{"title":"The Optimized Transcranial Direct Current Stimulation With Simulation Using MRI.","authors":"Mi-Jeong Yoon, Seong Hoon Lim","doi":"10.12786/bn.2024.17.e21","DOIUrl":"10.12786/bn.2024.17.e21","url":null,"abstract":"<p><p>Transcranial direct current stimulation (tDCS) has emerged as a valuable neuromodulation technique. Many clinical conditions are associated with brain damage, and in severe cases, structural changes such as skull defects are common. These clinical characteristics result in distinct electrical flow patterns during tDCS application compared to cases without brain damage. Recently, notable advancements have been made in both the medical and engineering fields pertaining to the use of in silico modelling and simulation with the aid of magnetic resonance imaging (MRI). As a result, it is now possible to conduct simulations tailored to the unique structural anatomy of an individual's brain, using their own MRI data, to provide targeted tDCS. We have developed software that performs both segmentation and simulation, and have conducted randomized controlled trials using optimized tDCS for stroke and disorders of consciousness. Additionally, we have carried out simulation-related research on stroke and burr hole surgery. This review examines various articles related to simulation and optimized tDCS, evaluating their clinical implications. We believe that these insights will provide valuable guidance for both current and future applications of tDCS.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 3","pages":"e21"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Torsten Rackoll, Tim Hinrichs, Konrad Neumann, Bernd Wolfarth, Alexander Heinrich Nave
{"title":"Improvements in Walking During Subacute Stroke Rehabilitation Translate to Physical Activity at the Chronic Stage: A Sub-Analysis From the Phys Stroke Trial.","authors":"Torsten Rackoll, Tim Hinrichs, Konrad Neumann, Bernd Wolfarth, Alexander Heinrich Nave","doi":"10.12786/bn.2024.17.e17","DOIUrl":"10.12786/bn.2024.17.e17","url":null,"abstract":"<p><p>Stroke frequently results in mobility impairments, contributing to an increased cardiovascular risk. Despite efforts to promote physical activity, stroke survivors fail to meet recommended levels. This secondary analysis of the 'Physical Fitness in Patients with Subacute Stroke' (Phys-Stroke) trial analyzes physical activity at 6 months post-stroke, and examines the effect of gains in walking capacity during the subacute phase on physical activity in the chronic stage. Phys-Stroke compared aerobic exercise vs relaxation in 200 stroke patients. Data from the 6-minute walk test (6MWT) pre and post intervention as well as accelerometry and questionnaire data at 6 months were used. Data was analyzed using mixed linear models and function-on-scalar regression. At 6 months after stroke, participants exhibited low daily step counts (5,623 ± 2,998 steps/day), with most activity occurring in the morning and midday. Per meter gained in the 6MWT during the intervention period, participants increased daily steps by 8.2 (95% confidence interval, 1.6 to 14.8, p = 0.017) at 6 months. Questionnaire data showed that engagement in sports activities was minimal, basic activities being the primary activity. Stroke survivors demonstrated suboptimal activity levels at 6 months but increases in walking capacity during the subacute stage did result in meaningful increases chronically.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT01953549.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 3","pages":"e17"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Safety and Efficacy of Balance Training on Stroke Patients With Reduced Balance Ability: A Meta-Analysis of Randomized Controlled Trials.","authors":"Yong Wook Kim, Seo Yeon Yoon","doi":"10.12786/bn.2024.17.e15","DOIUrl":"10.12786/bn.2024.17.e15","url":null,"abstract":"<p><p>To investigate the safety and efficacy of balance training for stroke patients with reduced balance ability by performing a meta-analysis of randomized controlled trials. The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched up to February 2022. Quality assessment was performed using the using the Cochrane risk of bias tool. Studies were included if: 1) patient allocation was randomized; 2) the participant was composed of stroke patients with reduced balance ability (Berg Balance Scale [BBS] ≤ 40, Timed-Up and Go ≥ 14 seconds, or Mini-Balance Evaluation Systems Test ≤ 