Functional Brain Correlates of Upper Limb Spasticity and Its Mitigation following Rehabilitation in Chronic Stroke Survivors

Pundik, Svetlana; Falchook, Aaron D.; McCabe, Jessica; Litinas, Krisanne; Daly, Janis J.

doi:10.1155/2014/306325

Cited by 14 publications

(16 citation statements)

References 38 publications

(40 reference statements)

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“…Alleviation of PSS at W4 was associated with an apparent reduction in the extent of activation, mostly of the bilateral parietal cortices and cerebellum, but returned close to the original extent at W11. This finding is in agreement with our previous studies and other previously published fMRI studies uncovering cerebral correlations with PSS treatment (14–16, 20, 49–52). Extended task-related cortical activation probably represents a general response of the lesioned brain to increased proprioceptive afferent input associated with PSS (13, 14).…”

Section: Discussionsupporting

confidence: 94%

Botulinum Toxin Modulates Posterior Parietal Cortex Activation in Post-stroke Spasticity of the Upper Limb

Veverka¹,

Hok²,

Otruba³

et al. 2019

Front. Neurol.

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Post-stroke spasticity (PSS) is effectively treated with intramuscular botulinum toxin type A (BoNT-A), although the clinical improvement is likely mediated by changes at the central nervous system level. Using functional magnetic resonance imaging (fMRI) of the brain, this study aims to confirm and locate BoNT-A-related changes during motor imagery with the impaired hand in severe PSS. Temporary alterations in primary and secondary sensorimotor representation of the impaired upper limb were expected. Thirty chronic stroke patients with upper limb PSS undergoing comprehensive treatment including physiotherapy and indicated for BoNT treatment were investigated. A change in PSS of the upper limb was assessed with the modified Ashworth scale (MAS). fMRI and clinical assessments were performed before (W0) and 4 weeks (W4) and 11 weeks (W11) after BoNT-A application. fMRI data were acquired using 1.5-Tesla scanners during imagery of finger-thumb opposition sequences with the impaired hand. At the group level, we separately modeled (1) average activation at each time point with the MAS score and age at W0 as covariates; and (2) within-subject effect of BoNT-A and the effect of time since W0 as independent variables. Comprehensive treatment of PSS with BoNT-A significantly decreased PSS of the upper limb with a maximal effect at W4. Task-related fMRI prior to treatment (W0) showed extensive activation of bilateral frontoparietal sensorimotor cortical areas, bilateral cerebellum, and contralesional basal ganglia and thalamus. After BoNT-A application (W4), the activation extent decreased globally, mostly in the bilateral parietal cortices and cerebellum, but returned close to baseline at W11. The intra-subject contrast revealed a significant BoNT-A effect, manifesting as a transient decrease in the activation of the ipsilesional intraparietal sulcus and superior parietal lobule. We demonstrate that BoNT-A treatment of PSS of the upper limb is associated with transient changes in the ipsilesional posterior parietal cortex, possibly resulting from temporarily altered sensorimotor upper limb representations.

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Section: Discussionsupporting

confidence: 94%

Botulinum Toxin Modulates Posterior Parietal Cortex Activation in Post-stroke Spasticity of the Upper Limb

Veverka¹,

Hok²,

Otruba³

et al. 2019

Front. Neurol.

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“…This study revealed a significant reduction in spasticity following rPMS along with a stronger mu rhythm ERD in the contralesional hemisphere. This is consistent with the results of Pundik et al ( 39 ) and Miyara et al ( 40 ). Pundik et al identified a positive correlation between decrease in spasticity and the strength of fMRI activation in the contralesional motor cortex.…”

Section: Discussionsupporting

confidence: 94%

“…By contrast, the present study adopted EEG to measure cortical activity. Stronger activations in the contralesional hemisphere have been detected using fMRI ( 39 ) and fNIRS ( 40 ); this is in agreement with the EEG results of the present study, which revealed decreased ERD power in the contralesional hemisphere. This finding may indicate that activity changes in the contralesional hemisphere are associated with decreases in spasticity.…”

Section: Discussionsupporting

confidence: 92%

Electroencephalography Mu Rhythm Changes and Decreased Spasticity After Repetitive Peripheral Magnetic Stimulation in Patients Following Stroke

Chen

Shu

et al. 2020

Front. Neurol.

