Sensorimotor cortex reorganization in subacute and chronic stroke: A neuronavigated TMS study

Yarossi, Mathew; Adamovich, Sergei V.; Tunik, Eugene

doi:10.1109/embc.2014.6944943

Cited by 15 publications

(11 citation statements)

References 17 publications

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“…In particular, it has been shown that an intact position sense following stroke strongly correlates with the likelihood of motor recovery of the hemiplegic arm (Kusoffsky et al, 1982 ; Smith et al, 1983 ; Rand et al, 1999 ; Schabrun and Hillier, 2009 ). This is further supported by the recent neurophysiological finding that sensory input is integral in the preservation of cortical representation in both motor and sensory areas (Schabrun and Hillier, 2009 ; Chieffo et al, 2013 ; Yarossi et al, 2014 ). Indeed, the absence or reduction of sensory input in stroke subjects is known to bring about learned non-use and impaired or lost ability to react to or process sensory stimuli in the space contralateral to the brain lesion, a condition referred to as unilateral spatial neglect (Taub and Berman, 1963 ; Kerkhoff and Rossetti, 2006 ).…”

Section: Introductionmentioning

confidence: 59%

Robot-Assisted Training of the Kinesthetic Sense: Enhancing Proprioception after Stroke

Santis

Zenzeri

Casadio

et al. 2015

Front. Hum. Neurosci.

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Proprioception has a crucial role in promoting or hindering motor learning. In particular, an intact position sense strongly correlates with the chances of recovery after stroke. A great majority of neurological patients present both motor dysfunctions and impairments in kinesthesia, but traditional robot and virtual reality training techniques focus either in recovering motor functions or in assessing proprioceptive deficits. An open challenge is to implement effective and reliable tests and training protocols for proprioception that go beyond the mere position sense evaluation and exploit the intrinsic bidirectionality of the kinesthetic sense, which refers to both sense of position and sense of movement. Modulated haptic interaction has a leading role in promoting sensorimotor integration, and it is a natural way to enhance volitional effort. Therefore, we designed a preliminary clinical study to test a new proprioception-based motor training technique for augmenting kinesthetic awareness via haptic feedback. The feedback was provided by a robotic manipulandum and the test involved seven chronic hemiparetic subjects over 3 weeks. The protocol included evaluation sessions that consisted of a psychometric estimate of the subject’s kinesthetic sensation, and training sessions, in which the subject executed planar reaching movements in the absence of vision and under a minimally assistive haptic guidance made by sequences of graded force pulses. The bidirectional haptic interaction between the subject and the robot was optimally adapted to each participant in order to achieve a uniform task difficulty over the workspace. All the subjects consistently improved in the perceptual scores as a consequence of training. Moreover, they could minimize the level of haptic guidance in time. Results suggest that the proposed method is effective in enhancing kinesthetic acuity, but the level of impairment may affect the ability of subjects to retain their improvement in time.

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Section: Introductionmentioning

confidence: 59%

Robot-Assisted Training of the Kinesthetic Sense: Enhancing Proprioception after Stroke

Santis

Zenzeri

Casadio

et al. 2015

Front. Hum. Neurosci.

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“…In addition to NMSE, we computed several common map features as outcome measures: map volume, map area, and center of gravity in both the rostral-caudal plane (denoted COGx1) and in the medial-lateral plane (COGx2). Map volume and map area were calculated using double trapezoidal integration of the interpolated maps [44]. COGx1 and COGx2 were computed using standard equations [42].…”

Section: Assessment Of Accuracy Of the Sampling Methodsmentioning

confidence: 99%

Efficient TMS-Based Motor Cortex Mapping Using Gaussian Process Active Learning

Faghihpirayesh

Yarossi

Imbiriba

et al. 2021

IEEE Trans. Neural Syst. Rehabil. Eng.

