No abstract available.
Brain* ; Neurological Rehabilitation*

Although studies have demonstrated that several specific brain lesions are related to the recovery and functional prognosis in patients with stroke, it still remained to be illusive. Modern imaging techniques make us possible to identify regions that are commonly related to specific deficit. Superimposing individual lesions to identify an area related to a particular function is based on the assumption that these functional modules are in the same location in different individuals. It is traditional to overlay plots using ‘lesion subtraction.’ Additionally, voxel-based lesion-symptom mapping (VLSM) can be used to determine relationships between behavioral measures and its neural correlates in the brain. VLSM estimates statistical parameters on a voxel-by-voxel basis by calculating the correlations between t-scores for tasks and treating voxels as subjects, allowing fairly high spatial precision. Understanding their relative merits with regard to specific brain lesions should be useful in planning rehabilitation strategies and will become an important part of neurorehabilitation.
Brain ; Humans ; Neurological Rehabilitation ; Prognosis* ; Rehabilitation ; Stroke*

Virtual reality (VR) therapy has many benefits to promote neurological and functional recovery in the field of neurorehabilitation after brain injury. VR-assisted neurorehabilitation can be applied in motor, sensori-motor, cognitive, activities of daily living (ADL), and telerehabilitation. Recent reports found that VR therapy appears to be a safe intervention that is effective at improving arm function and ADL function following stroke. Greater improvements were seen at a higher VR therapeutic dose. There has been insufficient evidence that VR therapy improved lower extremity gait speed, balance, and cognitive function after brain injury. As a result, the number of commercially available devices have increased and large-scale controlled trials have reported positive effects recently. Interface devices, various feedback methods, and the advancement of augmented reality technology are quickly developing, therefore, the potential value of VR therapy in neurorehabilitation will be high and its clinical application will be diversified.
Activities of Daily Living ; Arm ; Brain Injuries ; Cognition ; Gait ; Lower Extremity ; Neurological Rehabilitation* ; Rehabilitation ; Stroke ; Telerehabilitation

PURPOSE: Functional electrical stimulation (FES) is a device that activates the sensorimotor cortex through electrodes attached to the surface of the skin. However, it is difficult to expect positive changes if the recipient is not attentive to the motion. To complement the perceived cognitive limitations of FES, we attempted to investigate the changes of sensorimotor cortex activity by simultaneously providing action observation with FES. METHODS: Electroencephalogram was measured in 28 healthy volunteers. Relative band power over the sensorimotor cortex was analyzed and compared in three conditions: during rest, during FES alone, during action observation with FES. RESULTS: The results showed significant differences in each relative band power. Relative alpha power and relative beta power were the lowest by application of FES combined with action observation, while the relative gamma power was the highest. CONCLUSION: These results suggest that combining FES with observation could be more effective than FES alone in neurorehabilitation.
Complement System Proteins ; Electric Stimulation* ; Electrodes ; Electroencephalography ; Healthy Volunteers ; Neurological Rehabilitation ; Sensorimotor Cortex* ; Skin

Cerebral blood volume (CBV) is a hemodynamic correlate of oxygen metabolism and changes due to neuronal activity. CBV alteration may precede other hemodynamic correlates and provide an early indication of hemodynamic impairment. CBV can be easily quantified using magnetic resonance imaging (MRI); moreover, CBV MRI has a strong point of high resolution compared to other neuroimaging modalities. The early and accurate assessments of cerebral metabolism and the brain map with the high resolution of CBV MRI enable advanced neurorehabilitation examinations in a neuroimaging study.
Blood Volume* ; Brain ; Hemodynamics ; Magnetic Resonance Imaging* ; Metabolism ; Neuroimaging ; Neurological Rehabilitation ; Neurons ; Oxygen

