Repetitive Bilateral Arm Training and Motor Cortex Activation in Chronic Stroke

Luft, Andreas R.; McCombe-Waller, Sandy; Whitall, Jill; Forrester, Larry W.; Macko, Richard F.; Sorkin, John D.; Schulz, Jörg B.; Goldberg, Andrew P.; Hanley, Daniel F.

doi:10.1001/jama.292.15.1853

Cited by 502 publications

(453 citation statements)

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“…controlled trial of BATRAC (bilateral arm training with rhythmic auditory cueing) over 6 weeks in older adults with hemiparesis due to stroke did not show overall improvement in function over a control exercise intervention [Luft et al, 2004]. However, fMRI scanning showed that BATRAC therapy was associated with greater activation of the cerebellum, ipsilateral precentral gyrus, and the contralateral hemisphere compared to controls, and there was an association between the fMRI response and clinical improvement.…”

Section: Structural Neuroplasticity After Therapy For Hemiparesismentioning

confidence: 89%

Plasticity in the developing brain: Implications for rehabilitation

Johnston

2009

Dev Disabil Res Revs

417

273

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Neuronal plasticity allows the central nervous system to learn skills and remember information, to reorganize neuronal networks in response to environmental stimulation, and to recover from brain and spinal cord injuries. Neuronal plasticity is enhanced in the developing brain and it is usually adaptive and beneficial but can also be maladaptive and responsible for neurological disorders in some situations. Basic mechanisms that are involved in plasticity include neurogenesis, programmed cell death, and activity-dependent synaptic plasticity. Repetitive stimulation of synapses can cause long-term potentiation or long-term depression of neurotransmission. These changes are associated with physical changes in dendritic spines and neuronal circuits. Overproduction of synapses during postnatal development in children contributes to enhanced plasticity by providing an excess of synapses that are pruned during early adolescence. Clinical examples of adaptive neuronal plasticity include reorganization of cortical maps of the fingers in response to practice playing a stringed instrument and constraint-induced movement therapy to improve hemiparesis caused by stroke or cerebral palsy. These forms of plasticity are associated with structural and functional changes in the brain that can be detected with magnetic resonance imaging, positron emission tomography, or transcranial magnetic stimulation (TMS). TMS and other forms of brain stimulation are also being used experimentally to enhance brain plasticity and recovery of function. Plasticity is also influenced by genetic factors such as mutations in brain-derived neuronal growth factor. Understanding brain plasticity provides a basis for developing better therapies to improve outcome from acquired brain injuries. ' 2009 Wiley-Liss, Inc. Dev Disabil Res Rev 200915:94-101.

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Section: Structural Neuroplasticity After Therapy For Hemiparesismentioning

confidence: 89%

Plasticity in the developing brain: Implications for rehabilitation

Johnston

2009

Dev Disabil Res Revs

417

273

View full text Add to dashboard Cite

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“…Grefkes and colleagues23 used functional magnetic resonance imaging and dynamic causal modeling to demonstrate positive neural coupling between the ipsilesional primary motor cortex (M1) and the contralesional motor‐related areas in bilateral synchronized hand movements in subjects with stroke 23. Similarly, Luft and colleagues25 reported that activation of the contralesional cerebrum and ipsilesional cerebellum had increased after 6 weeks of bilateral arm training, but not after dose‐matched training based on the neurodevelopmental principles that focused on the paretic upper limb in subjects with stroke. In the same study,25 after exclusion of subjects without cortical activation changes from the analyses, the group with bilateral arm training also demonstrated greater improvement in hand function than the group with dose‐matched exercises.…”

Section: Introductionmentioning

confidence: 99%

“…Current evidence shows that bilateral intervention recruits spare neural substrates to enhance motor recovery17, 20, 21, 22, 23, 24, 25; we thus hypothesized that the application of TENS over both paretic and nonparetic legs (Bi‐TENS) might induce greater and earlier improvement in lower‐limb motor function than the use of Uni‐TENS in subjects with stroke. A literature search revealed that no study has compared the efficacy of Bi‐TENS+TOT and Uni‐TENS+TOT on motor recovery after stroke.…”

Section: Introductionmentioning

confidence: 99%

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower‐Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial

