Abstract:Objective. This study assesses upper limb recovery prognosis after stroke with solely physiological information, which can provide an objective estimation of recovery. Approach. Clinical recovery was forecasted using EEG-derived Event-Related Desynchronization/Synchronization and coherence, in addition to Transcranial Magnetic Stimulation elicited motor-evoked potentials and upper limb grip and pinch strength. A Regression Tree Ensemble predicted clinical recovery of a stroke database (n = 10) measured after a… Show more
“…We observed a moderate correlation between the MVF-induced high-beta ERD over the ipsilesional SMC at baseline and the improvement of FMA-UE. That result was similar to the findings in a previous study showing that the sensorimotor ERD in beta rhythm was the best marker for predicting the improvement scores of FMA-UE after stroke, 46 and our data further suggested that the higher range of beta rhythm may be more sensitive to the therapeutic response to rehabilitative training in patients with stroke. The SMC activation over the ipsilesional hemisphere elicited by MVF may be relevant to the capacity for use of sensory modalities that are supportive of motor learning, 16 thus causing it to be associated with the level of improvement after training.…”
BACKGROUND:
Intermittent theta burst stimulation (iTBS) creates a state with increased excitability that permits treatment modalities to induce neuroplasticity and motor learning. Continuous theta burst stimulation before iTBS may induce metaplasticity and boost the facilitatory effect of iTBS. This study investigated the effects of priming iTBS (ie, applying continuous theta burst stimulation before iTBS) on poststroke hemiparetic upper limb recovery.
METHODS:
In this randomized controlled trial, 42 patients with chronic stroke were recruited and randomly allocated to 10 sessions of either priming iTBS, nonpriming iTBS, or sham stimulation to the ipsilesional motor cortex, immediately before robot-assisted training. Outcomes included Fugl-Meyer Assessment-Upper Extremity, Action Research Arm Test and mean movement velocity during each robot-assisted training session. Twenty-one patients were enrolled for measuring the sensorimotor beta event-related desynchronization induced by either mirror visual feedback or movement.
RESULTS:
The Fugl-Meyer Assessment-Upper Extremity scores revealed a significant time-by-group interaction (
P
=0.011). Priming and nonpriming iTBS were both superior to sham stimulation in post hoc comparisons; however, the superiority was diminished at follow-up. Among patients with a higher functioning upper limb, priming iTBS yielded a significantly greater improvement in Fugl-Meyer Assessment-Upper Extremity scores than nonpriming iTBS (
P
=0.025) and sham stimulation (
P
=0.029) did. No significant interaction was found when analyzing the Action Research Arm Test and mean movement velocity. Priming iTBS enhanced the patients’ mirror visual feedback–induced high beta sensorimotor event-related desynchronization over their ipsilesional hemisphere.
CONCLUSIONS:
Priming and nonpriming iTBS are both superior to sham stimulation in enhancing treatment gains from robot-assisted training, and patients with a higher functioning upper limb may experience more benefits from priming iTBS. Priming iTBS may facilitate poststroke motor learning by enhancing the permissiveness of the ipsilesional sensorimotor area to therapeutic sensory modalities, such as the mirror visual feedback.
REGISTRATION:
URL:
https://www.clinicaltrials.gov;
Unique identifier: NCT04034069.
“…We observed a moderate correlation between the MVF-induced high-beta ERD over the ipsilesional SMC at baseline and the improvement of FMA-UE. That result was similar to the findings in a previous study showing that the sensorimotor ERD in beta rhythm was the best marker for predicting the improvement scores of FMA-UE after stroke, 46 and our data further suggested that the higher range of beta rhythm may be more sensitive to the therapeutic response to rehabilitative training in patients with stroke. The SMC activation over the ipsilesional hemisphere elicited by MVF may be relevant to the capacity for use of sensory modalities that are supportive of motor learning, 16 thus causing it to be associated with the level of improvement after training.…”
BACKGROUND:
Intermittent theta burst stimulation (iTBS) creates a state with increased excitability that permits treatment modalities to induce neuroplasticity and motor learning. Continuous theta burst stimulation before iTBS may induce metaplasticity and boost the facilitatory effect of iTBS. This study investigated the effects of priming iTBS (ie, applying continuous theta burst stimulation before iTBS) on poststroke hemiparetic upper limb recovery.
METHODS:
In this randomized controlled trial, 42 patients with chronic stroke were recruited and randomly allocated to 10 sessions of either priming iTBS, nonpriming iTBS, or sham stimulation to the ipsilesional motor cortex, immediately before robot-assisted training. Outcomes included Fugl-Meyer Assessment-Upper Extremity, Action Research Arm Test and mean movement velocity during each robot-assisted training session. Twenty-one patients were enrolled for measuring the sensorimotor beta event-related desynchronization induced by either mirror visual feedback or movement.
RESULTS:
The Fugl-Meyer Assessment-Upper Extremity scores revealed a significant time-by-group interaction (
P
=0.011). Priming and nonpriming iTBS were both superior to sham stimulation in post hoc comparisons; however, the superiority was diminished at follow-up. Among patients with a higher functioning upper limb, priming iTBS yielded a significantly greater improvement in Fugl-Meyer Assessment-Upper Extremity scores than nonpriming iTBS (
P
=0.025) and sham stimulation (
P
=0.029) did. No significant interaction was found when analyzing the Action Research Arm Test and mean movement velocity. Priming iTBS enhanced the patients’ mirror visual feedback–induced high beta sensorimotor event-related desynchronization over their ipsilesional hemisphere.
