Longitudinal Optical Imaging Study for Locomotor Recovery After Stroke

Miyai, Ichiro; Yagura, Hajime; Hatakenaka, Megumi; Oda, Ichiro; Konishi, Ichiro; Kubota, Kisou

doi:10.1161/01.str.0000100166.81077.8a

Cited by 214 publications

(173 citation statements)

References 40 publications

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“…7 The present data combined with the previous findings [2][3][4][5][6] suggest that ipsilateral motor tract is accountable, in part, for the mechanism of such an altered bihemispheric activation in the early stage of locomotor recovery. The enhanced SM1 activation in the affected hemisphere may be one common mechanism underlying motor recovery after stroke.…”

Section: Results Locomotor Function Datasupporting

confidence: 79%

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MRI and EEG findings in Heidenhain variant of Creutzfeldt–Jakob disease

Keyrouz¹,

Labib²,

Sethi³

2006

Neurology

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Abstract-The authors investigated bihemispheric motor network reorganization supporting locomotor recovery after stroke over time. They determined longitudinal changes in locomotor function and fMRI in 10 stroke patients at the subacute stage and the chronic stage. The results suggest that the bihemispheric reorganization mechanism underlying locomotor recovery evolved from the ipsilateral (contralesional) primary sensorimotor cortex (SM1) activation at the subacute stage to the contralateral (ipsilesional) SM1 activation at the chronic stage. Since the introduction of functional neuroimaging techniques, the motor recovery mechanism for stroke patients has been elucidated. 1 In addition, several studies have been reported that cortical activities can change as motor recovery progresses in stroke patients. [2][3][4][5][6] The clarification of such a relationship is important because results of such studies could guide new rehabilitation strategies for stroke patients. The majority of these studies focused on the interval changes with the motor recovery of upper extremity, and little is known about the cortical activation changes concurrent with locomotor recovery in stroke patients. 2-7Therefore, we investigated cortical activity changes occurring during locomotor recovery after stroke, using fMRI.Methods. Subjects. We recruited 10 stroke patients (six men; mean age 50.0 years, SE ϭ 2.7) and age-matched eight normal control subjects (four men; mean age 51.8 years, SE ϭ 2.4). All subjects signed an ethical approval and informed consent form. Inclusion criteria for stroke patients were 1) first-ever stroke, 2) complete loss of muscle strength of the paretic lower extremity at the onset of stroke but recovered to the extent of the ability to move the leg against gravity at least 3 weeks post-stroke, and 3) good locomotor recovery from the subacute to the chronic stage (more than 2 grade on the Modified Motor Assessment Scale [MMAS]).Locomotor function evaluation. Standardized Motoricity Index (MI) (lower extremity only) and MMAS (walking item only) were used to determine locomotor function. MI is a measure of integrity of lower extremity motor function with a maximum score of 100. MMAS was used to assess locomotor function. Each item is scored on a scale from 0 (unable to stand or walk) to 6 (walk up and down four steps). The reliability and validity for the MI and MMAS are well established. 8,9 fMRI. fMRI was performed in stroke patients twice and control subjects once. The first fMRI for stroke patients was performed when the patients were able to extend the knee against gravity (average time, 5.4 weeks), and the second fMRI was performed at 6 months from onset. The subject's head, trunk, pelvis, and hip were secured to prevent any motion artifact using a customized immobilizing frame. The task involved sequential knee flexion-extension with a predetermined angle of 0 to 60 degrees at a metronome-controlled frequency of 0.5 Hz (cycle of 15 seconds of rest and 15 seconds of stimulus).The blood oxygenation level-dep...

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Section: Results Locomotor Function Datasupporting

confidence: 79%

“…The majority of these studies focused on the interval changes with the motor recovery of upper extremity, and little is known about the cortical activation changes concurrent with locomotor recovery in stroke patients. [2][3][4][5][6][7] Therefore, we investigated cortical activity changes occurring during locomotor recovery after stroke, using fMRI.…”

mentioning

confidence: 99%

MRI and EEG findings in Heidenhain variant of Creutzfeldt–Jakob disease

Keyrouz¹,

Labib²,

Sethi³

2006

Neurology

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“…90,91 PET, functional MRI, and TMS 92 has detected functional reorganisation as a patient's sensorimotor and cognitive experience was manipulated, primarily in studies of arm recovery. 26,93 For walking, near-infrared spectroscopy 94 during stepping on a treadmill and functional MRI during ankle dorsiflexion (figure) 85,95,96 serve as markers of traininginduced plasticity. Improved motor control of the leg and faster walking speed were accompanied by recruitment of sensorimotor system neurons and representational changes.…”

