Brain Sciences

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12 pages, 1573 KiB

Open AccessArticle

Intermuscular Coherence during Quiet Standing in Sub-Acute Patients after Stroke: An Exploratory Study

by Eiji Yamanaka, Ryosuke Goto, Michiyuki Kawakami, Takaki Tateishi, Kunitsugu Kondo and Ippei Nojima

Brain Sci. 2023, 13(12), 1640; https://doi.org/10.3390/brainsci13121640 - 26 Nov 2023

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Abstract

Asymmetrically impaired standing control is a prevalent disability among stroke patients; however, most of the neuromuscular characteristics are unclear. Therefore, the main purpose of this study was to investigate between-limb differences in intermuscular coherence during quiet standing. Consequently, 15 patients who had sub-acute [...] Read more.

Asymmetrically impaired standing control is a prevalent disability among stroke patients; however, most of the neuromuscular characteristics are unclear. Therefore, the main purpose of this study was to investigate between-limb differences in intermuscular coherence during quiet standing. Consequently, 15 patients who had sub-acute stroke performed a quiet standing task without assistive devices, and electromyography was measured on the bilateral tibialis anterior (TA), soleus (SL), and medial gastrocnemius (MG). The intermuscular coherence of the unilateral synergistic (SL–MG) pair and unilateral antagonist (TA–SL and TA–MG) pairs in the delta (0–5 Hz) and beta (15–35 Hz) bands were calculated and compared between the paretic and non-paretic limbs. The unilateral synergistic SL–MG coherence in the beta band was significantly greater in the non-paretic limb than in the paretic limb (p = 0.017), while unilateral antagonist TA–MG coherence in the delta band was significantly greater in the paretic limb than in the non-paretic limb (p < 0.01). During quiet standing, stroke patients showed asymmetry in the cortical control of the plantar flexor muscles, and synchronous control between the antagonistic muscles was characteristic of the paretic limb. This study identified abnormal muscle activity patterns and asymmetrical cortical control underlying impaired standing balance in patients with sub-acute stroke using an intermuscular coherence analysis. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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9 pages, 608 KiB

Open AccessArticle

Effects of Twins Therapy on Egocentric and Allocentric Neglect in Stroke Patients: A Feasibility Study

by Woo-Hyuk Jang, Hyeong-Min Hwang and Jae-Yeop Kim

Brain Sci. 2023, 13(6), 952; https://doi.org/10.3390/brainsci13060952 - 14 Jun 2023

Viewed by 1179

Abstract

(1) Background: Existing treatment methods for neglect are concentrated on egocentric neglect and may lead to various problems such as cost/space constraints and portability. Therefore, this study seeks to determine how a new treatment (also known as twins therapy, TT) for stroke patients [...] Read more.

(1) Background: Existing treatment methods for neglect are concentrated on egocentric neglect and may lead to various problems such as cost/space constraints and portability. Therefore, this study seeks to determine how a new treatment (also known as twins therapy, TT) for stroke patients can improve an existing problem associated with neglect. (2) Method: A pre/post-test control group research design was used and both groups continued to receive existing rehabilitation treatment, whilst TT intervention was only added to the experimental group. TT intervention was conducted for a total of 20 sessions (1 session for 30 min/day, 5 days/week, for 4 weeks). (3) Result: There was no significant difference in the manual function test (MFT) and the Korean version of the Modified Barthel Index (K-MBI) items (p > 0.05) before and after the TT intervention. However, the score and execution time of the apple cancellation test showed a significant reduction only in the experimental group (p < 0.05). (4) Conclusion: TT not only improved egocentric neglect, but also allocentric neglect symptoms in stroke patients. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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9 pages, 774 KiB

Open AccessArticle

The Safety and Feasibility of Lower Body Positive Pressure Treadmill Training in Individuals with Chronic Stroke: An Exploratory Study

by Sattam M. Almutairi, Moodhi M. Alfouzan, Taghreed S. Almutairi, Hatem A. Alkaabi, Misoon T. AlMulaifi, Marzouq K. Almutairi, Faisal K. Alhuthaifi and Chad Swank

Brain Sci. 2023, 13(2), 166; https://doi.org/10.3390/brainsci13020166 - 18 Jan 2023

Cited by 1 | Viewed by 1735

Abstract

Background: Lower body positive pressure (LBPP) may provide a novel intervention for gait training in neurological conditions. Nonetheless, studies investigating the safety and feasibility of LBPP in patients with stroke are insufficient. Objectives: The purpose of this study was to evaluate the safety [...] Read more.

