Brain-actuated functional electrical stimulation elicits lasting arm motor recovery after stroke

Brain-computer interfaces (BCI) are used in stroke rehabilitation to translate brain signals into intended movements of the paralyzed limb. However, the efficacy and mechanisms of BCI-based therapies remain unclear. Here we show that BCI coupled to functional electrical stimulation (FES) elicits significant, clinically relevant, and lasting motor recovery in chronic stroke survivors more effectively than sham FES. Such recovery is associated to quantitative signatures of functional neuroplasticity. BCI patients exhibit a significant functional recovery after the intervention, which remains 6–12 months after the end of therapy. Electroencephalography analysis pinpoints significant differences in favor of the BCI group, mainly consisting in an increase in functional connectivity between motor areas in the affected hemisphere. This increase is significantly correlated with functional improvement. Results illustrate how a BCI–FES therapy can drive significant functional recovery and purposeful plasticity thanks to contingent activation of body natural efferent and afferent pathways

A Fragment of the LG3 Peptide of Endorepellin Is Present in the Urine of Physically Active Mining Workers: A Potential Marker of Physical Activity

Biomarker analysis has been implemented in sports research in an attempt to monitor the effects of exertion and fatigue in athletes. This study proposed that while such biomarkers may be useful for monitoring injury risk in workers, proteomic approaches might also be utilised to identify novel exertion or injury markers. We found that urinary urea and cortisol levels were significantly elevated in mining workers following a 12 hour overnight shift. These levels failed to return to baseline over 24 h in the more active maintenance crew compared to truck drivers (operators) suggesting a lack of recovery between shifts. Use of a SELDI-TOF MS approach to detect novel exertion or injury markers revealed a spectral feature which was associated with workers in both work categories who were engaged in higher levels of physical activity. This feature was identified as the LG3 peptide, a C-terminal fragment of the anti-angiogenic/anti-tumourigenic protein endorepellin. This finding suggests that urinary LG3 peptide may be a biomarker of physical activity. It is also possible that the activity mediated release of LG3/endorepellin into the circulation may represent a biological mechanism for the known inverse association between physical activity and cancer risk/survival

Possibilités thérapeutiques de l'infarctus cérébral en phase aiguë

Les nouvelles perspectives thérapeutiques de l'ischémie cérébrale impliquent une prise en charge urgente des patients victimes d'un infarctus cérébral. En phase aiguë, il convient d'assurer un contrôle optimal des paramètres métaboliques électrolytiques, de la pression artérielle, d'exclure des troubles du rythme cardiaque. Plusieurs études ont démontré le bénéfice de la thrombolyse, mais non sans quelques incertitudes. Des études sont en ours pour clarifier l'indication appropriée d'un tel traitement. En attendant, quand l'heure exacte de la survenue d'un infarctus cérébral est connue, tout patient devrait être adressé à un centre spécialisé pour évaluer l'indication à la thrombolyse. De nombreuses substances neuroprotectrices sont encore à l'étude et vont probablement modifier la prise en charge des patients en phase aiguë

Return to work after a traumatic brain injuryVocational Rehabilitation. Pari

Introduction In spite of improvements in the prevention of car and work accidents, traumatic brain injury (TBI) is still devastating for the patients and their families and still constitutes a public health problem. In the USA, every year 1.5 million people sustain a TBI. Fiftythousand persons will die from the consequences of brain injury, 230,000 will be hospitalised and 70,000 to 90,000 will experience a long-term loss of functioning The benefit of work for the quality of life with TBI is well established and job loss can be a frequent consequence of severe TBI Among the factors which determine the success of returning to work after a TBI, the bio psychosocial ones are also very important: level of education and vocational training, culture, familial support, psychiatric history, type of jo

Increased alpha-rhythm dynamic range promotes recovery from visuospatial neglect: A neurofeedback study

Contains fulltext : 180928.pdf (publisher's version ) (Open Access)Despite recent attempts to use electroencephalogram (EEG) neurofeedback (NFB) as a tool for rehabilitation of motor stroke, its potential for improving neurological impairments of attention - such as visuospatial neglect - remains underexplored. It is also unclear to what extent changes in cortical oscillations contribute to the pathophysiology of neglect, or its recovery. Utilizing EEG-NFB, we sought to causally manipulate alpha oscillations in 5 right-hemisphere stroke patients in order to explore their role in visuospatial neglect. Patients trained to reduce alpha oscillations from their right posterior parietal cortex (rPPC) for 20 minutes daily, over 6 days. Patients demonstrated successful NFB learning between training sessions, denoted by improved regulation of alpha oscillations from rPPC. We observed a significant negative correlation between visuospatial search deficits (i.e., cancellation test) and reestablishment of spontaneous alpha-rhythm dynamic range (i.e., its amplitude variability). Our findings support the use of NFB as a tool for investigating neuroplastic recovery after stroke and suggest reinstatement of intact parietal alpha oscillations as a promising target for reversing attentional deficits. Specifically, we demonstrate for the first time the feasibility of EEG-NFB in neglect patients and provide evidence that targeting alpha amplitude variability might constitute a valuable marker for clinical symptoms and self-regulation.9 p

Face-arm-trunk-leg sensory loss limited to the contralateral side in lateral medullary infarction: a new variant

Two patients are reported on who experienced loss of pain and temperature sensation in the entire contralateral hemibody but sparing the ispsilateral face (pure sensory stroke pattern) related to acute lateral medullary infarction. In both patients MRI showed a notch-like retro-olivary ischaemic lesion in the ventromedial tegmentum with preservation of the far lateral medulla. The mediolateral lesion involved the crossed lateral spinothalamic tract and the ventral trigeminothalamic tract, corresponding to sensory loss in the contralateral face, arm, and upper trunk. The ventrolateral extension of infarct damaged the far lateral part of the spinothalamic tract, corresponding to sensory loss in the contralateral lower trunk and leg. The findings suggest that hemisensory loss of the spinothalamic type involving—and limited to—the whole hemibody can occur in infarction in the lower brainstem. This form of pure sensory stroke may be classified as type IV of sensory loss in lateral medullary infarction.


Approches thérapeutiques de la spasticité

La spasticité est un signe neurologique lié à une atteinte du motoneurone supérieur qui peut entraver la mobilité du patient. Différents moyens physiques peuvent être utiles pour diminuer le tonus en dirigeant leurs effets sur un groupe musculaire. Parmi les traitements médicamenteux qui ont un effet systémique, le baclofène et la tizanidine sont les plus utiles. Le baclofène peut également être utilisé au niveau intrathécal dans les formes de spasticité d'origine spinale. Dans les cas de spasticité à composante dystonique, la toxine botulique se profile comme le traitement de choix et évite de recourir à des techniques plus invasives comme la neuralyse ou la chirurgie