Targeted Vagus Nerve Stimulation for Rehabilitation After Stroke

Frontiers in Neuroscience, Journal Year: 2019, Volume and Issue: 13

Published: March 29, 2019

Stroke is a leading cause of disability worldwide, and in approximately 60% individuals, upper limb deficits persist 6 months after stroke. These adversely affect the functional use restrict participation day to activities. An important goal stroke rehabilitation improve quality life by enhancing independence Since are one best predictors stroke, effective interventions targeting these may represent means life. increased understanding neurobiological processes underlying recovery has led development targeted approaches motor deficits. One such strategy uses brief bursts Vagus Nerve Stimulation (VNS) paired with enhance plasticity support function chronic vagus nerve triggers release promoting neuromodulators, as acetylcholine norepinephrine, throughout cortex. Timed engagement neuromodulators concurrent training drives task-specific cortex provides basis for VNS therapy. A number studies preclinical models ischemic demonstrated that rehabilitative significantly improved forelimb compared without VNS. The improvements were associated synaptic reorganization cortical networks recruitment residual neurons controlling impaired forelimb, demonstrating putative mechanisms function. provided conducting two multi-site, randomized controlled pilot trials individuals moderate severe weakness In both studies, alone. 120-patient pivotal study designed evaluate efficacy therapy This manuscript will discuss rationale therapy, provide an in-depth discussion animal human outline challenges opportunities future

Language: Английский

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Putting the “Sensory” Into Sensorimotor Control: The Role of Sensorimotor Integration in Goal-Directed Hand Movements After Stroke

Frontiers in Integrative Neuroscience, Journal Year: 2019, Volume and Issue: 13

Published: May 22, 2019

Integration of sensory and motor information is one-step, among others, that underlies the successful production goal-directed hand movements necessary for interacting with our environment. Disruption sensorimotor integration prevalent in many neurologic disorders, including stroke. In most stroke survivors, persistent paresis reduces function overall quality life. Current rehabilitative methods are based on neuroplastic principles to promote learning focus regaining lost due paresis, but contributions control often overlooked currently understudied. There a need evaluate understand contribution both rehabilitation skilled after Here, we will highlight importance produce healthy individuals We then discuss how compromised influences relearning Finally, propose an approach target through manipulation input output may have therapeutic implications.

Language: Английский

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Priming Intermittent Theta Burst Stimulation for Hemiparetic Upper Limb After Stroke: A Randomized Controlled Trial

Stroke, Journal Year: 2022, Volume and Issue: 53(7), P. 2171 - 2181

Published: March 23, 2022

Intermittent theta burst stimulation (iTBS) creates a state with increased excitability that permits treatment modalities to induce neuroplasticity and motor learning. Continuous before iTBS may metaplasticity boost the facilitatory effect of iTBS. This study investigated effects priming (ie, applying continuous iTBS) on poststroke hemiparetic upper limb recovery.In this randomized controlled trial, 42 patients chronic stroke were recruited randomly allocated 10 sessions either iTBS, nonpriming or sham ipsilesional cortex, immediately robot-assisted training. Outcomes included Fugl-Meyer Assessment-Upper Extremity, Action Research Arm Test mean movement velocity during each training session. Twenty-one enrolled for measuring sensorimotor beta event-related desynchronization induced by mirror visual feedback movement.The Extremity scores revealed significant time-by-group interaction (P=0.011). Priming both superior in post hoc comparisons; however, superiority was diminished at follow-up. Among higher functioning limb, yielded significantly greater improvement than (P=0.025) (P=0.029) did. No found when analyzing velocity. enhanced patients' feedback-induced high over their hemisphere.Priming are enhancing gains from training, experience more benefits facilitate learning permissiveness area therapeutic sensory modalities, such as feedback.URL: https://www.gov; Unique identifier: NCT04034069.

Language: Английский

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Bridging Minds and Machines: The Recent Advances of Brain-Computer Interfaces in Neurological and Neurosurgical Applications

World Neurosurgery, Journal Year: 2024, Volume and Issue: 189, P. 138 - 153

Published: May 22, 2024

Brain-computer interfaces (BCIs), a remarkable technological advancement in neurology and neurosurgery, mark significant leap since the inception of electroencephalography 1924. These effectively convert central nervous system signals into commands for external devices, offering revolutionary benefits to patients with severe communication motor impairments due myriad neurological conditions like stroke, spinal cord injuries, neurodegenerative disorders. BCIs enable these individuals communicate interact their environment, using brain operate environmental control. This technology is especially crucial those completely locked in, providing lifeline where other methods fall short. The advantages are profound, autonomy an improved quality life disabilities. They allow direct interaction various devices prostheses, bypassing damaged or nonfunctional neural pathways. However, challenges persist, including complexity accurately interpreting signals, need individual calibration, ensuring reliable, long-term use. Additionally, ethical considerations arise regarding autonomy, consent, potential dependence on technology. Despite challenges, represent transformative development neurotechnology, promising enhanced patient outcomes deeper understanding brain-machine interfaces.

