Restorative Neurology and Neuroscience - Volume 32, issue 2

Authors: Kwon, Tae Gun | Kim, Yun-Hee | Chang, Won Hyuk | Bang, Oh Young | Shin, Yong-Il

Article Type: Research Article

Abstract: Purpose: Enhanced therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on the motor function of stroke patients when provided in combination with motor training have been reported. The objective of this study was to determine the most effective method for combining rTMS and motor training in stroke patients. Methods: Fourteen stroke patients were enrolled. All patients participated in two randomly arranged intervention sessions, each of which incorporated a differently combined rTMS and motor training method. With an interleaved combination method (ICM), an rTMS train and a short period of motor training were interleaved and repeated. With a preconditioning combination method …(PCM), rTMS trains were applied as preconditioning, followed by repeated blocks of motor training. The total rTMS pulses and total duration of motor training were the same in both sessions. Results: Performance of a sequential finger motor task improved significantly after both the ICM and PCM interventions: movement accuracy increased and movement time decreased. The PCM-associated improvements were significantly greater than the ICM-associated improvements. Performance in the Purdue Pegboard Test and Nine-Hole Peg Test also improved significantly after both interventions but without a significant difference between the two interventions. Cortical excitability improved after both the ICM and PCM interventions but without a significant difference between the two. Conclusions: In combining rTMS and motor training, preconditioning with rTMS followed by motor training is more effective than interleaving the rTMS and motor training to facilitate the motor performance of stroke patients. Show more

Keywords: Rehabilitation method, motor training, stroke, trancranial magnetic stimulation

DOI: 10.3233/RNN-130313

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 223-232, 2014

Authors: Nardone, Antonio | Turcato, Anna Maria | Schieppati, Marco

Article Type: Research Article

Abstract: Purpose: To investigate whether the response to rehabilitation differs between patients with abnormalities of balance and gait due to vascular or to degenerative cerebellar disease. Methods: We reviewed the outcome of 27 cerebellar patients. Fourteen patients with vascular and 13 with degenerative cerebellar disease underwent a 3-week inpatient physical therapy program for 5 days/week, 90 min/day, focused on balance and gait. Body sway area during quiet stance with eyes open and eyes closed, and gait velocity, stride length, cadence and step width were recorded. The Berg Balance Scale (BBS) and Functional Independence Measure (FIM) were administered. All tests were performed …before and after treatment. Results: Before treatment, both groups showed comparable values in all sway and gait variables and in BBS. FIM score was higher in degenerative than vascular patients. After treatment, a significant reduction of body sway area was observed under both visual conditions in both groups. Gait velocity, stride length and step width improved more in the vascular than in the degenerative patient group. BBS improved in both groups. FIM improved to a larger extent in the vascular patients. Conclusion: Short-term treatment may not be sufficient to produce definite improvement in locomotion in degenerative as much as occurs in vascular patients, even if clinical and functional signs of balance improve in both groups. Show more

Keywords: Cerebellum, balance, gait, rehabilitation

DOI: 10.3233/RNN-130315

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 233-245, 2014

Authors: Abboud, Sami | Hanassy, Shlomi | Levy-Tzedek, Shelly | Maidenbaum, Shachar | Amedi, Amir

Article Type: Research Article

Abstract: Purpose: Sensory-substitution devices (SSDs) provide auditory or tactile representations of visual information. These devices often generate unpleasant sensations and mostly lack color information. We present here a novel SSD aimed at addressing these issues. Methods: We developed the EyeMusic, a novel visual-to-auditory SSD for the blind, providing both shape and color information. Our design uses musical notes on a pentatonic scale generated by natural instruments to convey the visual information in a pleasant manner. A short behavioral protocol was utilized to train the blind to extract shape and color information, and test their acquired abilities. Finally, we conducted a survey …and a comparison task to assess the pleasantness of the generated auditory stimuli. Results: We show that basic shape and color information can be decoded from the generated auditory stimuli. High performance levels were achieved by all participants following as little as 2–3 hours of training. Furthermore, we show that users indeed found the stimuli pleasant and potentially tolerable for prolonged use. Conclusions: The novel EyeMusic algorithm provides an intuitive and relatively pleasant way for the blind to extract shape and color information. We suggest that this might help facilitating visual rehabilitation because of the added functionality and enhanced pleasantness. Show more