Background: Lower body positive pressure (LBPP) may provide a novel intervention for gait training in neurological conditions. Nonetheless, studies investigating the safety and feasibility of LBPP in patients with stroke are insufficient. Objectives: The purpose of this study was to evaluate the safety and feasibility of LBPP as a rehabilitation intervention for individuals with chronic stroke. Methods: Individuals with chronic stroke were recruited from the community to participate in LBPP gait training three times a week for six weeks. The LBPP’s safety and feasibility were documented throughout the study and at the end of six weeks. Safety and feasibility referred to the incidence of adverse events, complications, the participant and therapist satisfaction questionnaire, and the device limitation including but not limited to technical issues and physical constraints. In addition, blood pressure, pulse rate, and oxygen saturation were taken pre- and post-session. Dependent t-tests were used to analyze the difference between assessments. A Wilcoxon test was used to assess the ordinal data (Trial registration number NCT04767334). Results: Nine individuals (one female, eight males) aged 57 ± 15.4 years were enrolled. All participants completed the intervention without adverse events. All participants reported positive scores from 4 (very satisfying) to 5 (extremely satisfying) in the safety and feasibility questionnaire. No significant differences were observed in blood pressure and oxygen saturation during the intervention sessions. However, significant increases were observed in heart rate from 82.6 ± 9.1 beats/min (pre-session) to 88.1 ± 6.8 beats/min (post-session) (p = 0.027). Conclusions: LBPP is a safe and feasible rehabilitation tool to use with individuals with chronic stroke. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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14 pages, 1394 KiB

Open AccessArticle

Cerebral Hemodynamic Changes during Unaffected Handgrip Exercises in Stroke Patients: An fNIRS Study

by Yuqin Ma, Yang Yu, Wen Gao, Yongfeng Hong and Xianshan Shen

Brain Sci. 2023, 13(1), 141; https://doi.org/10.3390/brainsci13010141 - 13 Jan 2023

Cited by 4 | Viewed by 2172

Abstract

This study aimed to assess the effect of the altered strength of the sound limb on the hemodynamics in the affected brain of stroke patients. We recruited 20 stroke patients to detect changes in the HbO concentrations in the bilateral prefrontal cortex (PFC), [...] Read more.

This study aimed to assess the effect of the altered strength of the sound limb on the hemodynamics in the affected brain of stroke patients. We recruited 20 stroke patients to detect changes in the HbO concentrations in the bilateral prefrontal cortex (PFC), sensorimotor cortex (SMC), and occipital lobe (OL). We performed functional near-infrared spectroscopy (fNIRS) to detect changes in oxyhemoglobin (HbO) concentrations in regions of interest (ROIs) in the bilateral cerebral hemispheres of stroke patients while they performed 20%, 50%, and 80% maximal voluntary contraction (MVC) levels of handgrip tasks with the unaffected hands. The results suggest that when patients performed handgrip tasks with 50% of the MVC force, SMC in the affected cerebral hemisphere was strongly activated and the change in the HbO concentration was similar to that of the handgrip with 80% of MVC. When the force was 50% of MVC, the SMC in the affected hemisphere showed a more proportional activation than that at 80% MVC. Overall, this research suggests that stroke patients with a poor upper limb function should perform motor training with their sound hands at 50% of the MVC grip task to activate the ipsilesional hemisphere. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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12 pages, 2374 KiB

Open AccessArticle

A Method for Using Video Presentation to Increase Cortical Region Activity during Motor Imagery Tasks in Stroke Patients

by Kengo Fujiwara, Rikako Shimoda, Masatomo Shibata, Yoshinaga Awano, Koji Shibayama and Toshio Higashi

Brain Sci. 2023, 13(1), 29; https://doi.org/10.3390/brainsci13010029 - 23 Dec 2022

Cited by 1 | Viewed by 1379

Abstract

Previous studies have reported that stroke patients have difficulty recalling the motor imagery (MI) of a task, also known as MI vividness. Research on combining MI with action observation is gaining importance as a method to improve MI vividness. We enrolled 10 right-handed [...] Read more.

