The cortical control of cycling exercise in stroke patients: An fNIRS study

Abstract

Stroke survivors suffering from deficits in motor control typically have limited functional abilities, which could result in poor quality of life. Cycling exercise is a common training paradigm for restoring locomotion rhythm in patients. The provision of speed feedback has been used to facilitate the learning of controlled cycling performance and the neuromuscular control of the affected leg. However, the central mechanism for motor relearning of active and passive pedaling motions in stroke patients has not been investigated as extensively. The aim of this study was to measure the cortical activation patterns during active cycling with and without speed feedback and during power-assisted (passive) cycling in stroke patients. A frequency-domain near-infrared spectroscopy (FD-NIRS) system was used to detect the hemodynamic changes resulting from neuronal activity during the pedaling exercise from the bilateral sensorimotor cortices (SMCs), supplementary motor areas (SMAs), and premotor cortices (PMCs). The variation in cycling speed and the level of symmetry of muscle activation of bilateral rectus femoris were used to evaluate cycling performance. The results showed that passive cycling had a similar cortical activation pattern to that observed during active cycling without feedback but with a smaller intensity of the SMC of the unaffected hemisphere. Enhanced PMC activation of the unaffected side with improved cycling performance was observed during active cycling with feedback, with respect to that observed without feedback. This suggests that the speed feedback enhanced the PMC activation and improved cycling performance in stroke patients.

Review of functional near-infrared spectroscopy in neurorehabilitation

“…These findings suggested that the unaffected premotor activation may play a compensative role in stroke recovery. 39 However, the pattern of functional reorganization is not uniform and may vary with the type of lesion or symptom of each patient. In patients with stroke with ataxia, gait-related activation in the medial SMC is comparable to that of healthy subjects.…”

The effects of post-stroke upper-limb training with an electromyography (EMG)-driven hand robot

“…The system can help the paretic hand perform hand grasp and release according to a subject's voluntary motor intention detected by EMG signal from the residual muscles of the affected side, meanwhile the subject also can conduct the whole upper limb movement at the same time, such as reaching. Voluntary physical experience is a major modulator for the neural plasticity in the nervous system after stroke (Jiang et al, 2013;Lin et al, 2012Lin et al, , 2009Miyai et al, 2006;Takeuchi and Izumi, 2013;Ding et al, 2011). Involvement of voluntary efforts during rehabilitation training has been found to be more effective than those only with passive motions (Volpe et al, 2004).…”

“…Reorganization of surviving neural networks in the brain rather than repair of the damaged tissue is the key for motor functional restoration after stroke, which depends on repeated and intensive physical practice of the paretic limb on the motor skills to be restored (Lin et al, 2012(Lin et al, , 2009Miyai et al, 2006;Murata et al, 2006;Dijkhuizen et al, 2012;Takeuchi and Izumi, 2013). Therefore, physical training related to daily tasks has been widely adopted in post-stroke rehabilitation (Tan et al, 2012).…”

Passive cycling in neurorehabilitation after spinal cord injury: A review

“…A frequency-domain near-infrared spectroscopy (FD-NIRS) system was used in stroke patients to detect the hemodynamic changes resulting from neuronal activity during the pedaling exercise from the bilateral SMCs, SMAs, and PMCs. 55 The results showed that PC had a cortical activation pattern similar to that observed during active cycling without feedback but with a smaller intensity in the SMC of the unaffected hemisphere.…”