CONCLUSIONS:
Priming and nonpriming iTBS are both superior to sham stimulation in enhancing treatment gains from robot-assisted training, and patients with a higher functioning upper limb may experience more benefits from priming iTBS. Priming iTBS may facilitate poststroke motor learning by enhancing the permissiveness of the ipsilesional sensorimotor area to therapeutic sensory modalities, such as the mirror visual feedback.
REGISTRATION:
URL:
https://www.clinicaltrials.gov;
Unique identifier: NCT04034069.
“…The other 2 papers used a standardized treatment in which all patients received the same dose of a particular treatment (auditory discrimination training 46 and mechanical endovascular therapy 47 ) (Figure 3). The other 12 papers with mean EEG time >2 months post-stroke used a standardized upper extremity treatment including standardized manual motor rehabilitation, 48-52 visuomotor tracking training, 53 virtual reality training, 43 brain–computer interface training, 39,54 semantic/phonological-based therapy, 55 and robot assisted therapy. 56,57 Figure 3.Distribution of papers per study characteristics, including time since stroke, EEG protocol, EEG variable type, outcome domain, and outcome measure shows a lack of uniformity.…”
Section: Resultsmentioning
confidence: 99%
“…EEG was obtained for both clinical [58][59][60][61][62][63][64][65] (n = 8 papers) and research [33][34][35][36][37][38][39][40][41][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57] (n = 67 papers) purposes. Of 63 papers with mean EEG time ≤2 months post-stroke, 47 papers obtained EEG during rest, 1 paper obtained EEG during upper limb movement, and 15 papers obtained EEG response to stimuli, the majority being electrical nerve stimulation in 9 papers (Figure 3).…”
Section: Eeg Protocolmentioning
confidence: 99%
“…48,59,64,73,83,90,92,107 In 7 papers, EEG further separated patients with good or poor prognosis after the consideration of the initial clinical score. 38,45,54,65,99,102,104 In 6 papers, EEG correlated with outcome while initial clinical score did not. 49,52,60,80,81,91 Mixed results were found in 6 papers, where EEG enhanced prognostic ability of conventional predictors only for some EEG variables, 78,84 EEG time, 33 subgroup, 72 outcome domain, 74 and analysis method.…”
Background Improved ability to predict patient recovery would guide post-stroke care by helping clinicians personalize treatment and maximize outcomes. Electroencephalography (EEG) provides a direct measure of the functional neuroelectric activity in the brain that forms the basis for neuroplasticity and recovery, and thus may increase prognostic ability. Objective To examine evidence for the prognostic utility of EEG in stroke recovery via systematic review/meta-analysis. Methods Peer-reviewed journal articles that examined the relationship between EEG and subsequent clinical outcome(s) in stroke were searched using electronic databases. Two independent researchers extracted data for synthesis. Linear meta-regressions were performed across subsets of papers with common outcome measures to quantify the association between EEG and outcome. Results 75 papers were included. Association between EEG and clinical outcomes was seen not only early post-stroke, but more than 6 months post-stroke. The most studied prognostic potential of EEG was in predicting independence and stroke severity in the standard acute stroke care setting. The meta-analysis showed that EEG was associated with subsequent clinical outcomes measured by the Modified Rankin Scale, National Institutes of Health Stroke Scale, and Fugl-Meyer Upper Extremity Assessment (r = .72, .70, and .53 from 8, 13, and 12 papers, respectively). EEG improved prognostic abilities beyond prediction afforded by standard clinical assessments. However, the EEG variables examined were highly variable across studies and did not converge. Conclusions EEG shows potential to predict post-stroke recovery outcomes. However, evidence is largely explorative, primarily due to the lack of a definitive set of EEG measures to be used for prognosis.
“…Rihui et al reported the FC in the ipsilateral hemispheric premotor cortex was positively correlated with the motor recovery after a 4-week intervention [21]. Using coherence measures, Ruben et al reported that FCs in the somatosensory cortex of the unaffected hemisphere associated with clinical recovery of stroke patients at 2 months, which reflected the importance of contralateral hemispheric FC integrity in prognosing rehabilitation of upper limb [39]. Although the literature showed that using FCs from specific ROIs could indicate motor recovery.…”
Stroke often leads to permanent impairment in motor function. Accurate and quantitative prognosis of potential motor recovery before rehabilitation intervention can help healthcare centers improve resources organization and enable individualized intervention. The context of this paper investigated the potential of using electroencephalography (EEG) functional connectivity (FC) measures as biomarkers for assessing and prognosing improvement of Fugl-Meyer Assessment in upper extremity motor function (𝜟𝑭𝑴𝑼) among participants with chronic stroke. EEG data from resting and motor imagery task were recorded from 13 participants with chronic stroke. Three functional connectivity methods, which were Pearson correlation measure (PCM), weighted Phase Lag Index (wPLI) and phase synchronization index (PSI), were investigated, under three regions of interest (interhemispheric, intra-hemispheric, and whole-brain), in two statues (resting and motor imagery), with 15 refined center frequencies. We applied correlation analysis to identify the optimal center frequencies and pairs of synchronized channels that were consistently associated with 𝜟𝑭𝑴𝑼 . Predictive models were generated using regression analysis algorithms based on optimized center frequencies and channel pairs identified from the proposed analysis method, with leave-one-out cross-validation. We found that PSI in the Alpha band (with center frequency of 9Hz) was the most sensitive FC measures for prognosing motor recovery. Strong and significant correlations were identified between the predictions and actual 𝜟𝑭𝑴𝑼 scores both in the resting state (R 2 =0.79, P<0.001, N=13) and motor imagery (R 2 =0.65, P<0.001, N=13). Our results suggested that EEG connectivity measured with PSI in resting state could be a promising biomarker for quantifying motor recovery before motor rehabilitation intervention.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