Section: Functional Neuroimaging In Rehabilitationmentioning

confidence: 99%

Strategies for stroke rehabilitation

Dobkin

2004

The Lancet Neurology

618

370

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Rehabilitation after hemiplegic stroke has typically relied on the training of patients in compensatory strategies. The translation of neuroscientific research into care has led to new approaches and renewed promise for better outcomes. Improved motor control can progress with task-specific training incorporating increased use of proximal and distal movements during intensive practice of real-world activities. Functional gains are incorrectly said to plateau by 3-6 months. Many patients retain latent sensorimotor function that can be realised any time after stroke with a pulse of goal-directed therapy. The amount of practice probably best determines gains for a given level of residual movement ability. Clinicians should encourage patients to build greater strength, speed, endurance, and precision of multijoint movements on tasks that increase independence and enrich daily activity. Imaging tools may help clinicians determine the capacity of residual networks to respond to a therapeutic approach and help establish optimal dose-response curves for training. Promising adjunct approaches include practice with robotic devices or in a virtual environment, electrical stimulation to increase cortical excitability during training, and drugs to optimise molecular mechanisms for learning. Biological strategies for neural repair may augment rehabilitation in the next decade.Rehabilitation of patients with hemiplegia after stroke has been limited for decades by a lack of theory-driven strategies leading to successful clinical trials with improvement in motor skills for daily activities. Recent therapeutic approaches have begun to build on methods to manipulate the remarkable adaptability or plasticity of the brain in response to task-specific practice, drugs, robotic trainers, and other ways to augment motor learning. 1 In this review, I offer conceptual bases for a clinical science of neurorehabilitation and emphasise mechanisms and procedures to improve walking and arm movement to lessen disability and limitations in daily life. One goal is to diminish the pessimism of physicians regarding the effect of additional rehabilitation and to provide them with sensible advice to offer patients who seek to improve motor skills at any time after stroke. Patients with sensorimotor and visual-field loss are much more dependent on carers than those with pure motor impairments, but even the latter may walk too slowly to participate in out-of-home activities or may be unable to integrate the use of an affected arm into personal care.Rehabilitation for hemiplegic stroke includes organised multidisciplinary, supportive services that begin 48 h after onset in stable patients. Inpatient and outpatient rehabilitation works to the advantage of patients and families in a general sense, but the effectiveness of each component of care falls short of evidence-based practice standards. The training of patients to compensate with the unaffected arm or leg has been a mainstay of rehabilitation. Physical, occupational, and speech therapists ...

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“…Investigators assessed the recovery of walking in eight subjects 3-4 months after a hemiparetic stroke using optical imaging with NIRS (Miyai et al, 2003). Regional activation by foot movements alone during NIRS is similar to that of walking on a treadmill when arm and truncal movements are subtracted out (Miyai et al, 2001).…”

Section: Locomotor Training-induced Plasticitymentioning

confidence: 99%

Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation

et al. 2004

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The ability to walk independently with the velocity and endurance that permit home and community activities is a highly regarded goal for neurological rehabilitation after stroke. This pilot study explored a functional magnetic resonance imaging (fMRI) activation paradigm for its ability to reflect phases of motor learning over the course of locomotor rehabilitation-mediated functional gains. Ankle dorsiflexion is an important kinematic aspect of the swing and initial stance phase of the gait cycle. The motor control of dorsiflexion depends in part on descending input from primary motor cortex. Thus, an fMRI activation paradigm using voluntary ankle dorsiflexion has face validity for the serial study of walking-related interventions. Healthy control subjects consistently engaged contralateral primary sensorimotor cortex (S1M1), supplementary motor area (SMA), premotor (PM) and cingulate motor (CMA) cortices, and ipsilateral cerebellum. Four adults with chronic hemiparetic stroke evolved practice-induced representational plasticity associated with gains in speed, endurance, motor control, and kinematics for walking. For example, an initial increase in activation within the thoracolumbar muscle representation of S1M1 in these subjects was followed by more focused activity toward the foot representation with additional pulses of training. Contralateral CMA and the secondary sensory area also reflected change with practice and gains. We demonstrate that the supraspinal sensorimotor network for the neural control of walking can be assessed indirectly by ankle dorsiflexion. The ankle paradigm may serve as an ongoing physiological assay of the optimal type, duration, and intensity of rehabilitative gait training.

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Longitudinal Optical Imaging Study for Locomotor Recovery After Stroke

Abstract: Locomotor recovery after stroke may be associated with improvement of asymmetry in SMC activation and enhanced PMC activation in the affected hemisphere.

Cited by 214 publications

References 40 publications

MRI and EEG findings in Heidenhain variant of Creutzfeldt–Jakob disease

MRI and EEG findings in Heidenhain variant of Creutzfeldt–Jakob disease

Strategies for stroke rehabilitation

Ankle dorsiflexion as an fMRI paradigm to assay motor control for walking during rehabilitation

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