Language: Английский

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Does hand robotic rehabilitation improve motor function by rebalancing interhemispheric connectivity after chronic stroke? Encouraging data from a randomised-clinical-trial

Clinical Neurophysiology, Journal Year: 2019, Volume and Issue: 130(5), P. 767 - 780

Published: March 15, 2019

Language: Английский

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Is Recovery of Somatosensory Impairment Conditional for Upper-Limb Motor Recovery Early After Stroke?

Neurorehabilitation and neural repair, Journal Year: 2020, Volume and Issue: 34(5), P. 403 - 416

Published: May 1, 2020

Background. Spontaneous recovery early after stroke is most evident during a time-sensitive window of heightened neuroplasticity, known as spontaneous neurobiological recovery. It unknown whether poststroke upper-limb motor and somatosensory impairment both reflect or if and/or influences Methods. Motor (Fugl-Meyer upper-extremity [FM-UE]) impairments (Erasmus modification the Nottingham Sensory Assessment [EmNSA-UE]) were measured in 215 patients within 3 weeks at 5, 12, 26 first-ever ischemic stroke. The longitudinal association between FM-UE EmNSA-UE was examined with (FM-UE ≤ 60 37) baseline. Results. A total 94 included analysis. increased significantly up to 12 poststroke. disappeared when correcting for progress time not different severe baseline impairment. Patients score ≥18 (n = 55) showed significant positive impairments, irrespective time. Conclusions. Progress time, reflection recovery, an important factor that drives well first Severe does directly compromise study rather suggests prerequisite full upper paretic limb.

Language: Английский

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Point of View on Outcome Prediction Models in Post-Stroke Motor Recovery

Neurorehabilitation and neural repair, Journal Year: 2024, Volume and Issue: 38(5), P. 386 - 398

Published: March 18, 2024

Stroke is a leading cause of disability worldwide which can significant and persistent upper limb (UL) impairment. It difficult to predict UL motor recovery after stroke forecast the expected outcomes rehabilitation interventions during acute subacute phases when using clinical data alone. Accurate prediction response treatment could allow for more timely targeted interventions, thereby improving recovery, resource allocation, reducing economic impact post-stroke disability. Initial impairment currently strongest predictor recovery. Despite progress, current models be refined with additional predictors, an emphasis on time dependency patient-specific predictions profiles. In paper panel experts provide their opinion predictors aspects literature that help advance outcome models. Potential strategies include close attention collection timeframes adoption individual-computerized modeling methods connected patient’s health record. These should account non-linear variable pattern spontaneous neurological Additionally, input extended cognitive, genomic, sensory, neural injury, function measures as The accuracy may further improved by including standardized outcome. Finally, we consider potential healthcare costs.

Language: Английский

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Applicability of the grip strength and automated von Frey tactile sensitivity tests in the mouse photothrombotic model of stroke

Behavioural Brain Research, Journal Year: 2017, Volume and Issue: 336, P. 250 - 255

Published: Sept. 9, 2017

Language: Английский

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Repetitive Peripheral Sensory Stimulation and Upper Limb Performance in Stroke: A Systematic Review and Meta-analysis

Neurorehabilitation and neural repair, Journal Year: 2018, Volume and Issue: 32(10), P. 863 - 871

Published: Sept. 10, 2018

Background. Enhancement of sensory input in the form repetitive peripheral stimulation (RPSS) can enhance excitability motor cortex and upper limb performance. Objective. To perform a systematic review meta-analysis effects RPSS compared with control on improvement outcomes subjects stroke. Methods. We searched studies published between 1948 December 2017 selected 5 that provided individual data applied specific paradigm (trains 1-ms pulses at 10 Hz, delivered 1 Hz). Continuous were analyzed means standard deviations differences performance before after active or interventions. Adverse events also assessed. Results. There was statistically significant beneficial effect (standard mean difference RPSS, 0.67; 95% CI, 0.09-1.24; I 2 = 65%). Only study included subacute phase Subgroup analysis only chronic showed (1.04; 0.66-1.42) no heterogeneity. Significant results obtained for body structure function as well activity limitation according to International Classification Function, Disability Health, when analyzed. No serious adverse reported. Conclusions. is safe intervention potential become an adjuvant tool extremity paresis rehabilitation stroke phase.

Language: Английский

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Transcutaneous Auricular Vagus Nerve Stimulation with Upper Limb Repetitive Task Practice May Improve Sensory Recovery in Chronic Stroke

Journal of Stroke and Cerebrovascular Diseases, Journal Year: 2019, Volume and Issue: 28(12), P. 104348 - 104348

Published: Sept. 27, 2019

Language: Английский

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