Enhanced Motor Recovery After Stroke With Combined Cortical Stimulation and Rehabilitative Training Is Dependent on Infarct Location

Abstract

Background Cortical electrical stimulation of motor cortex in combination with rehabilitative training (CS/RT) has been shown to enhance motor recovery in animal models of focal cortical stroke yet in clinical trials the effects are much less robust. The variability of stroke location in human patient populations that include both cortical and subcortical brain regions may contribute to the failure to find consistent effects clinically. Objective This study sought to determine whether infarct location influences the enhanced motor recovery previously observed in response to CS/RT. The efficacy of CS/RT to promote improvements in motor function was examined in two different rat models of stroke that varied the amount and location of cortical and subcortical damage. Methods Ischemic infarctions were induced by injecting the vasoconstricting peptide endothelin-1 either 1) onto the middle cerebral artery (MCAo) producing damage to frontal cortex and lateral striatum or 2) into a subcortical region producing damage to the posterior thalamus and internal capsule (SCII). Daily CS/RT or RT alone was then given for twenty days during which time performance on a skilled reaching task was assessed. Results Animals with MCAo infarctions exhibited enhanced improvements on a skilled reaching task in response to CS/RT relative to RT alone. No such enhancement was observed in animals with SCII infarctions across the twenty days of treatment. Conclusions The efficacy of cortical stimulation for enhancing motor recovery after stroke may depend in part on the extent and location of the ischemic infarct.

Electrical Stimulation Enhances Migratory Ability of Transplanted Bone Marrow Stromal Cells in a Rodent Ischemic Stroke Model

“…In addition, we used implantable electrical stimulator which can stimulate rats continuously and allow rats to move freely in their home cages. A combination of electrical stimulation and rehabilitation is thought to augment these endogenous plasticity processes [45, 46]. Therefore, rats may have showed more amelioration of motor function due to the merit of stimulation system used in this study.…”

Promoting post-stroke recovery through focal or whole body vibration: criticisms and prospects from a narrative review

“…Conversely, a single subcortical white matter damage would result in cortical differentiation causing widespread cortical dysfunction or severe motor impairment and poor motor recovery [63,64]. Hence, when evaluating the effect of fMV/WBV on post-stroke recovery, it should be taken into account that the efficacy would depend on the specific pattern of brain damage [62]. Only a few sporadic case series have been carried out specifically on this issue.…”

“…Studies evaluating balance before and after WBV found no beneficial effect in chronic stroke patients [59]. Similarly, measures of clinical functional evaluation in chronic stroke patients such as the 6 Minute Walking Test [60,61], Timed Up and Go test [57], and Berg Balance Scale [62] revealed non-significant effects of WBV. Concerning the exact timing of clinical, neurophysiological, or behavioral evaluations before and after WBV, many studies have made the evaluation before and soon after WBV [54,[57][58][59]61] or at 1 month [56, 60] and 6 weeks following WBV [55].…”

Regenerative Rehabilitation for Stroke Recovery by Inducing Synergistic Effects of Cell Therapy and Neurorehabilitation on Motor Function: A Narrative Review of Pre-Clinical Studies

“…The anatomical region that is injured is also thought to be associated with this result [55]. In other words, it has been hypothesized that corticospinal tract integrity is essential for CS to have an effect.…”