Keywords: Sensory substitution devices, SSD, blindness, rehabilitation, color, pleasant sounds

DOI: 10.3233/RNN-130338

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 247-257, 2014

Authors: Lopez, William Omar Contreras | Nikkhah, Guido | Schültke, Elisabeth | Furlanetti, Luciano | Trippel, Michael

Article Type: Research Article

Abstract: Purpose: Intrastriatal neural transplantation using multiple grafts is an experimental approach to the treatment of Huntington's disease (HD). Brain atrophy makes stereotactic plans in these patients a tedious procedure with a risk of suboptimal spatial distribution of the grafts in transplantation procedures. Here we present a self-developed software to optimize the surgical stereotactic planning for bilateral neurotransplantation procedures. It allows close to symmetrical distribution of the stereotactic coordinates in relation to the mid-commissural point (MCP), proposing automatically the planning coordinates for the first transplanted hemisphere and mirrored coordinates to be used in the contra-lateral hemisphere. Methods: Twenty-two consecutive HD patients …underwent bilateral stereotactic striatal transplantation. Two caudate nucleus and four putaminal tracks were planned bilaterally. For the second, contra-lateral transplantation, the coordinates were mirrored in order to determine contralateral targets and trajectories. Intra-individual comparison between software given coordinates and finally used coordinates was performed. Results: No statistical significance was found comparing a) the differences between coordinates proposed by the software and the final coordinates and b) the distribution of the transplantation sites in relation to the midline for the right vs. left hemisphere. No intra- or postoperative transplantation-related adverse events occurred. Conclusions: The use of model-based and mirrored coordinates allowed optimal spatial distribution of the grafts. Minor changes were required comparing right to left coordinates giving proof-of principle. The initial use of the software suggests that it may be useful in experimental transplantation trials where neural cell grafts are to be implanted into predefined target sites in the human brain, whether unilateral or bilateral. Show more

Keywords: Huntington's disease, human fetal striatal transplantation, anterior commissure-posterior commissure line (AC-PC), mid-commissural point (MCP), whole ganglionic eminence (WGE), caudate nucleus, putamen

DOI: 10.3233/RNN-130340

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 259-268, 2014

Authors: Fritzsch, Claire | Wang, Jing | dos Santos, Luara Ferreira | Mauritz, Karl-Heinz | Brunetti, Maddalena | Dohle, Christian

Article Type: Research Article

Abstract: Purpose: Mirror therapy can improve motor and sensory functions, but effects of the mirror illusion on primary motor and somatosensory cortex could not be established consistently. Methods: Fifteen right handed healthy volunteers performed or observed a finger-thumb opposition task. Cerebral activations during normal movement (NOR), mirrored movement (MIR) and movement observation (OBS) by means of a video chain were recorded with functional magnetic resonance imaging (fMRI). Activation sizes in movement > static conditions were identified using SPM8 (p < 0.001, unc.) and attributed to predefined areas employing the Anatomy toolbox 1.8. Laterality indices for the responsive areas were calculated on …the basis of the number of activated voxels. Results: Relevant bilateral BOLD responses were found in primary motor (M1) and somatosensory (S1 – BA 2, 3b and 3a) cortex, premotor and parietal areas and V5. When comparing MIR to NOR, no significant change of contralateral activation in M1 was found, but clearly at S1 with differences between hands. Conclusion: The mirror illusion does not elicit immediate changes in motor areas, yet there is a direct effect on somatosensory areas, especially for left hand movements. These results suggest different effects of mirror therapy on processing and rehabilitation of motor and sensory function. Show more

Keywords: Movement, mirror, laterality, stroke, sensorimotor cortex

DOI: 10.3233/RNN-130343

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 269-280, 2014

Authors: Ferreri, F. | Ponzo, D. | Vollero, L. | Guerra, A. | Di Pino, G. | Petrichella, S. | Benvenuto, A. | Tombini, M. | Rossini, L. | Denaro, L. | Micera, S. | Iannello, G. | Guglielmelli, E. | Denaro, V. | Rossini, P.M.