17.5); and 3) intervention was additional balance training for the experimental group. Six studies including 466 patients were included in the final analysis. The meta-analysis showed a significant improvement in the BBS (mean difference [MD], 8.14; 95% confidence interval [CI], 4.65, 11.64) and Trunk Impairment Scale (MD, 4.71; 95% CI, 3.45, 5.96) after balance training relative to the comparison group. Ambulation function was significantly improved (standardized MD, 0.98; 95% CI, 0.46, 1.49) after balance training. There was one report of a femur fracture among 230 participants in the balance training group. Balance training in addition to conventional rehabilitation program in stroke patients with reduced balance ability appears to be effective and safe.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 3","pages":"e15"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Impact of the Total Amount of Exercise Therapy on Post-Stroke Activities of Daily Living and Motor Function: A Meta-Analysis.","authors":"Sun Im, Yeo Hyung Kim","doi":"10.12786/bn.2024.17.e16","DOIUrl":"10.12786/bn.2024.17.e16","url":null,"abstract":"<p><p>Although the benefits of exercise therapy in stroke rehabilitation are well-documented, the optimal amount remains a matter of debate. This study investigated the impact of the total amount of exercise therapy on clinical outcomes in adult patients with stroke. We conducted a comprehensive search of three major international databases (Medline, Embase, and the Cochrane Library) and included 18 randomized controlled trials that compared the effects of different amounts of exercise therapy on activities of daily living, upper limb function, lower limb function, and adverse events in stroke patients. We performed a risk of bias assessment, conducted a meta-analysis using a random-effects model, and evaluated the certainty of the evidence. The results indicated that more time spent in exercise therapy significantly improved activities of daily living compared to less time (standardized mean difference [SMD], 0.18; 95% confidence interval [CI], 0.06, 0.30; p = 0.002), with moderate evidence. Additionally, higher intensity of exercise therapy enhanced lower limb function compared to lower intensity (SMD, 0.66; 95% CI, 0.18, 1.13; p = 0.007), with a low level of evidence. No significant differences were found in the incidence of adverse events. Based on these findings, physicians may consider increasing the total amount of exercise therapy for stroke patients in order to improve their activities of daily living and motor function, while carefully considering each patient's neurological and medical condition.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 3","pages":"e16"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yong Hur, Byung-Mo Oh, Han Gil Seo, Sung Eun Hyun, Dong-Joo Kim, Hakseung Kim, Tae-Seong Han, Hye Jung Park, Chae Hyeon Lee, Woo Hyung Lee
{"title":"Reliability of Surface Electromyography From the Lower-limb Muscles During Maximal and Submaximal Voluntary Isometric Contractions in In-bed Healthy Individuals and Patients With Subacute Stroke.","authors":"Yong Hur, Byung-Mo Oh, Han Gil Seo, Sung Eun Hyun, Dong-Joo Kim, Hakseung Kim, Tae-Seong Han, Hye Jung Park, Chae Hyeon Lee, Woo Hyung Lee","doi":"10.12786/bn.2024.17.e14","DOIUrl":"10.12786/bn.2024.17.e14","url":null,"abstract":"<p><p>This study aims to develop maximal voluntary isometric contraction (MVIC) and submaximal voluntary isometric contraction (subMVIC) methods and to assess the reliability of the developed methods for in-bed healthy individuals and patients with subacute stroke. The electromyography (EMG) activities from the lower-limb muscles including the tensor fascia lata (TFL), rectus femoris (RF), tibialis anterior (TA), and gastrocnemius (GC) on both sides were recorded during MVIC and subMVIC using surface EMG sensors in 20 healthy individuals and 20 subacute stroke patients. In inter-trial reliability, both MVIC and subMVIC methods demonstrated excellent reliability for all the measured muscles at baseline and follow-up evaluations in both healthy individuals and stroke patients. In inter-day reliability, MVIC showed good reliability for the TFL and moderate reliability for the RF, TA, and GC, while subMVIC showed good reliability for the TFL, RF, and GC and poor reliability for the TA in healthy individuals. In conclusion, the MVIC and subMVIC methods of EMG activities were feasible in in-bed healthy individuals and patients with subacute stroke. The results can serve as a basis for the clinical evaluation of muscular activities using quantitative EMG signals on the lower-limb muscles in stroke patients with impaired mobility.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 2","pages":"e14"},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jun-Sang Han, Seong-Mun Ryu, Young-Hwan Lim, Ae-Ryoung Kim, Tae-Du Jung
