Task-specific brain reorganization in motor recovery induced by a hybrid-rehabilitation combining training with brain stimulation after stroke

Ask your doctor if this is far enough along to be copied and made into a stroke protocol. You are going to have to force your doctor to do this. I bet it will require a phone call to the hospital president before it gets accomplished. 
Rant started
Yes I'm being a very bad cop but for years there has been research on rehab that looked promising but never seems to be translated into useable interventions for survivors.  Either we replace all the existing stroke medical doctors with newer ones that still have a sense of desire to help or we force our doctors to actually do their job.
Rant completed, I feel better now.
If I'm wrong about this, tell me exactly where I'm wrong and we can discuss it.
http://www.sciencedirect.com/science/article/pii/S0168010214002272

• Satoko Koganemaru^{a, b, ,} ,
• Nobukatsu Sawamoto^c,
• Toshihiko Aso^b,
• Akiko Sagara^d,
• Tomoko Ikkaku^d,
• Kenji Shimada^d,
• Madoka Kanematsu^d,
• Ryosuke Takahashi^c,
• Kazuhisa Domen^d,
• Hidenao Fukuyama^b,
• Tatsuya Mima^b

 Show more

Choose an option to locate/access this article:

Check if you have access through your login credentials or your institution

Check access

Purchase $35.95

• 

DOI: 10.1016/j.neures.2014.10.004

Get rights and content

---

Highlights

•

We developed a new hybrid-rehabilitation combining rTMS and motor training for stroke.

•

We investigated the task-specific multi-regional brain reorganization induced by it.

•

We found reduced activities in ipsilesional SMC, contralesional CMC and PMC after it.

•

The findings were shown only for the trained movements but not for the untrained ones.

•

The clinical improvements were associated with the amount of activation change.

---

Abstract

Recently, we have developed a new hybrid-rehabilitation combining 5 Hz repetitive transcranial magnetic stimulation and extensor motor training of the paretic upper-limb for stroke patients with flexor hypertonia. We previously showed that the extensor-specific plastic change in M1 was associated with beneficial effects of our protocol (Koganemaru et al., 2010). Here, we investigated whether extensor-specific multiregional brain reorganization occurred after the hybrid-rehabilitation using functional magnetic resonance imaging. Eleven chronic stroke patients were scanned while performing upper-limb extensor movements. Untrained flexor movements were used as a control condition. The scanning and clinical assessments were done before, immediately and 2 weeks after the hybrid-rehabilitation. As a result, during the trained extensor movements, the imaging analysis showed a significant reduction of brain activity in the ipsilesional sensorimotor cortex, the contralesional cingulate motor cortex and the contralesional premotor cortex in association with functional improvements of the paretic hands. The activation change was not found for the control condition. Our results suggested that use-dependent plasticity induced by repetitive motor training with brain stimulation might be related to task-specific multi-regional brain reorganization. It provides a key to understand why repetitive training of the target action is one of the most powerful rehabilitation strategies to help patients.

Noninvasive brain-computer interface enables communication after brainstem stroke

How many decades before this gets rolled out to your hospital? A great stroke association would be personally contacting every single stroke department head and getting commitments to stay up-to-date on all stroke rehab. This is absolutely necessary since the hospital is waiting on somebody else to solve the problem.   Depending on the response is whether the good cop or the bad cop would show up.
http://stm.sciencemag.org/content/6/257/257re7

1. Eric W. Sellers¹,*,
2. David B. Ryan¹ and
3. Christopher K. Hauser¹,²

+ Author Affiliations

1. ¹Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA.
2. ²Department of Neurobiology and Anatomy, Wake Forest University, Winston Salem, NC 27106, USA.

1. ↵*Corresponding author. E-mail: sellers@etsu.edu

AbstractBack to Top

Brain-computer interfaces (BCIs) provide communication that is independent of muscle control, and can be especially important for individuals with severe neuromuscular disease who cannot use standard communication pathways or other assistive technology. It has previously been shown that people with amyotrophic lateral sclerosis (ALS) can successfully use BCI after all other means of independent communication have failed. The BCI literature has asserted that brainstem stroke survivors can also benefit from BCI use. This study used a P300-based event-related potential spelling system. This case study demonstrates that an individual locked-in owing to brainstem stroke was able to use a noninvasive BCI to communicate volitional messages. Over a period of 13 months, the participant was able to successfully operate the system during 40 of 62 recording sessions. He was able to accurately spell words provided by the experimenter and to initiate dialogues with his family. The results broadly suggest that, regardless of the precipitating event, BCI use may be of benefit to those with locked-in syndrome.

• Copyright © 2014, American Association for the Advancement of Science

Citation: E. W. Sellers, D. B. Ryan, C. K. Hauser, Noninvasive brain-computer interface enables communication after brainstem stroke. Sci. Transl. Med. 6, 257re7 (2014).

Read the Full Text

Margaret Heffernan: Dare to disagree

And boy do I disagree with everything in the stroke medical world. I still need to find the good cop that can polish off my obnoxious know-it-all edges.
http://www.ted.com/talks/margaret_heffernan_dare_to_disagree.html