Article Type: Research Article

Abstract: Purpose: Following limb amputation, central and peripheral nervous system relays partially maintain their functions and can be exploited for interfacing prostheses. The aim of this study is to investigate, for the first time by means of an EEG-TMS co-registration study, whether and how direct bidirectional connection between brain and hand prosthesis impacts on sensorimotor cortical topography. Methods: Within an experimental protocol for robotic hand control, a 26 years-old, left-hand amputated male was selected to have implanted four intrafascicular electrodes (tf-LIFEs-4) in the median and ulnar nerves of the stump for 4 weeks. Before tf-LIFE-4s implant (T0) and after the training …period, once electrodes have been removed (T1), experimental subject's cortico-cortical excitability, connectivity and plasticity were tested via a neuronavigated EEG–TMS experiment. Results: The statistical analysis clearly demonstrated a significant modulation (with t-test p < 0.0001) of EEG activity between 30 and 100 ms post-stimulus for the stimulation of the right hemisphere. When studying individual latencies in that time range, a global amplitude modulation was found in most of the TMS-evoked potentials; particularly, the GEE analysis showed significant differences between T0 and T1 condition at 30 ms (p < 0.0404), 46 ms (p < 0.0001) and 60 ms (p < 0.007) latencies. Finally, also a clear local decrement in N46 amplitude over C4 was evident. No differences between conditions were observed for the stimulation of the left hemisphere. Conclusions: The results of this study confirm the hypothesis that bidirectional neural interface could redirect cortical areas -deprived of their original input/output functions- toward restorative neuroplasticity. This reorganization strongly involves bi-hemispheric networks and intracortical and transcortical modulation of GABAergic inhibition. Show more

Keywords: Limb amputation, tf-LIFEs-4, bidirectional neural interface, neuro-plasticity, EEG-TMS co-registration

DOI: 10.3233/RNN-130347

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 281-292, 2014

Authors: Meesen, Raf L.J. | Thijs, Herbert | Leenus, Daphnie J.F. | Cuypers, Koen

Article Type: Research Article

Abstract: Purpose: To assess the effects of atDCS on motor performance in patients with multiple sclerosis (MS). Previously, anodal transcranial direct current stimulation (atDCS) has been shown to improve motor performance in healthy subjects and neurodegenerative populations. However, the effect of atDCS on motor performance is not examined in MS. Methods: In the current study, a sham controlled double-blind crossover design was used to evaluate the effect of 20 minutes of 1 mA atDCS or sham tDCS (stDCS) on a unimanual motor sequence-training task, consisting of sequential finger presses on a computer keyboard with the most impaired hand. Patients received stimulation …(atDCS or stDCS) during motor training. tDCS was applied over the primary motor cortex contralateral to the most impaired hand. Motor performance was assessed immediately before, during and 30 minutes after stimulation. Results: Although we need to be careful with the interpretation of the data due to lack of power, our results showed no significant effect of atDCS on motor performance. Conclusions: Our findings indicate that atDCS-supported motor training was not able to improve motor performance more than sham-supported motor training. Possibly, the effects of atDCS are mediated by specific MS-related characteristics. Furthermore, increasing atDCS intensity and offering multiple stimulation sessions might be necessary to optimize motor performance resulting from atDCS-supported motor training. Show more

Keywords: Multiple sclerosis, transcranial direct current stimulation, tDCS, neural rehabilitation, motor training

DOI: 10.3233/RNN-130348

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 293-300, 2014

Authors: Fusco, Augusto | Iosa, Marco | Venturiero, Vincenzo | De Angelis, Domenico | Morone, Giovanni | Maglione, Luisa | Bragoni, Maura | Coiro, Paola | Pratesi, Luca | Paolucci, Stefano