{"title":"Is the Korean Mini-Mental State Examination (K-MMSE) Useful in Evaluating the Cognitive Function of Brain Injury Patients?: Through Correlation Analysis With Computerized Neurocognitive Test (CNT).","authors":"Jun-Sang Han, Seong-Mun Ryu, Young-Hwan Lim, Ae-Ryoung Kim, Tae-Du Jung","doi":"10.12786/bn.2024.17.e13","DOIUrl":"10.12786/bn.2024.17.e13","url":null,"abstract":"<p><p>Patients with brain injury often experience accompanying disabilities that can make it challenging for them to use tools or perform complex tests. Therefore, Korean Mini-Mental State Examination (K-MMSE) is widely used in clinical practice as an alternative to the computerized neurocognitive test (CNT) or Wechsler Adult Intelligence Scale tests to assess cognitive function in these individuals. This study aimed to investigate the correlation between the K-MMSE and CNT in brain injury patients to evaluate the and clinical usefulness of K-MMSE. A total of 120 patients were assessed using both tests, and a significant correlation was observed between the total scores of K-MMSE and CNT. The orientation component of K-MMSE was significantly correlated with CNT components, indicating that individuals who perform well on orientation tasks are likely to have better cognitive abilities overall. While K-MMSE has limitations in evaluating specific cognitive domains, it is a useful tool in clinical practice for evaluating cognitive impairment, especially in patients who have difficulty using more complex cognitive tests.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 2","pages":"e13"},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kwangsub Song, Hae-Yeon Park, Sangui Choi, Seungyup Song, Hanee Rim, Mi-Jeong Yoon, Yeun Jie Yoo, Hooman Lee, Sun Im
{"title":"Sarcopenia Diagnostic Technique Based on Artificial Intelligence Using Bio-signal of Neuromuscular System: A Proof-of-Concept Study.","authors":"Kwangsub Song, Hae-Yeon Park, Sangui Choi, Seungyup Song, Hanee Rim, Mi-Jeong Yoon, Yeun Jie Yoo, Hooman Lee, Sun Im","doi":"10.12786/bn.2024.17.e12","DOIUrl":"10.12786/bn.2024.17.e12","url":null,"abstract":"<p><p>In this paper, we propose an artificial intelligence (AI)-based sarcopenia diagnostic technique for stroke patients utilizing bio-signals from the neuromuscular system. Handgrip, skeletal muscle mass index, and gait speed are prerequisite components for sarcopenia diagnoses. However, measurement of these parameters is often challenging for most hemiplegic stroke patients. For these reasons, there is an imperative need to develop a sarcopenia diagnostic technique that requires minimal volitional participation but nevertheless still assesses the muscle changes related to sarcopenia. The proposed AI diagnostic technique collects motor unit responses from stroke patients in a resting state via stimulated muscle contraction signals (SMCSs) recorded from surface electromyography while applying electrical stimulation to the muscle. For this study, we extracted features from SMCS collected from stroke patients and trained our AI model for sarcopenia diagnosis. We validated the performance of the trained AI models for each gender against other diagnostic parameters. The accuracy of the AI sarcopenia model was 96%, and 95% for male and females, respectively. Through these results, we were able to provide preliminary proof that SMCS could be a potential surrogate biomarker to reflect sarcopenia in stroke patients.