Background: Although quite a very few studies have tested structural connectivity changes following an intervention, it reflects only selected key brain regions in the motor network. Thus, the understanding of structural connectivity changes related to the motor recovery process remains unclear. Objective: This study investigated structural connectivity changes of the motor execution network following a combined intervention of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) and intensive occupational therapy (OT) after a stroke using graph theory approach. Methods: Fifty-six stroke patients underwent Fugl-Meyer Assessment (FMA), Wolf Motor Function Test-Functional Ability Scale (WMFT-FAS), diffusion tensor imaging (DTI), and T1 weighted imaging before and after the intervention. We examined graph theory measures related to twenty brain regions using structural connectomes. Results: The ipsilesional and contralesional hemisphere showed structural connectivity changes post-intervention after stroke. We found significantly increased regional centralities and nodal efficiency within the frontal pole and decreased degree centrality and nodal efficiency in the ipsilesional thalamus. Correlations were found between network measures and clinical assessments in the cuneus, postcentral gyrus, precentral gyrus, and putamen of the ipsilesional hemisphere. The contralesional areas such as the caudate, cerebellum, and frontal pole also showed significant correlations. Conclusions: This study was helpful to expand the understanding of structural connectivity changes in both hemispheric networks during the motor recovery process following LF-rTMS and intensive OT after stroke.

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BACKGROUND: The present study developed a head-mounted display with the visual direction of a web camera modified to the right as a left unilateral spatial neglect (USN) model with respect to postural balance control. AIM: We aimed to estimate the validity and reliability of center of pressure (CoP) measurements in static standing balance (SSB) and dynamic standing balance (DSB) of healthy participants were using the USN model and to examine whether this model's use influenced postural balance control. METHOD: A portable CoP force plate was used to quantify postural balance control in 64 healthy participants as the model. The CoP displacement of the non-USN and USN models in the medial-lateral (ML) and anterior-posterior (AP) planes, CoP length, and bilateral load ratio in SSB and DSB to the right (R) and left (L) were evaluated. RESULTS: Regression analysis indicated that most CoP measurements have excellent concurrent validity. Bland–Altman plots showed good agreement between the non-USN and USN models in the CoP measurements. Test-retest reliability estimation between two times measurements varied in the frontal and sagittal planes. A Comparison of the results demonstrated that the CoP-AP and CoP length changed (-1.40% and 7.67%, respectively) significantly in SSB (P<0.05). Moreover, the CoP-AP changed very significantly in DSB-R and DSB-L (-1.50% and 1.86%, respectively) in opposite directions (P<0.01) when the subjects performed as the model. CONCLUSION: CoP measurements are valid and reliable to quantify standing balance control in both non-USN and USN models that appear to modulate changes in postural adaptation and adjustment.

This study aimed to determine the effect of delayed visual feedback on the center of pressure and sitting balance in patients with stroke. [Participants and Methods] This was a single-blinded, randomized crossover trial. The duration of each intervention in real-time visual feedback and delayed visual feedback conditions while sitting on the platform was five days. We measured the center of pressure, function in sitting test, and functional independence measure for physiotherapy assessment. [Results] Twenty patients with stroke were included in this study. The delayed visual feedback condition improved the center of pressure for lateral distance, function in sitting test, and functional independence measure. The lateral center of pressure deviation increased significantly after 500 ms of intervention. The function in sitting test evaluated the interaction between pre-and post-training, and these conditions revealed that timing and condition factors contributed to the improvement. Sitting balance training affected the functional independence measure. [Conclusion] Sensory-motor and cognitive learning was facilitated through balance training with delayed visual feedback, and the internal model was updated with the efference copy of error correction. Sensory-motor feedback to visual stimulation can improve postural control, balance, and activities of daily living.

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Tujuan: Mempelajari pengaruh pelatihan rhythmic auditory stimulation (RAS) terhadap visual cue training (VCT) untuk memperbaiki kemampuan berjalan pasien stroke. Metode: Penelitian bersifat quasi experimental yang melibatkan 20 sampel dengan pembagian 10 sampel kontrol hanya VCT dan 10 sampel perlakuan RAS dan VCT, kemampuan berjalan diukur menggunakan dynamic gait index (DGI). Hasil: Pada kelompok kontrol di uji dengan paired sample test didapatkan nilai sebelum 14,80±1,61 dan sesudah 15,10±1,28, p=0,193 (p>0,05) artinya tidak ditemui perubahan kemampuan berjalan pasien stroke. Pada kelompok perlakuan diuji dengan wilcoxon sign rank test didapatkan nilai sebelum 12,90±2,42 dan sesudah 14,10±1,66, p=0,016 (p<0,05) artinya terdapat perubahan kemampuan berjalan pasien stroke. Pengaruh antara kedua kelompok diuji dengan mann whitney u test didapatkan nilai p=0,030 (p<0,05) artinya ada perbedaan kemampuan berjalan. Kesimpulan: Pelatihan rhythmic auditory stimulation dan visual cue training berpengaruh signifikan terhadap perbaikan kemampuan berjalan pasien stroke.

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