Previous studies have reported that stroke patients have difficulty recalling the motor imagery (MI) of a task, also known as MI vividness. Research on combining MI with action observation is gaining importance as a method to improve MI vividness. We enrolled 10 right-handed stroke patients and compared MI vividness and cortical activity under different presentation methods (no inverted image, inverted image of another individual’s hand, and an inverted image of the patient’s nonparalyzed hand) using near-infrared spectroscopy. Images of the nonparalyzed upper limb were inverted to make the paralyzed upper limb appear as if it were moving. Three tasks (non inverted image, AO + MI (other hand), AO + MI (own hand)) were randomly performed on 10 stroke patients. MI vividness was significantly higher when the inverted image of the nonparalyzed upper limb was presented compared to the other conditions (p < 0.01). The activity of the cortical regions was also significantly enhanced (p < 0.01). Our study highlights the potential application of inverted images of a stroke patient’s own nonparalyzed hand in mental practice to promote the motor recovery of stroke patients. This technique achieved higher levels of MI vividness and cortical activity when performing motor tasks. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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14 pages, 954 KiB

Open AccessArticle

Effects of Transcranial Direct Current Stimulation Combined with Treadmill Training on Kinematics and Spatiotemporal Gait Variables in Stroke Survivors: A Randomized, Triple-Blind, Sham-Controlled Study

by Arislander Jonathan Lopes Dumont, Veronica Cimolin, Rodolfo Borges Parreira, Danilo Armbrust, Daniela Rosana Pedro Fonseca, Adriano Luís Fonseca, Lorraine Cordeiro, Renata Calhes Franco, Natália Almeida Carvalho Duarte, Manuela Galli and Cláudia Santos Oliveira

Brain Sci. 2023, 13(1), 11; https://doi.org/10.3390/brainsci13010011 - 21 Dec 2022

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Abstract

The present study assessed the effects of anodal transcranial direct current stimulation (tDCS) combined with treadmill training on spatiotemporal and kinematic variables in stroke survivors using gait speed as the primary outcome. A randomized, sham-controlled, triple-blind, study was conducted involving 28 patients with [...] Read more.

The present study assessed the effects of anodal transcranial direct current stimulation (tDCS) combined with treadmill training on spatiotemporal and kinematic variables in stroke survivors using gait speed as the primary outcome. A randomized, sham-controlled, triple-blind, study was conducted involving 28 patients with hemiparesis allocated to two groups. The experimental group was submitted to treadmill training combined with anodal tDCS over the primary motor cortex (M1) of the damaged hemisphere. The control group was submitted to treadmill training combined with sham tDCS. Stimulation was administered (2 mA, 20 min) five times a week for two weeks during treadmill training. No significant differences (p > 0.05) in spatiotemporal variables were found in the intra-group and inter-group analyses. However, the experimental group demonstrated improvements in kinematic variables of the knee and ankle (p < 0.05) and these results were maintained one month after the end of the intervention. The inter-group analysis revealed significant differences (p < 0.05) with regard to the pelvis, hip and knee. Anodal tDCS over M1 of the damaged hemisphere combined with treadmill training did not affect spatiotemporal variables, but promoted improvements in kinematic variables of the pelvis, hip, knee and ankle and results were maintained one month after treatment. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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12 pages, 2029 KiB

Open AccessArticle

Effects of Gaze Stabilization Exercises on Gait, Plantar Pressure, and Balance Function in Post-Stroke Patients: A Randomized Controlled Trial

by Ruoxin Zhao, Jun Lu, Yue Xiao, Xinrong Liu, Yu Wang and Guangxu Xu

Brain Sci. 2022, 12(12), 1694; https://doi.org/10.3390/brainsci12121694 - 9 Dec 2022

Cited by 6 | Viewed by 2584

Abstract

This study aims to explore the effects of gaze stabilization exercises (GSEs) on gait, plantar pressure, and balance function in post-stroke patients (≤6 months). Forty post-stroke patients were randomly divided into an experimental group (n = 20) and a control group ( [...] Read more.