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 2","pages":"e12"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cerebrolysin Concentrate: Therapeutic Potential for Severe Oral Apraxia After Stroke: A Case Report.","authors":"Hyeonwoo Jeon, Doo Young Kim","doi":"10.12786/bn.2024.17.e11","DOIUrl":"10.12786/bn.2024.17.e11","url":null,"abstract":"<p><p>Cerebrolysin concentrate is a medication whose main active ingredient is brain-derived neurotrophic factor. It has been reported to help in the restoration of cognitive function and overall physical function after brain injuries. We present the case of a 72-year-old man with severe oral apraxia due to a left middle cerebral artery ischemic stroke involving the left insular cortex. He was being tube fed due to severe oral apraxia with cognitive decline that made it difficult for him to even imitate simple oral movements. The patient initially had impaired consciousness and cognitive function. He also had limited physical activity due to acute stroke complications, such as hemorrhagic transformation of cerebral infarction, and required bed rest until 23 days after onset. The patient received intravenous cerebrolysin concentrate in addition to intensive rehabilitation therapy from 23 days after onset. After rehabilitation and administration of cerebrolysin concentrate, there was a marked recovery within a short period of time to the point where oral intake of a regular diet was possible, indicating a significant improvement in oral apraxia. It is a notable example of the potential therapeutic effect of cerebrolysin concentrate for post-stroke oral apraxia.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 2","pages":"e11"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yerim Ji, Mi-Jeong Yoon, Kwangsub Song, Sangui Choi, Hooman Lee, Ji Yoon Jung, Seungyup Song, Ilsoo Kim, Jae Yi Kim, Sun Im
{"title":"Feasibility of Sarcopenia Diagnosis Using Stimulated Muscle Contraction Signal in Hemiplegic Stroke Patients.","authors":"Yerim Ji, Mi-Jeong Yoon, Kwangsub Song, Sangui Choi, Hooman Lee, Ji Yoon Jung, Seungyup Song, Ilsoo Kim, Jae Yi Kim, Sun Im","doi":"10.12786/bn.2024.17.e10","DOIUrl":"10.12786/bn.2024.17.e10","url":null,"abstract":"<p><p>Sarcopenia, a condition characterized by muscle weakness and mass loss, poses significant risks of accidents and complications. Traditional diagnostic methods often rely on physical function measurements like handgrip strength which can be challenging for affected patients, including those with stroke. To address these challenges, we propose a novel sarcopenia diagnosis model utilizing stimulated muscle contraction signals captured via wearable devices. Our approach achieved impressive results, with an accuracy of 93% and 100% in sarcopenia classification for male and female stroke patients, respectively. These findings underscore the significance of our method in diagnosing sarcopenia among stroke patients, offering a non-invasive and accessible solution.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 2","pages":"e10"},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eunjin Park, Junghyeon Park, So-Youn Chang, Youngkook Kim
{"title":"Nontraumatic Myositis Ossificans After Spontaneous Subarachnoid Hemorrhage: A Case Report.","authors":"Eunjin Park, Junghyeon Park, So-Youn Chang, Youngkook Kim","doi":"10.12786/bn.2024.17.e9","DOIUrl":"https://doi.org/10.12786/bn.2024.17.e9","url":null,"abstract":"<p><p>Myositis ossificans is uncommon in patients with nontraumatic brain injuries. This report presents a challenging case in which myositis ossificans was diagnosed and treated by medical management in a patient who was unable to complain of any symptoms due to akinetic mutism that occurred after nontraumatic subarachnoid hemorrhage. The patient had intermittent high-grade fever, and laboratory tests showed elevated C-reactive protein and D-dimer levels without clinical signs of infection two months after subarachnoid hemorrhage. Lower-extremity venography using computed tomography was performed to rule out deep venous thrombosis. There was no thrombus, but right vastus medialis muscle showed inflammatory change with faint multilayered curvilinear hyperdense rims. The administration of indomethacin helped prevent abnormal bone formation. For the early detection of myositis ossificans, careful observation of clinical presentation and a high index of clinical suspicion is necessary in brain-injured patients. Further, elevated serum inflammatory markers accompanied by elevated alkaline phosphatase can be a critical clue. Early computed tomography helps identify early 'string sign' prior to characteristic ossification. Our report highlights that the myositis ossificans is remediable by early detection and appropriate nonsurgical management.</p>","PeriodicalId":72442,"journal":{"name":"Brain & NeuroRehabilitation","volume":"17 1","pages":"e9"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10990839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140862043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}