Neurorehabilitation and neural repair最新文献

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.

Background: Understanding the impact of timing of post-stroke motor recovery research trials is critical for clinical care.

Objective: To examine and compare differences in Fugl-Meyer Assessment Upper Extremity (FMA-UE) scores at 2 different time points post-stroke on the effectiveness of upper extremity (UE) rehabilitation interventions compared to conventional care or sham therapy controls in stroke rehabilitation randomized controlled trials (RCTs).

Methods: A meta-analysis was conducted in accordance with PRISMA guidelines. Searches were conducted in CINAHL, Embase, PubMed, Scopus, and Web of Science, up to April 1st, 2021. Inclusion criteria were: (1) English RCTs of adults (≥18 years) diagnosed with stroke; (2) examined a single intervention for stroke UE rehabilitation; (3) used conventional care/sham as the control arm; and (4) assessed FMA-UE as one of the outcome measures.

Results: 157 RCTs were included, including 17 types of interventions. In the acute and subacute phases post stroke, 16 interventions were assessed, and the analyses of 11 interventions showed significant beneficial effects. In the chronic post-stroke phase, 9 intervention types were assessed, and 7 of them showed significant improvements. Greater FMA-UE score improvements were found for the same interventions in the acute and subacute post-stroke phases when compared to the chronic phase.

Conclusions: Interventions studied in the acute and subacute phases showed greater magnitude improvements in the FMA-UE scores compared to the chronic phase. The effectiveness of upper extremity rehabilitation interventions may be underestimated when studied exclusively in the chronic phase, with some of the observed differences potentially attributable to variations in baseline severity.

BackgroundAnimal models suggest that intensive physical training may promote neuroplasticity in Parkinson's disease (PD), but its effects in humans remain underexplored.ObjectivesTo investigate the effects of aerobic interval training (AIT) on brain-derived neurotrophic factor (BDNF) levels, striatal [¹⁸F]fluorodopa positron emission tomography/computed tomography (PET/CT) uptake ([¹⁸F]DOPA_PET/CT), electroencephalography (EEG), and motor function, and to explore their interrelations.MethodsThirty PD patients were randomly assigned to a 12-week moderate-intensity AIT group (PD Training Group [PD-TR], n = 15) or a non-training group (PD Non-Training Group, n = 15). Pre- and post-intervention assessments included BDNF levels, striatal [¹⁸F]DOPA_PET/CT, EEG during motor task-evoked desynchronization (ERD_MT) and rest-evoked synchronization (ERS_REST) in primary motor cortex (M1) and supplementary motor area (SMA), and motor function assessed using the Unified PD Rating Scale (UPDRS) Part III and the Manual Bradykinesia Score for the Affected Upper Extremity (MBS-AUE) calculated as the sum of UPDRS items 3.4 to 3.6.ResultsThe PD-TR group showed increased BDNF levels (P < .001) and improved motor scores (UPDRS III and MBS-AUE; P < .05). Both groups exhibited increased EEG-ERS_REST M1 (P < .05) over time, with no changes in striatal [¹⁸F]DOPA_PET/CT uptake. Significant group differences were observed in correlations between changes (Δ = POST minus PRE) in: ΔBDNF with Δ[¹⁸F] DOPA_PET/CT uptake in the putamen and ΔEEG-ERD_MT M1 (P < .001); Δ[¹⁸F]DOPA_PET/CT uptake in the putamen with Δ[¹⁸F]DOPA_PET/CT uptake in the caudate and ΔEEG-ERS_REST SMA (P < .05); ΔMBS-AUE scores with ΔEEG-ERS_REST SMA (P < .001).ConclusionsTwelve-week AIT enhanced BDNF levels and motor function in PD-TR, with central nervous system neuroplasticity supporting motor recovery.