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Transcranial Magnetic Stimulation (TMS) can be used to map cortical motor topography by spatially sampling the sensorimotor cortex while recording Motor Evoked Potentials (MEP) with surface electromyography (EMG). Traditional sampling strategies are time-consuming and inefficient, as they ignore the fact that responsive sites are typically sparse and highly spatially correlated. An alternative approach, commonly employed when TMS mapping is used for presurgical planning, is to leverage the expertise of the coil operator to use MEPs elicited by previous stimuli as feedback to decide which loci to stimulate next. In this paper, we propose to automatically infer optimal future stimulus loci using active learning Gaussian Process-based sampling in place of user expertise. We first compare the user-guided (USRG) method to the traditional grid selection method and randomized sampling to verify that the USRG approach has superior performance. We then compare several novel active Gaussian Process (GP) strategies with the USRG approach. Experimental results using real data show that, as expected, the USRG method is superior to the grid and random approach in both time efficiency and MEP map accuracy. We also found that an active warped GP entropy and a GP random-based strategy performed equally as well as, or even better than, the USRG method. These methods were completely automatic, and succeeded in efficiently sampling the regions in which the MEP response variations are largely confined. This work provides the foundation for highly efficient, fully automatized TMS mapping, especially when considered in the context of advances in robotic coil operation.

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“…MEP amplitudes and stimulation points were interpolated to a 7 × 7 cm mesh of 0.375 mm resolution (centered on the M1 hotspot) using cubic surface interpolation [52, 53] allowing comparisons across maps and sessions. Extent of the representation producing corticospinal output (MEPs) for individual muscles, or map area, was calculated using double trapezoidal integration of the interpolated map [43].…”

Section: Methodsmentioning

confidence: 99%

Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study

Patel

Fluet

Qiu

et al. 2019

J NeuroEngineering Rehabil

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Background There is conflict regarding the benefits of greater amounts of intensive upper limb rehabilitation in the early period post-stroke. This study was conducted to test the feasibility of providing intensive therapy during the early period post-stroke and to develop a randomized control trial that is currently in process. Specifically, the study investigated whether an additional 8 h of specialized, intensive (200–300 separate hand or arm movements per hour) virtual reality (VR)/robotic based upper limb training introduced within 1-month post-stroke resulted in greater improvement in impairment and behavior, and distinct changes in cortical reorganization measured via Transcranial Magnetic Stimulation (TMS), compared to that of a control group. Methods Seven subjects received 8–1 h sessions of upper limb VR/robotic training in addition to their inpatient therapy (PT, OT, ST). Six subjects only received their inpatient therapy. All were tested on measures of impairment [Upper Extremity Fugl-Meyer Assessment (UEFMA), Wrist AROM, Maximum Pinch Force], behavior [Wolf Motor Function Test (WMFT)], and also received TMS mapping until 6 months post training. ANOVAs were conducted to measure differences between groups across time for all outcome measures. Associations between changes in ipsilesional cortical maps during the early period of enhanced neuroplasticity and long-term changes in upper limb impairment and behavior measures were evaluated. Results The VR/robotic group made significantly greater improvements on UEFMA and Wrist AROM scores compared to the usual care group. There was also less variability in the association between changes in the First Dorsal Interosseus (FDI) muscle map area and WMFT and Maximum Force change scores for the VR/robotic group. Conclusions An additional 8 h of intensive VR/robotic based upper limb training initiated within the first month post-stroke may promote greater gains in impairment compared to usual care alone. Importantly, the data presented demonstrated the feasibility of conducting this intervention and multiple outcome measures (impairment, behavioral, neurophysiological) in the early period post-stroke.

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Sensorimotor cortex reorganization in subacute and chronic stroke: A neuronavigated TMS study

Cited by 15 publications

References 17 publications

Robot-Assisted Training of the Kinesthetic Sense: Enhancing Proprioception after Stroke

Robot-Assisted Training of the Kinesthetic Sense: Enhancing Proprioception after Stroke

Efficient TMS-Based Motor Cortex Mapping Using Gaussian Process Active Learning

Intensive virtual reality and robotic based upper limb training compared to usual care, and associated cortical reorganization, in the acute and early sub-acute periods post-stroke: a feasibility study

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