Functional and structural cortical characteristics after restricted focal motor cortical infarction evaluated at chronic stage – Indications from a preliminary study

Julkunen, Petro; Määttä, Sara; Säïsänen, Laura; Kallioniemi, Elisa; Könönen, Mervi; Jäkälä, Pekka; Vanninen, Ritva; Vaalto, Selja

doi:10.1016/j.clinph.2016.05.013

Cited by 12 publications

(7 citation statements)

References 71 publications

(91 reference statements)

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“…TMS studies confirm that increased contralesional M1 activity as compared to the ipsilesional M1 is associated with lesser clinical outcome. Some TMS research suggests that for some well-recovered stroke patients contralesional corticomotor excitability does not decrease, but rather only the ipsilesional corticomotor excitability increases with recovery (Stinear et al, 2015 ) and often the interhemispheric asymmetry within M1 persists even years after stroke (Julkunen et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, although TMS of only the ipsilesional hemisphere of well-recovered stroke patients, and not the contralesional, induced motor-evoked potentials in Nair et al, TMS did reveal greater transcallosal inhibition from the contralesional to the ipsilesional hemisphere than in the reverse direction (Nair et al, 2007 ). In Julkunen et al, TMS in conjunction with diffusion weighted imaging revealed that inter-hemispheric asymmetry in the M1 persists even years after stroke for well-recovered patients where clinical symptoms have normalized (Julkunen et al, 2016 ). These findings, along with a number of noninvasive brain stimulation studies that report null effects, suggest that the aim to strictly normalize the interhemispheric balance may be over-simplistic (Di Pino et al, 2014 ).…”

Section: The Role Of the Contralesional And Ipsilesional Hemispheres mentioning

confidence: 99%

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Role of the Contralesional vs. Ipsilesional Hemisphere in Stroke Recovery

Dodd

Nair

Prabhakaran

2017

Front. Hum. Neurosci.

167

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Following a stroke, the resulting lesion creates contralateral motor impairment and an interhemispheric imbalance involving hyperexcitability of the contralesional hemisphere. Neuronal reorganization may occur on both the ipsilesional and contralesional hemispheres during recovery to regain motor functionality and therefore bilateral activation for the hemiparetic side is often observed. Although ipsilesional hemispheric reorganization is traditionally thought to be most important for successful recovery, definitive conclusions into the role and importance of the contralesional motor cortex remain under debate. Through examining recent research in functional neuroimaging investigating motor cortex changes post-stroke, as well as brain-computer interface (BCI) and transcranial magnetic stimulation (TMS) therapies, this review attempts to clarify the contributions of each hemisphere toward recovery. Several functional magnetic resonance imaging studies suggest that continuation of contralesional hemisphere hyperexcitability correlates with lesser recovery, however a subset of well-recovered patients demonstrate contralesional motor activity and show decreased functional capability when the contralesional hemisphere is inhibited. BCI therapy may beneficially activate either the contralesional or ipsilesional hemisphere, depending on the study design, for chronic stroke patients who are otherwise at a functional plateau. Repetitive TMS used to excite the ipsilesional motor cortex or inhibit the contralesional hemisphere has shown promise in enhancing stroke patients' recovery.

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Section: Discussionmentioning

confidence: 99%

Section: The Role Of the Contralesional And Ipsilesional Hemispheres mentioning

confidence: 99%

Role of the Contralesional vs. Ipsilesional Hemisphere in Stroke Recovery

Dodd

Nair

Prabhakaran

2017

Front. Hum. Neurosci.

167

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“…However, the role of the ipsilesional vs. contralesional hemispheres on stroke recovery depends on the size and location of the infarct (for review see [82]) and timing of rehabilitation can profoundly alter outcome [40,83]. Because structural and functional asymmetries persist in well-recovered stroke patients even after clinical symptoms have normalized [84], more systematic approaches are required to unravel causal influences for differences in outcome.…”

Section: Interhemispheric Influences On Recovery and Implications To Clinical Strokementioning

confidence: 99%

Homotopic contralesional excitation suppresses spontaneous circuit repair and global network reconnections following ischemic stroke

Bice

Xiao

Kong

et al. 2021

Preprint

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Understanding circuit-level changes that affect the brain's capacity for plasticity will inform the design of targeted interventions for treating stroke recovery. We combine optogenetic photostimulation with optical neuroimaging to examine how contralesional excitatory activity affects cortical remodeling after stroke in mice. Following photothrombosis of left primary somatosensory forepaw (S1FP) cortex, mice received chronic excitation of right S1FP, a maneuver mimicking the use of the unaffected limb during recovery. Contralesional excitation suppressed perilesional S1FP remapping and was associated with abnormal patterns of evoked activity in the unaffected limb. Contralesional stimulation prevented the restoration of resting-state functional connectivity (RSFC) within the S1FP network, RSFC in several networks functionally-distinct from somatomotor regions, and resulted in persistent limb-use asymmetry. In stimulated mice, perilesional tissue exhibited suppressed transcriptional changes in several genes important for recovery. These results suggest that contralesional excitation impedes local and global circuit reconnection through suppression of several neuroplasticity-related genes after stroke.

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“…Some reported studies have linked high abnormal activity to a high inhibitory signaling drive onto the ipsilesional cortex [19], which may be a major contributor to motor impairment [6], [20]. Recent studies have also investigated the benefits of activating the contralesional and/or ipsilesional hemispheres in functional motor recovery using brain-computer interface (BCI) and transcranial magnetic stimulation (TMS) therapies [21], [22].…”

Section: Introductionmentioning

confidence: 99%

Self-Support Biofeedback Training for Recovery From Motor Impairment After Stroke

Alnajjar¹,

Itkonen²,

Yamasaki³

et al. 2020

IEEE Access

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Unilateral arm paralysis is a common symptom of stroke. In stroke patients, we observed that self-guided biomechanical support by the nonparetic arm unexpectedly triggered electromyographic activity with normal muscle synergies in the paretic arm. The muscle activities on the paretic arm became similar to the muscle activities on the nonparetic arm with self-supported exercises that were quantified by the similarity index (SI). Electromyogram (EMG) signals and functional near-infrared spectroscopy (fNIRS) of the patients (n=54) showed that self-supported exercise can have an immediate effect of improving the muscle activities by 40-80% according to SI quantification, and the muscle activities became much more similar to the muscle activities of the age-matched healthy subjects. Using this self-supported exercise, we investigated whether the recruitment of a patient's contralesional nervous system could reactivate their ipsilesional neural circuits and stimulate functional recovery. We proposed biofeedback training with self-supported exercise where the muscle activities were visualized to encourage the appropriate neural pathways for activating the muscles of the paretic arm. We developed the biofeedback system and tested the recovery speed with the patients (n=27) for 2 months. The clinical tests showed that self-support-based biofeedback training improved SI approximately by 40%, Stroke Impairment Assessment Set (SIAS) by 35%, and Functional Independence Measure (FIM) by 20%. INDEX TERMS Stroke rehabilitation, muscle synergy, brain imagining, biofeedback training.

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Functional and structural cortical characteristics after restricted focal motor cortical infarction evaluated at chronic stage – Indications from a preliminary study

Cited by 12 publications

References 71 publications

Role of the Contralesional vs. Ipsilesional Hemisphere in Stroke Recovery

Role of the Contralesional vs. Ipsilesional Hemisphere in Stroke Recovery

Homotopic contralesional excitation suppresses spontaneous circuit repair and global network reconnections following ischemic stroke

Self-Support Biofeedback Training for Recovery From Motor Impairment After Stroke

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