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Background: Spasticity is common among patients with stroke. Repetitive peripheral magnetic stimulation (rPMS) is a painless and noninvasive therapy that is a promising approach to reducing spasticity. However, the central mechanism of this therapy remains unclear. Changes in cortical activity and decreased spasticity after rPMS intervention require further exploration. The aim of this study was to explore the electroencephalography (EEG) mu rhythm change and decrease in spasticity after rPMS intervention in patients with stroke. Materials and methods: A total of 32 patients with spasticity following stroke were recruited in this study and assigned to the rPMS group ( n = 16) or sham group ( n = 16). The modified Ashworth scale, modified Tardieu scale, and Fugl–Meyer assessment of the upper extremity were used to assess changes in upper limb spasticity and motor function. Before and after the rPMS intervention, EEG evaluation was performed to detect EEG mu rhythm changes in the brain. Results: After one session of rPMS intervention, spasticity was reduced in elbow flexors ( p < 0.05) and wrist flexors ( p < 0.05). Upper limb motor function measured according to the Fugl–Meyer assessment was improved ( p < 0.05). In the rPMS group, the power of event-related desynchronization decreased in the mu rhythm band (8–12 Hz) in the contralesional hemisphere ( p < 0.05). Conclusions: The results indicate that rPMS intervention reduced spasticity. Cortical activity changes may suggest this favorable change in terms of its neurological effects on the central nervous system.

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“…A recent publication used another standardized clinical measure of spasticity, the Modified Ashworth Scale (MAS), and evaluated summed scores across upper extremity muscle groups to reflect a primary outcome measure (Pundik et al, 2014). Based on this precedent, and the expectation that we might see improvement in multiple muscles along the path of current flow, we utilized summed scores for the MTS across the upper extremity muscles (MTS UE ), as the MTS has been demonstrated to be more sensitive to changes in spasticity as compared to the MAS (Haugh et al, 2006;Akpinar et al, 2017;Mehrholz et al, 2005).…”

Section: Clinical Assessments Modified Tardieu Scale (Mts)mentioning

confidence: 99%

Non-invasive treatment of patients with upper extremity spasticity following stroke using paired trans-spinal and peripheral direct current stimulation

et al. 2019

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Background: Muscle spasticity is a common impediment to motor recovery in patients with chronic stroke. Standard-of-care treatments such as botulinum toxin injections can temporarily relieve muscle stiffness and pain associated with spasticity, but often at the expense of increased muscle weakness. Recent preclinical investigations of a non-invasive treatment that pairs trans-spinal direct current stimulation and peripheral nerve direct current stimulation (tsDCS+pDCS) provided promising data for a novel approach based on bioelectronic medicine for the treatment of patients with post-stroke spasticity. Methods: Twenty-six patients with upper limb hemiparesis and wrist spasticity at least 6 months after their initial stroke participated in this single-blind crossover design study to test whether tsDCS+pDCS reduces chronic upperextremity spasticity. Subjects received five consecutive daily sessions (20 min of stimulation or sham) of anodal tsDCS+pDCS, separated by a one-week washout period. The sham condition always preceded the active condition. Clinical and objective measures of spasticity and motor function were collected before and after each condition, and for five weeks after the completion of the active intervention. Results: Subjects treated with active tsDCS+pDCS demonstrated significant reductions in both Modified Tardieu Scale scores (summed across the upper limb, P < 0.05), and in objective torque measures (Nm) of the spastic catch response at the wrist flexor (P < 0.05), compared to the sham condition. Motor function also improved significantly (measured by the Fugl-Meyer and Wolf Motor Function Test; P < 0.05 for both tests) after active treatment. Conclusions: tsDCS+pDCS intervention alone significantly reduced upper limb spasticity in participants with stroke. Decreased spasticity was persistent for five weeks after treatment, and was accompanied by improved motor function even though patients were unsupervised and there was no prescribed activity or training during that interval.

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Functional Brain Correlates of Upper Limb Spasticity and Its Mitigation following Rehabilitation in Chronic Stroke Survivors

Cited by 14 publications

References 38 publications

Botulinum Toxin Modulates Posterior Parietal Cortex Activation in Post-stroke Spasticity of the Upper Limb

Botulinum Toxin Modulates Posterior Parietal Cortex Activation in Post-stroke Spasticity of the Upper Limb

Electroencephalography Mu Rhythm Changes and Decreased Spasticity After Repetitive Peripheral Magnetic Stimulation in Patients Following Stroke

Non-invasive treatment of patients with upper extremity spasticity following stroke using paired trans-spinal and peripheral direct current stimulation

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