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Plasticity of premotor cortico-muscular coherence in severely impaired stroke patients with hand paralysis.

Abstract Motor recovery in severely impaired stroke patients is often very limited. To refine therapeutic interventions for regaining motor control in this patient group, the functionally relevant mechanisms of neuronal plasticity need to be detected. Cortico-muscular coherence (CMC) may provide physiological and topographic insights to achieve this goal. Synchronizing limb movements to motor-related brain activation is hypothesized to reestablish cortico-motor control indexed by CMC. In the present study, right-handed, chronic stroke patients with right-hemispheric lesions and left hand paralysis participated in a four-week training for their left upper extremity. A brain-robot interface turned event-related beta-band desynchronization of the lesioned sensorimotor cortex during kinesthetic motor-imagery into the opening of the paralyzed hand by a robotic orthosis. Simultaneous MEG/EMG recordings and individual models from MRIs were used for CMC detection and source reconstruction of cortico-muscular connectivity to the affected finger extensors before and after the training program. The upper extremity-FMA of the patients improved significantly from 16.23 ± 6.79 to 19.52 ± 7.91 (p = 0.0015). All patients showed significantly increased CMC in the beta frequency-band, with a distributed, bi-hemispheric pattern and considerable inter-individual variability. The location of CMC changes was not correlated to the severity of the motor impairment, the motor improvement or the lesion volume. Group analysis of the cortical overlap revealed a common feature in all patients following the intervention: a significantly increased level of ipsilesional premotor CMC that extended from the superior to the middle and inferior frontal gyrus, along with a confined area of increased CMC in the contralesional premotor cortex. In conclusion, functionally relevant modulations of CMC can be detected in patients with long-term, severe motor deficits after a brain-robot assisted rehabilitation training. Premotor beta-band CMC may serve as a biomarker and therapeutic target for novel treatment approaches in this patient group.
PMID
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Authors

Mayor MeshTerms

Hand

Keywords

Brain-computer interface

Brain-machine interface

Brain-robot interface

Cortical reorganization

Cortico-spinal coherence

Functional restoration

Hemiparesis

Journal Title neuroimage. clinical
Publication Year Start




PMID- 28409112
OWN - NLM
STAT- MEDLINE
DA  - 20170414
DCOM- 20170420
LR  - 20170420
IS  - 2213-1582 (Electronic)
IS  - 2213-1582 (Linking)
VI  - 14
DP  - 2017
TI  - Plasticity of premotor cortico-muscular coherence in severely impaired stroke
      patients with hand paralysis.
PG  - 726-733
LID - 10.1016/j.nicl.2017.03.005 [doi]
AB  - Motor recovery in severely impaired stroke patients is often very limited. To
      refine therapeutic interventions for regaining motor control in this patient
      group, the functionally relevant mechanisms of neuronal plasticity need to be
      detected. Cortico-muscular coherence (CMC) may provide physiological and
      topographic insights to achieve this goal. Synchronizing limb movements to
      motor-related brain activation is hypothesized to reestablish cortico-motor
      control indexed by CMC. In the present study, right-handed, chronic stroke
      patients with right-hemispheric lesions and left hand paralysis participated in a
      four-week training for their left upper extremity. A brain-robot interface turned
      event-related beta-band desynchronization of the lesioned sensorimotor cortex
      during kinesthetic motor-imagery into the opening of the paralyzed hand by a
      robotic orthosis. Simultaneous MEG/EMG recordings and individual models from MRIs
      were used for CMC detection and source reconstruction of cortico-muscular
      connectivity to the affected finger extensors before and after the training
      program. The upper extremity-FMA of the patients improved significantly from
      16.23 +/- 6.79 to 19.52 +/- 7.91 (p = 0.0015). All patients showed significantly 
      increased CMC in the beta frequency-band, with a distributed, bi-hemispheric
      pattern and considerable inter-individual variability. The location of CMC
      changes was not correlated to the severity of the motor impairment, the motor
      improvement or the lesion volume. Group analysis of the cortical overlap revealed
      a common feature in all patients following the intervention: a significantly
      increased level of ipsilesional premotor CMC that extended from the superior to
      the middle and inferior frontal gyrus, along with a confined area of increased
      CMC in the contralesional premotor cortex. In conclusion, functionally relevant
      modulations of CMC can be detected in patients with long-term, severe motor
      deficits after a brain-robot assisted rehabilitation training. Premotor beta-band
      CMC may serve as a biomarker and therapeutic target for novel treatment
      approaches in this patient group.
FAU - Belardinelli, Paolo
AU  - Belardinelli P
AD  - Division of Functional and Restorative Neurosurgery, Centre for Integrative
      Neuroscience, Eberhard Karls University Tuebingen, Germany.
AD  - Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research,
      Eberhard Karls University Tuebingen, Germany.
FAU - Laer, Leonard
AU  - Laer L
AD  - Division of Functional and Restorative Neurosurgery, Centre for Integrative
      Neuroscience, Eberhard Karls University Tuebingen, Germany.
FAU - Ortiz, Erick
AU  - Ortiz E
AD  - Division of Functional and Restorative Neurosurgery, Centre for Integrative
      Neuroscience, Eberhard Karls University Tuebingen, Germany.
FAU - Braun, Christoph
AU  - Braun C
AD  - MEG Center, Eberhard Karls University Tuebingen, Germany.
FAU - Gharabaghi, Alireza
AU  - Gharabaghi A
AD  - Division of Functional and Restorative Neurosurgery, Centre for Integrative
      Neuroscience, Eberhard Karls University Tuebingen, Germany.
LA  - eng
PT  - Journal Article
DEP - 20170316
PL  - Netherlands
TA  - Neuroimage Clin
JT  - NeuroImage. Clinical
JID - 101597070
SB  - IM
MH  - Adult
MH  - Aged
MH  - Brain Mapping
MH  - Brain-Computer Interfaces
MH  - Electromyography
MH  - Evoked Potentials, Motor/*physiology
MH  - Female
MH  - *Hand
MH  - Humans
MH  - Magnetic Resonance Imaging
MH  - Magnetoencephalography
MH  - Male
MH  - Middle Aged
MH  - Motor Cortex/*physiopathology
MH  - Neuronal Plasticity/*physiology
MH  - Quadriplegia/diagnostic imaging/*etiology/rehabilitation
MH  - Stroke/*complications/diagnostic imaging/pathology
MH  - Stroke Rehabilitation
MH  - Treatment Outcome
PMC - PMC5379882
OTO - NOTNLM
OT  - Brain-computer interface
OT  - Brain-machine interface
OT  - Brain-robot interface
OT  - Cortical reorganization
OT  - Cortico-spinal coherence
OT  - Functional restoration
OT  - Hemiparesis
EDAT- 2017/04/15 06:00
MHDA- 2017/04/21 06:00
CRDT- 2017/04/15 06:00
PHST- 2016/10/30 [received]
PHST- 2017/02/23 [revised]
PHST- 2017/03/15 [accepted]
AID - 10.1016/j.nicl.2017.03.005 [doi]
AID - S2213-1582(17)30065-7 [pii]
PST - epublish
SO  - Neuroimage Clin. 2017 Mar 16;14:726-733. doi: 10.1016/j.nicl.2017.03.005.
      eCollection 2017.

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