Restorative Neurology and Neuroscience - Volume 40, issue 3

Authors: Borowczyk, Martyna | Wojtysiak, Magdalena | Chmielarz-Czarnocińska, Anna | Braszka, Małgorzata | Danielewski, Piotr | Bryndal, Aleksandra | Michalak, Michał | Huber, Juliusz

Article Type: Research Article

Abstract: Background: Traditional repetitive Transcranial Magnetic Stimulation (rTMS) remains applicable in speech studies on healthy participants. Although the procedure of inducing speech arrest by rTMS has been used for over 25 years, there are still significant discrepancies in its methodology. Objective: The study aimed to simplify and improve the old methodology of triggering speech arrest by (rTMS). Our goal was to establish the best step-by-step algorithm and verify the procedure on a representative group of participants. Methods: 47 healthy, right-handed volunteers (23 men and 24 women) at a median age of 23 (range 19–34) were included in …the study. Handedness was determined using the Edinburgh Handedness Inventory Test. After setting the individual’s motor threshold (MT) and heuristic choice of the place of stimulation, which targeted Inferior Frontal Gyrus (IFG), participants were asked to count downwards from 20 to 10. While counting, a series of 2-second pulses was generated at a frequency of 2 Hz at 120% or 150% of MT. The procedure was video-recorded and subsequently assessed by 3 independent reviewers and self-assessed by participants on visual analogue scales for the effect and comfort of stimulation. Results: Speech arrest was induced in 45 people (95.7%). Language dominance was determined to be either left-sided (for 42.2%) or bilateral (55.3%). Total speech arrest was observed more often in participants for whom Broca’s area was active exclusively in the left hemisphere. Conclusion: In our study, we present the step-by-step procedure for a simplified, as far as possible, methodology of inducing speech arrest using rTMS with its verification on a representative group of right-handed healthy individuals. Our results prove that the chosen stimulation parameters present a good efficacy ratio and seems to be justified. The traditional applications of rTMS in speech studies may be highly broadened if the methods used are further improved and simplified. Show more

Keywords: Repetitive transcranial magnetic stimulation, speech, speech arrest, methodology

DOI: 10.3233/RNN-211237

Citation: Restorative Neurology and Neuroscience, vol. 40, no. 3, pp. 125-135, 2022

Authors: Battaglini, Luca | Di Ponzio, Michele | Ghiani, Andrea | Mena, Federica | Santacesaria, Paola | Casco, Clara

Article Type: Research Article

Abstract: Background: Vision is the sense which we rely on the most to interact with the environment and its integrity is fundamental for the quality of our life. However, around the globe, more than 1 billion people are affected by debilitating vision deficits. Therefore, finding a way to treat (or mitigate) them successfully is necessary. Objective: This narrative review aims to examine options for innovative treatment of visual disorders (retinitis pigmentosa, macular degeneration, optic neuropathy, refractory disorders, hemianopia, amblyopia), especially with Perceptual Learning (PL) and Electrical Stimulation (ES). Methods: ES and PL can enhance visual abilities in …clinical populations, inducing plastic changes. We describe the experimental set-ups and discuss the results of studies using ES or PL or their combination in order to suggest, based on literature, which treatment is the best option for each clinical condition. Results: Positive results were obtained using ES and PL to enhance visual functions. For example, repetitive transorbital Alternating Current Stimulation (rtACS) appeared as the most effective treatment for pre-chiasmatic disorders such as optic neuropathy. A combination of transcranial Direct Current Stimulation (tDCS) and visual training seems helpful for people with hemianopia, while transcranial Random Noise Stimulation (tRNS) makes visual training more efficient in people with amblyopia and mild myopia. Conclusions: This narrative review highlights the effect of different ES montages and PL in the treatment of visual disorders. Furthermore, new options for treatment are suggested. It is noteworthy to mention that, in some cases, unclear results emerged and others need to be more deeply investigated. Show more

Keywords: Electrical stimulation, perceptual learning, plasticity, vision, treatment, visual damage

DOI: 10.3233/RNN-221261

Citation: Restorative Neurology and Neuroscience, vol. 40, no. 3, pp. 137-168, 2022

Authors: Roumengous, Thibault | Peterson, Carrie L.

Article Type: Research Article

Abstract: BACKGROUND: Assessment of voluntary activation is useful in the study of neuromuscular impairments, particularly after spinal cord injury (SCI). Measurement of voluntary activation with transcranial magnetic stimulation (VATMS ) is limited by technical challenges, including the difficulty in preferential stimulation of cortical neurons projecting to the target muscle and minimal stimulation of antagonists. Thus, the motor evoked potential (MEP) response to TMS in the target muscle compared to its antagonist may be an important parameter in the assessment of VATMS . OBJECTIVE: The purpose of this study was to evaluate the effect of isometric elbow flexion angle on …two metrics in individuals with tetraplegia following SCI: 1) the ratio of biceps/triceps MEP amplitude across a range of voluntary efforts, and 2) VATMS . METHODS: Ten individuals with tetraplegia and ten nonimpaired individuals were recruited to participate in three sessions wherein VATMS was assessed at 45°, 90°, and 120° of isometric elbow flexion. RESULTS: In SCI participants, the biceps/triceps MEP ratio was not modulated by elbow angle. In nonimpaired participants, the biceps/triceps MEP ratio was greater in the more flexed elbow angle (120° flexion) compared to 90° during contractions of 50% and 75% MVC, but VATMS was not different. VATMS assessed in the more extended elbow angle (45° flexion) was lower relative to 90° elbow flexion; this effect was dependent on the biceps/triceps MEP ratio. In both groups, VATMS was sensitive to the linearity of the voluntary moment and superimposed twitch relationship, regardless of elbow angle. Linearity was lower in SCI relative to nonimpaired participants. CONCLUSIONS: Increasing the MEP ratio via elbow angle did not enable estimation of VATMS in SCI participants. VATMS may not be a viable approach to assess neuromuscular function in individuals with tetraplegia. Show more

