Yin-Liang Lin1, Kelsey A Potter-Baker2, David A Cunningham3, Manshi Li4, Vishwanath Sankarasubramanian5, John Lee6, Stephen Jones7, Ken Sakaie7, Xiaofeng Wang4, Andre G Machado8, Ela B Plow9. 1. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan. 2. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veteran's Affairs, Cleveland, OH, USA; Department of Health and Biomedical Sciences, University of Texas Rio Grande Valley, Edinburg, TX, USA. 3. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, OH, USA; MetroHealth Rehabilitation Institute of Ohio, MetroHealth Medical Center, Cleveland, OH, USA; Cleveland Functional Electrical Stimulation Center, Louis Stokes Cleveland Department of Veteran's Affairs, Cleveland, OH, USA. 4. Respiratory Institute Biostatistics Core, Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA. 5. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA. 6. Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, OH, USA. 7. Department of Diagnostic Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA. 8. Neurological Institute, Cleveland Clinic, OH, USA. 9. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, OH, USA. Electronic address: plowe2@ccf.org.
Abstract
OBJECTIVE: A recent "bimodal-balance recovery" model suggests that contralesional influence varies based on the amount of ipsilesional reserve: inhibitory when there is a large reserve, but supportive when there is a low reserve. Here, we investigated the relationships between contralesional influence (inter-hemispheric inhibition, IHI) and ipsilesional reserve (corticospinal damage/impairment), and also defined a criterion separating subgroups based on the relationships. METHODS: Twenty-four patients underwent assessment of IHI using Transcranial Magnetic Stimulation (ipsilateral silent period method), motor impairment using Upper Extremity Fugl-Meyer (UEFM), and corticospinal damage using Diffusion Tensor Imaging and active motor threshold. Assessments of UEFM and IHI were repeated after 5-week rehabilitation (n = 21). RESULTS: Relationship between IHI and baseline UEFM was quadratic with criterion at UEFM 43 (95%conference interval: 40-46). Patients less impaired than UEFM = 43 showed stronger IHI with more impairment, whereas patients more impaired than UEFM = 43 showed lower IHI with more impairment. Of those made clinically-meaningful functional gains in rehabilitation (n = 14), more-impaired patients showed further IHI reduction. CONCLUSIONS: A criterion impairment-level can be derived to stratify patient-subgroups based on the bimodal influence of contralesional cortex. Contralesional influence also evolves differently across subgroups following rehabilitation. SIGNIFICANCE: The criterion may be used to stratify patients to design targeted, precision treatments.
OBJECTIVE: A recent "bimodal-balance recovery" model suggests that contralesional influence varies based on the amount of ipsilesional reserve: inhibitory when there is a large reserve, but supportive when there is a low reserve. Here, we investigated the relationships between contralesional influence (inter-hemispheric inhibition, IHI) and ipsilesional reserve (corticospinal damage/impairment), and also defined a criterion separating subgroups based on the relationships. METHODS: Twenty-four patients underwent assessment of IHI using Transcranial Magnetic Stimulation (ipsilateral silent period method), motor impairment using Upper Extremity Fugl-Meyer (UEFM), and corticospinal damage using Diffusion Tensor Imaging and active motor threshold. Assessments of UEFM and IHI were repeated after 5-week rehabilitation (n = 21). RESULTS: Relationship between IHI and baseline UEFM was quadratic with criterion at UEFM 43 (95%conference interval: 40-46). Patients less impaired than UEFM = 43 showed stronger IHI with more impairment, whereas patients more impaired than UEFM = 43 showed lower IHI with more impairment. Of those made clinically-meaningful functional gains in rehabilitation (n = 14), more-impaired patients showed further IHI reduction. CONCLUSIONS: A criterion impairment-level can be derived to stratify patient-subgroups based on the bimodal influence of contralesional cortex. Contralesional influence also evolves differently across subgroups following rehabilitation. SIGNIFICANCE: The criterion may be used to stratify patients to design targeted, precision treatments.
Authors: Vishwanath Sankarasubramanian; Andre G Machado; Adriana B Conforto; Kelsey A Potter-Baker; David A Cunningham; Nicole M Varnerin; Xiaofeng Wang; Ken Sakaie; Ela B Plow Journal: Clin Neurophysiol Date: 2017-03-21 Impact factor: 3.708
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Authors: Danielle De S Boasquevisque; Larissa Servinsckins; Joselisa P Q de Paiva; Daniel G Dos Santos; Priscila Soares; Danielle S Pires; Jed A Meltzer; Ela B Plow; Paloma F de Freitas; Danielli S Speciali; Priscila Lopes; Mario F P Peres; Gisele S Silva; Shirley Lacerda; Adriana B Conforto Journal: Neural Plast Date: 2021-08-10 Impact factor: 3.599