Kwong

Chung

et al. 2018

JAHA

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BackgroundTranscutaneous electrical nerve stimulation (TENS) has been used to augment the efficacy of task‐oriented training (TOT) after stroke. Bilateral intervention approaches have also been shown to be effective in augmenting motor function after stroke. The purpose of this study was to compare the efficacy of bilateral TENS combined with TOT versus unilateral TENS combined with TOT in improving lower‐limb motor function in subjects with chronic stroke.Methods and ResultsEighty subjects were randomly assigned to bilateral TENS+TOT or to unilateral TENS+TOT and underwent 20 sessions of training over a 10‐week period. The outcome measures included the maximal strength of the lower‐limb muscles and the results of the Lower Extremity Motor Coordination Test, Berg Balance Scale, Step Test, and Timed Up and Go test. Each participant was assessed at baseline, after 10 and 20 sessions of training and 3 months after the cessation of training. The subjects in the bilateral TENS+TOT group showed greater improvement in paretic ankle dorsiflexion strength (β=1.32; P=0.032) and in the completion time for the Timed Up and Go test (β=−1.54; P=0.004) than those in the unilateral TENS+TOT group. However, there were no significant between‐group differences for other outcome measures.ConclusionsThe application of bilateral TENS over the common peroneal nerve combined with TOT was superior to the application of unilateral TENS combined with TOT in improving paretic ankle dorsiflexion strength after 10 sessions of training and in improving the completion time for the Timed Up and Go test after 20 sessions of training.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02152813.

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“…Disability adds to the costs of disease management that total $74 billion/ year [4]. Developing methods to effectively alleviate residual deficits will reduce health and economic burden of stroke.Several evidence-based rehabilitative approaches have been developed with prominent ones, including neuromuscular electrical stimulation [5], motor learning [6], robotic training [7] constraint-induced movement therapy [8], and bilateral arm training [9], etc. In spite of extensive therapy, recovery is frequently incomplete [10].…”

mentioning

confidence: 99%

“…Several evidence-based rehabilitative approaches have been developed with prominent ones, including neuromuscular electrical stimulation [5], motor learning [6], robotic training [7] constraint-induced movement therapy [8], and bilateral arm training [9], etc. In spite of extensive therapy, recovery is frequently incomplete [10].…”

mentioning

confidence: 99%

Invasive Neurostimulation in Stroke Rehabilitation

Plow

Machado

2014

Neurotherapeutics

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The last decade has seen a growing interest in adjuvant treatments that synergistically influence mechanisms underlying rehabilitation of paretic upper limb in stroke. One such approach is invasive neurostimulation of spared cortices at the periphery of a lesion. Studies in animals have shown that during training of paretic limb, adjuvant stimulation targeting the peri-infarct circuitry enhances mechanisms of its reorganization, generating functional advantage. Success of early animal studies and clinical reports, however, failed to translate to a phase III clinical trial. As lesions in humans are diffuse, unlike many animal models, peri-infarct circuitry may not be a feasible, or consistent target across most. Instead, alternate mechanisms, such as changing transcallosal inhibition between hemispheres, or reorganization of other viable regions in motor control, may hold greater potential. Here, we review comprehensive mechanisms of clinical recovery and factors that govern which mechanism(s) become operative when. We suggest novel approaches that take into account a patient's initial clinical-functional state, and findings from neuroimaging and neurophysiology to guide to their most suitable mechanism for ideal targeting. Further, we suggest new localization schemes, and bypass strategies that indirectly target peri-lesional circuitry, and methods that serve to counter technical and theoretical challenge in identifying and stimulating such targets at the periphery of infarcts in humans. Last, we describe how stimulation may modulate mechanisms differentially across varying phases of recovery-a temporal effect that may explain missed advantage in clinical trials and help plan for the next stage. With information presented here, future trials would effectively be able to target patient's specific mechanism(s) with invasive (or noninvasive) neurostimulation for the greatest, most consistent benefit. [2], which remains one of the most important predictors of disability and poor quality of life [3]. Disability adds to the costs of disease management that total $74 billion/ year [4]. Developing methods to effectively alleviate residual deficits will reduce health and economic burden of stroke.Several evidence-based rehabilitative approaches have been developed with prominent ones, including neuromuscular electrical stimulation [5], motor learning [6], robotic training [7] constraint-induced movement therapy [8], and bilateral arm training [9], etc. In spite of extensive therapy, recovery is frequently incomplete [10]. There is a critical need for adjuvant strategies that augment rehabilitative outcomes of paretic hand.The last decade has seen a growing interest in the promise of adjuvant treatments that synergistically influence mechanisms associated with rehabilitation. One such approach is invasive neuromodulation, involving electrical stimulation applied to cortical or subcortical targets spared by stroke. By directly stimulating viable targets, it is believed that potential for plasticity underlying reh...

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Repetitive Bilateral Arm Training and Motor Cortex Activation in Chronic Stroke

Cited by 502 publications

References 43 publications

Plasticity in the developing brain: Implications for rehabilitation

Plasticity in the developing brain: Implications for rehabilitation

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower‐Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial

Invasive Neurostimulation in Stroke Rehabilitation

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