OBJECTIVE: To observe the effect of staged acupuncture on serum irisin level, neurological deficit, balance ability and spasticity in patients with ischemic stroke. METHODS: Sixty patients with ischemic stroke were randomly divided into a staged acupuncture group and a routine acupuncture group, 30 cases in each group; another 30 healthy subjects were selected as a normal group. The patients with ischemic stroke were treated with aspirin (100 mg each time, once a day, changing to 50 mg for prophylactic dose after 4 weeks). The patients in the staged acupuncture group were treated with staged acupuncture (acupoints were selected according to the soft paralysis period, spasticity period and recovery period, sequelae period) and rehabilitation treatment, while the patients in the routine acupuncture group were treated with acupuncture of soft paralysis-period as the staged acupuncture group and rehabilitation treatment. All the treatment was given once a day, 5 times a week, 2 weeks as a course of treatment, and 4 consecutive courses of treatment were provided. Before treatment and at 2 weeks, 4 weeks, 6 weeks and 8 weeks into treatment, the serum irisin level was measured, and the scores of National Institutes of Health stroke scale (NIHSS), Fugl-Meyer assessment scale-balance (FM-B) and comprehensive spasticity scale (CSS) were compared, and the correlation between the serum irisin level and NIHSS and FM-B scores in the two groups was analyzed. RESULTS: Before treatment, the serum irisin levels in the two groups were lower than those in the normal group (P<0.01). Compared before treatment, the serum irisin levels and FM-B scores were increased (P<0.01), and the NIHSS scores were decreased at 2, 4, 6 and 8 weeks into treatment in the two groups (P<0.01). At 4, 6 and 8 weeks into treatment, in the staged acupuncture group, the serum irisin levels and FM-B scores were higher than those in the routine acupuncture group (P<0.01, P<0.05), and the NIHSS scores were lower than those in the routine acupuncture group (P<0.01). After treatment, the CSS scores in the two groups were increased first and then decreased. Compared before treatment, the CSS scores were increased at 2, 4, 6 and 8 weeks into treatment in the two groups (P<0.01). At 4, 6 and 8 weeks into treatment, the CSS scores in the staged acupuncture group were lower than those in the routine acupuncture group (P<0.01). The serum irisin level was negatively correlated with NIHSS score (r =-0.772, P =0.000), and positively correlated with FM-B score (r =0.675, P =0.000). CONCLUSION The severity of neurological deficit and balance ability are related to serum irisin level in patients with ischemic stroke. The staged acupuncture could increase the serum irisin level, improve the neurological function, balance ability and spasticity in patients with ischemic stroke.
Acupuncture Therapy ; Fibronectins ; Humans ; Ischemic Stroke ; Muscle Spasticity ; Neurological Rehabilitation ; Paralysis/complications* ; Stroke/therapy* ; Stroke Rehabilitation ; Treatment Outcome

OBJECTIVE: To investigate the effects of using motor imagery (MI) in combination with a virtual reality (VR) program on healthy volunteers and stroke patients. In addition, this study investigated whether task variability within the VR-guided MI programs would influence corticomotor excitability. METHODS: The present study included 15 stroke patients and 15 healthy right-handed volunteers who were presented with four different conditions in a random order: rest, MI alone, VR-guided MI, and VR-guided MI with task variability. The corticomotor excitability of each participant was assessed before, during, and after each condition by measuring changes in the various parameters of motor-evoked potentials (MEPs) of the extensor carpi radials (ECR). Changes in intracortical inhibition (ICI) and intracortical facilitation (ICF) were calculated after each condition as percentages of inhibition (%INH) and facilitation (%FAC) at rest. RESULTS: In both groups, the increases in MEP amplitudes were greater during the two VR-guided MI conditions than during MI alone. Additionally, the reductions in ECR %INH in both groups were greater under the condition involving VR-guided MI with task variability than under that involving VR-guided MI with regular interval. CONCLUSION: The corticomotor excitability elicited by MI using a VR avatar representation was greater than that elicited by MI with real body observations. Furthermore, the use of task variability in a VR program may enhance neural regeneration after stroke by reducing ICI. The present findings support the use of various VR programs as well as the concept of combining MI with VR programs for neurorehabilitation.
Healthy Volunteers* ; Humans ; Imagery (Psychotherapy) ; Neurological Rehabilitation ; Regeneration ; Stroke* ; Transcranial Magnetic Stimulation ; Upper Extremity ; Virtual Reality Exposure Therapy ; Volunteers