Article Type: Research Article

Abstract: Purpose: Transcranial direct current stimulation (tDCS) of the motor cortex seems to be effective in improving motor performance in patients with chronic stroke, while some recent findings have reported conflicting results for the subacute phase. We aimed to verify whether upper extremity motor rehabilitation could be enhanced by treatment with tDCS administered before a rehabilitative session. Methods: Hand dexterity and force in 16 individuals with subacute stroke were assessed before (T0) and after anodal stimulation (T1) and after a successive session of motor rehabilitation (T2) in a double-blind, randomized, sham-controlled, crossover trial. To confirm the value of the device as …a specific effector, behavioral tests were also administered. Results: Anodal and sham stimulation plus rehabilitation significantly improved manual dexterity (repeated-measure Anova: A-tDCS: p = 0.005; S-tDCS: p = 0.042). Post hoc analysis revealed a significant stimulation effect only for A-tDCS (p = 0.013 between T0 and T1) and not for S-tDCS, whereas the rehabilitation effect (between T1 and T2) was not significant in either group. Hand force and behavioral features were unchanged. Conclusions: Anodal brain stimulation improves hand dexterity but does not increase the effectiveness of the rehabilitation directly. These results suggest the presence of aftereffects, not priming effects, of A-tDCS superimposed onto motor learning phenomena. Show more

Keywords: Brain stimulation, stroke rehabilitation, motor learning, manual force, upper limb function

DOI: 10.3233/RNN-130349

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 301-312, 2014

Authors: Chung, Eunjung | Lee, Byoung-Hee | Hwang, Sujin

Article Type: Research Article

Abstract: Objective: The purpose of this study was to examine the feasibility of core stabilization exercise with real-time feedback on balance and gait function in patients with chronic hemiparetic stroke. Methods: Nineteen stroke subjects were enrolled in this study. The patients were randomly divided into the experimental (n = 10) and control groups (n = 9). Subjects in the experimental group performed core stabilization exercise with real-time feedback training for 30 minutes per day during a period of six weeks. Subjects in the control group performed core stabilization exercise during the same period. This study assessed the kinematic parameters using a …portable walkway system, and timed up-and-go test. Results: Gait velocity showed significantly greater improvement in the experimental group (7.3 ± 5.0 sec) than in the control group (−0.7 ± 10.6). Stride length showed significantly greater increase in the experimental group (13.2 ± 7.9 on the affected side and 12.6 ± 8.0 on the less affected side) than the control group (3.5 ± 8.7 on the affected side and 3.4 ± 8.5 on the less affected side). After training, change in results on the timed up and go test was significantly greater in the experimental group than in the control group. Conclusion: Core stabilization exercise using real-time feedback produces greater improvement in gait performance in chronic hemiparetic stroke patients than core stabilization exercise only. Show more

Keywords: Core stabilization exercise, hemiparesis, real-time feedback, stroke

DOI: 10.3233/RNN-130353

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 313-321, 2014

Authors: Carey, James R. | Deng, Huiqiong | Gillick, Bernadette T. | Cassidy, Jessica M. | Anderson, David C. | Zhang, Lei | Thomas, William

Article Type: Research Article

Abstract: Purpose: This study analyzed the characteristics of responders vs. nonresponders in people with stroke receiving a novel form of repetitive transcranial magnetic stimulation (rTMS) to improve hand function. Methods: Twelve people with stroke received five treatments of 6-Hz primed low-frequency rTMS to the contralesional primary motor area. We compared demographic factors, clinical features, and the ipsilesional/contralesional volume ratio of selected brain regions in those who improved hand performance (N = 7) on the single-hand component of the Test Évaluant la performance des Membres supérieurs des Personnes Âgées (TEMPA) and those who showed no improvement (N = 5). Results: Responders showed …significantly greater baseline paretic hand function on the TEMPA, greater preservation volume of the ipsilesional posterior limb of the internal capsule (PLIC), and lower scores (i.e. less depression) on the Beck Depression Inventory than nonresponders. There were no differences in age, sex, stroke duration, paretic side, stroke hemisphere, baseline resting motor threshold for ipsilesional primary motor area (M1), NIH Stroke Scale, Upper Extremity Fugl-Meyer, Mini-Mental State Examination, or preservation volume of M1, primary somatosensory area, premotor cortex, or supplementary motor area. Conclusion: Our results support that preserved PLIC volume is an important influential factor affecting responsiveness to rTMS. Show more

Keywords: stroke, repetitive transcranial magnetic stimulation, posterior limb internal capsule, primary motor area

DOI: 10.3233/RNN-130358

Citation: Restorative Neurology and Neuroscience, vol. 32, no. 2, pp. 323-335, 2014