcomes included postural sway, gait initiation parameters, and quality of life. Participants were blinded to group allocation.ResultsThe active a-tDCS group showed significantly greater improvement in ankle joint repositioning error compared to the sham group (mean difference -2.9 degrees, 95% CI [-3.1, -2.7]; P = .012). Postural sway (elliptical sway area, eyes closed) was also significantly reduced in the active a-tDCS group (-2.6 cm², 95% CI [-4.6, -0.6]; P = .038). Gait initiation time decreased in both groups, but only the active a-tDCS group showed a significant reduction in step time (-168 ms, 95% CI [-175, -160]; P = .005). No significant between-group difference was found in quality of life (P = .687).Discussion and ConclusionsMultiple sessions of a-tDCS combined with proprioceptive exercises explored preliminary evidence of enhanced proprioceptive acuity and postural control in people with Parkinson's. Gait initiation also improved with a-tDCS. All a-tDCS sessions were well-tolerated by participants, with no adverse effects reported. Further research is needed to explore long-term effects and underlying mechanisms. This pilot study provides preliminary evidence for a-tDCS as a potential adjunctive therapy, though larger trials are needed to confirm clinical efficacy.Clinical trial registration code:IRCT20230820059201N2 (Iranian Registry for Clinical Trials)Clinical trial registration URL:https://irct.behdasht.gov.ir/trial/76791Clinical trial registration Name:Effect of Adding Trans-Cranial Direct Current Stimulation on Supplementary Motor Area to Exercise Therapy on Proprioception Acuity, Postural Control, Initiation of Gait, and Brain Cortical Activity in People with Parkinson's.