This study aims to explore the effects of gaze stabilization exercises (GSEs) on gait, plantar pressure, and balance function in post-stroke patients (≤6 months). Forty post-stroke patients were randomly divided into an experimental group (n = 20) and a control group (n = 20). The experimental group performed GSEs combined with physical therapy, while the control group only performed physical therapy, once a day, 5 days a week, for 4 weeks. The Berg Balance Scale (BBS) was used to test the balance function and the risk of falling, which was the primary outcome. The Timed Up and Go test (TUGT) evaluated the walking ability and the fall risk. The envelope ellipse area and the plantar pressure proportion of the affected side were used to measure the patient’s supporting capacity and stability in static standing. The anterior–posterior center of pressure displacement velocity was used to test the weight-shifting capacity. Compared to the control group, the swing phase of the affected side, swing phase’s absolute symmetric index, envelope ellipse area when eyes closed, and TUGT of the experimental group had significantly decreased after GSEs (p < 0.05); the BBS scores, TUGT, the anterior–posterior COP displacement velocity, and the plantar pressure proportion of the affected side had significantly increased after 4 weeks of training (p < 0.05). In conclusion, GSEs combined with physical therapy can improve the gait and balance function of people following stroke. Furthermore, it can enhance the weight-shifting and one-leg standing capacity of the affected side, thus reducing the risk of falling. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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10 pages, 1987 KiB

Open AccessArticle

Repetitive Peripheral Magnetic Stimulation Combined with Motor Imagery Changes Resting-State EEG Activity: A Randomized Controlled Trial

by Shun Sawai, Shoya Fujikawa, Ryu Ushio, Kosuke Tamura, Chihiro Ohsumi, Ryosuke Yamamoto, Shin Murata and Hideki Nakano

Brain Sci. 2022, 12(11), 1548; https://doi.org/10.3390/brainsci12111548 - 15 Nov 2022

Cited by 2 | Viewed by 1968

Abstract

Repetitive peripheral magnetic stimulation is a novel non-invasive technique for applying repetitive magnetic stimulation to the peripheral nerves and muscles. Contrarily, a person imagines that he/she is exercising during motor imagery. Resting-state electroencephalography can evaluate the ability of motor imagery; however, the effects [...] Read more.

Repetitive peripheral magnetic stimulation is a novel non-invasive technique for applying repetitive magnetic stimulation to the peripheral nerves and muscles. Contrarily, a person imagines that he/she is exercising during motor imagery. Resting-state electroencephalography can evaluate the ability of motor imagery; however, the effects of motor imagery and repetitive peripheral magnetic stimulation on resting-state electroencephalography are unknown. We examined the effects of motor imagery and repetitive peripheral magnetic stimulation on the vividness of motor imagery and resting-state electroencephalography. The participants were divided into a motor imagery group and motor imagery and repetitive peripheral magnetic stimulation group. They performed 60 motor imagery tasks involving wrist dorsiflexion movement. In the motor imagery and repetitive peripheral magnetic stimulation group, we applied repetitive peripheral magnetic stimulation to the extensor carpi radialis longus muscle during motor imagery. We measured the vividness of motor imagery and resting-state electroencephalography before and after the task. Both groups displayed a significant increase in the vividness of motor imagery. The motor imagery and repetitive peripheral magnetic stimulation group exhibited increased β activity in the anterior cingulate cortex by source localization for electroencephalography. Hence, combined motor imagery and repetitive peripheral magnetic stimulation changes the resting-state electroencephalography activity and may promote motor imagery. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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17 pages, 819 KiB

Open AccessArticle

Does Executive Function Training Impact on Communication? A Randomized Controlled tDCS Study on Post-Stroke Aphasia

by Francesca Pisano, Alessio Manfredini, Andrea Castellano, Carlo Caltagirone and Paola Marangolo

Brain Sci. 2022, 12(9), 1265; https://doi.org/10.3390/brainsci12091265 - 19 Sep 2022

Cited by 4 | Viewed by 3258

Abstract

New approaches in aphasia rehabilitation have recently identified the crucial role of executive functions (EFs) in language recovery, especially for people with severe aphasia (PWSA). Indeed, EFs include high-order cognitive abilities such as planning and problem solving, which enable humans to adapt to [...] Read more.

New approaches in aphasia rehabilitation have recently identified the crucial role of executive functions (EFs) in language recovery, especially for people with severe aphasia (PWSA). Indeed, EFs include high-order cognitive abilities such as planning and problem solving, which enable humans to adapt to novel situations and are essential for everyday functional communication. In a randomized double-blind crossover design, twenty chronic Italian PWSA underwent ten days of transcranial direct current stimulation (tDCS) (20 min, 2 mA) over the right dorsolateral prefrontal cortex (DLPFC). Two conditions were considered, i.e., anodal and sham, while performing four types of cognitive training (alertness, selective attention, visuo-spatial working memory, and planning), all of which were related to executive functions. After anodal tDCS, a greater improvement in selective attention, visuospatial working memory and planning abilities was found compared to the sham condition; this improvement persisted one month after the intervention. Importantly, a significant improvement was also observed in functional communication, as measured through the Communication Activities of Daily Living Scale, in noun and verb naming, in auditory and written language comprehension tasks and in executive function abilities. This evidence emphasizes, for the first time, that tDCS over the right DLPFC combined with executive training enhances functional communication in severe aphasia. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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Review