Keywords: Spinal cord injury, central activation ratio; arm posture, biceps brachii, voluntary contraction, interpolated twitch technique, quadriplegia

DOI: 10.3233/RNN-221254

Citation: Restorative Neurology and Neuroscience, vol. 40, no. 3, pp. 169-184, 2022

Authors: Schrader, Mareike | Sterr, Annette | Kettlitz, Robyn | Wohlmeiner, Anika | Buschfort, Rüdiger | Dohle, Christian | Bamborschke, Stephan

Article Type: Research Article

Abstract: Background: Standard mirror therapy (MT) is a well-established therapy regime for severe arm paresis after acquired brain injury. Bilateral robot-assisted mirror therapy (RMT) could be a solution to provide visual and somatosensory feedback simultaneously. Objective: The study compares the treatment effects of MT with a version of robot-assisted MT where the affected arm movement was delivered through a robotic glove (RMT). Methods: This is a parallel, randomized trial, including patients with severe arm paresis after stroke or traumatic brain injury with a Fugl-Meyer subscore hand/finger < 4. Participants received either RMT or MT in individual 30 minute …sessions (15 sessions within 5 weeks). Main outcome parameter was the improvement in the Fugl-Meyer Assessment upper extremity (FMA-UE) motor score. Additionally, the Motricity Index (MI) and the FMA-UE sensation test as well as a pain scale were recorded. Furthermore, patients’ and therapists’ experiences with RMT were captured through qualitative tools. Results: 24 patients completed the study. Comparison of the FMA-UE motor score difference values between the two groups revealed a significantly greater therapy effect in the RMT group than the MT group (p  = 0.006). There were no significant differences for the MI (p  = 0.108), the FMA-UE surface sensibility subscore (p  = 0.403) as well as the FMA-UE position sense subscore (p  = 0.192). In both groups the levels of pain remained stable throughout the intervention. No other adverse effects were observed. The RMT training was well accepted by patients and therapists. Conclusions: The study provides evidence that bilateral RMT achieves greater treatment benefit on motor function than conventional MT. The use of robotics seems to be a good method to implement passive co-movement in clinical practice. Our study further demonstrates that this form of training can feasibly and effectively be delivered in an inpatient setting. Show more

Keywords: Mirror therapy, robotics, somatosensory feedback, acquired brain injury, stroke, arm paresis, neurorehabilitation

DOI: 10.3233/RNN-221263

Citation: Restorative Neurology and Neuroscience, vol. 40, no. 3, pp. 185-194, 2022

Authors: Tosatto, Diego | Bonacina, Daniele | Signori, Alessio | Pellicciari, Leonardo | Cecchi, Francesca | Cornaggia, Cesare Maria | Piscitelli, Daniele

Article Type: Research Article

Abstract: Background: Researchers may be tempted to favorably distort the interpretation of their findings when reporting the abstract (i.e., spin). Spin bias overemphasizes the beneficial effects of the intervention compared with the results shown in the full text. Objective: To assess the occurrence of spin bias and incompleteness in reporting abstracts in post-stroke upper limb (UL) rehabilitation randomized clinical trials (RCTs). Methods: A sample of 120 post-stroke UL rehabilitation RCTs (indexed in PEDro database), published in English between 2012 and 2020, was included. The completeness of reporting and spin were assessed using the Consolidated Standards of Reporting …Trials for Abstracts (CONSORT-A) and the spin checklist. The relationship between CONSORT-A and spin checklist scores with RCT and journal characteristics was assessed. Results: CONSORT-A and spin checklist scored 5.3±2.4 (max 15-points, higher scores indicating better reporting) and 5.5±2.0 (max 7-points, higher scores indicating presence of spin), respectively; Significant differences were detected between abstract and full-text scores in the CONSORT-A checklist (p  < 0.01) and the spin checklist (p  < 0.01). Items of the CONSORT-A checklist in the abstracts and full text showed a fair agreement (k  = 0.31), while a moderate agreement (k  = 0.59) for the spin checklist was detected. Completeness of abstract was associated (R2  = 0.46) with journal Impact Factor (p  < 0.01), CONSORT Guideline endorsement (p  = 0.04), and abstract word number (p  = 0.02). A lower spin was associated with a higher journal Impact Factor (p  = 0.01) and CONSORT Guideline endorsement (p  = 0.01). Conclusions: Post-stroke UL rehabilitation RCTs abstracts were largely incomplete showing spin. Authors, reviewers, publishers, and stakeholders should be aware of this phenomenon. Publishers should consider allowing more words in abstracts to improve the completeness of reporting abstracts. Although we have investigated only stroke rehabilitation, our results suggest that health care professionals of all disciplines should avoid clinical decision-making based solely upon abstracts. Show more

Keywords: Data accuracy, stroke, abstracting and indexing, neurological rehabilitation, spin bias, randomized controlled trials

DOI: 10.3233/RNN-211247

Citation: Restorative Neurology and Neuroscience, vol. 40, no. 3, pp. 195-207, 2022