Lack of a region-specific brain stimulation modality having both spatial specificity and depth penetration has limited clinicians to explore novel non-pharmacological treatment options in neurorehabilitation. Focused ultrasound (FUS) has shown excitatory and suppressive modulatory effects on neural tissues in both central and peripheral nervous systems by transcranially delivering low-intensity highly focused acoustic pressure waves to region-specific neural structures in a completely non-invasive fashion. This emerging technique, with exquisite spatial selectively and depth penetration, is considered as a new mode of brain stimulation that may significantly improve existing brain stimulation modalities. This review aims to provide the perspectives of FUS-mediated brain stimulation in neurorehabilitation, along with potential pitfalls and cautions that need to be taken into consideration. When combined with the intravascular introduction of microbubble-based ultrasound contrast agents, the technique adds therapeutic potentials in delivering drug/genes/cells across the blood-brain barrier, which may open new opportunities for neurorehabilitation. Efforts are being made to construct FUS devices appropriate for routine clinical use, to investigate its fundamental mechanisms, and to optimize the sonication parameters. Repeated administration of the technique for inducing neuroplasticity, including the assessment of long-term safety, is warranted to reveal its utility in neurorehabilitation.
Acoustics ; Blood-Brain Barrier ; Brain* ; Contrast Media ; Neurological Rehabilitation* ; Neuronal Plasticity ; Peripheral Nervous System ; Sensitivity and Specificity ; Sonication ; Ultrasonography*

Corticobasal syndrome (CBS) is characterized by asymmetric dystonia, and myoclonus accompanied by higher cortical features including apraxia, alien limb phenomena, cortical sensory loss. Here, we report treatment course of 3 CBS patients. Asymmetric dystonia was seen in the first and second cases, a cortical sensory loss was seen in the third case and left lower limb apraxia was common in all cases. In the first and second cases, we performed an alcohol block on the obturator nerve and injected botulinum toxin into the lower leg to reduce dystonia. In the third case, patient was treated with a robotic assisted gait training, whole body therapeutic pool and gait training with laser pointer visual cueing. After appropriate treatment for patients, all 3 cases showed improvement in gait.
Apraxias ; Botulinum Toxins ; Cues ; Dystonia ; Emigrants and Immigrants ; Extremities ; Gait Apraxia ; Gait* ; Humans ; Leg ; Lower Extremity ; Myoclonus ; Nerve Block ; Neurological Rehabilitation ; Obturator Nerve ; Rehabilitation*

OBJECTIVE: To evaluate the effectiveness of intensive rehabilitation to support recovery of neurological function after brain tumor surgery and assess long-term satisfaction. METHODS: This retrospective study included patients with neurological impairment after brain tumor surgery who underwent intensive rehabilitation therapy between December 2013 and May 2017. To assess effectiveness of rehabilitation, functional outcomes (motor, cognition, and activities of daily living [ADL]) were compared between brain tumor group and a control group enrolling stroke patients who received equivalent rehabilitation during the study period. Long-term satisfaction with rehabilitation was evaluated by surveying family caregivers. RESULTS: This study included 21 patients with benign brain tumor, 14 with malignant brain tumor, and 108 with stroke. Significant and similar improvement in motor, cognition, and ADL function were noted in both the brain tumor group and the stroke group. Malignancy status did not influence the extent of functional improvement. According to medical records and surveys, 9 (69.2%) patients with malignant tumor and 2 (11.8%) with benign tumor had expired by the time of the survey. Most family caregivers confirmed that rehabilitation was effective for functional improvement (>60%), expressing overall satisfaction and stating they would recommend such therapy to patients with similar conditions (approximately 70%). CONCLUSION: Intensive rehabilitation may help promote functional improvement following brain tumor surgery regardless of malignancy compared with stroke patients. Family caregivers expressed overall satisfaction with rehabilitation at long-term follow-up. These findings support the provision of intensive rehabilitation therapy for neurologic function recovery following brain tumor surgery.
Activities of Daily Living ; Brain Neoplasms ; Brain ; Caregivers ; Cognition ; Follow-Up Studies ; Humans ; Medical Records ; Neurological Rehabilitation ; Pilot Projects ; Recovery of Function ; Rehabilitation ; Retrospective Studies ; Stroke ; Treatment Outcome