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8 pages, 1649 KiB

Open AccessReview

Rehabilitation of Severe Impairment in Motor Function after Stroke: Suggestions for Harnessing the Potentials of Mirror Neurons and the Mentalizing Systems to Stimulate Recovery

by Auwal Abdullahi, Thomson W. L. Wong and Shamay S. M. Ng

Brain Sci. 2022, 12(10), 1311; https://doi.org/10.3390/brainsci12101311 - 28 Sep 2022

Cited by 5 | Viewed by 2653

Abstract

Rehabilitation of severe impairment in motor function following stroke is very challenging. This is because one of the driving forces for recovery of motor function is tasks practice, something this category of patients cannot voluntarily perform. However, it has now been shown that [...] Read more.

Rehabilitation of severe impairment in motor function following stroke is very challenging. This is because one of the driving forces for recovery of motor function is tasks practice, something this category of patients cannot voluntarily perform. However, it has now been shown that tasks practice can equally be carried out cognitively and through observation of another person’s practice, using techniques known as mental practice and tasks observation, respectively. Mental practice and tasks observation are believed to activate networks of neurons in the brain known as mirror neurons and mentalizing systems to induce recovery. The effectiveness of these techniques has, however, limited evidence at the moment. One possible explanation for this could be the nature of the protocols of these techniques, especially as regards to the intensity of practice. This article proposes ways the potentials of the mirror neurons and mentalizing systems can be harnessed to optimize recovery of severe impairment in motor function using mental practice and tasks observation. The article suggests, among other ways, protocols where tasks observation or mirror therapy are carried out first, and are then followed by mental practice, increasing the number of times the tasks are observed or mentalized, observation of significant others performing the tasks and mental practice of very familiar tasks. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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23 pages, 4222 KiB

Open AccessSystematic Review

Challenge Level Contributes to the Efficacy of Treadmill Interventions after Stroke: A Systematic Review and Meta-Analysis

by Sharon Olsen, Gemma Alder, Usman Rashid, Emeline Gomes, Madeleine Aislabie, Fran Chee, Caitlin Smith, Brody Kean, Nicola Towersey and Nada Signal

Brain Sci. 2023, 13(12), 1729; https://doi.org/10.3390/brainsci13121729 - 18 Dec 2023

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Abstract

Intervention parameters such as the challenge, amount, and dosage (challenge × amount) have the potential to alter the efficacy of rehabilitation interventions after stroke. This systematic review investigated the effect of intervention parameters of challenge, amount, and dosage on improvements in walking outcomes [...] Read more.

Intervention parameters such as the challenge, amount, and dosage (challenge × amount) have the potential to alter the efficacy of rehabilitation interventions after stroke. This systematic review investigated the effect of intervention parameters of challenge, amount, and dosage on improvements in walking outcomes following treadmill training (TT) and comparison interventions in people with stroke. Randomized controlled trials were included if they: (i) investigated interventions of TT or bodyweight-supported TT (BWSTT); (ii) made comparisons with other physiotherapy interventions, other types of TT, or no intervention; (iii) studied people with stroke; (iv) reported sufficient data on challenge and amount parameters; and (v) measured walking speed or endurance. Completeness of reporting was evaluated using the TIDieR-Rehab checklist and risk of bias was assessed using the revised Cochrane risk-of-bias tool. The review included 26 studies; 15 studies compared TT or BWSTT with other physiotherapy interventions and 11 studies compared different types of TT. Meta-analyses provided evidence with low to moderate certainty that greater differences in challenge and dosage between treadmill and comparison physiotherapy interventions produced greater effects on walking endurance (p < 0.01). However, challenge and dosage did not influence walking speed outcomes. The analysis of intervention amount was limited by the lack of studies that manipulated the amount of intervention. Overall, the findings indicate that, after stroke, some of the efficacy of TT on walking endurance can be explained by the challenge level during training. This supports the implementation of TT at higher challenge levels in stroke rehabilitation practice. Full article

(This article belongs to the Special Issue New Strategies and New Rehabilitation Evaluations to Stroke)

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