Clinical Neurology & Stroke

Epilepsy patients commonly report stress as a frequent seizure trigger; however, the objective seizure-stress relationship is unclear due to self-report biases and difficulty in objective quantification of stress. This work presents a dataset from twenty epilepsy patients undergoing cognitive stress elicitation protocols, participating in laboratory experiments with computer-based tasks at predefined difficulty levels, and in situational experiments by independently choosing tasks with at least two difficulty levels. Physiological signals from wearable electroencephalography, photoplethysmography, acceleration, electrodermal activity, and temperature sensors were recorded. The task‑related perceived cognitive stress was collected using two 5‑point Likert scales of self‑reported mental workload and stress, contrasted by a pairwise NASA‑TLX questionnaire. Additionally, the dataset includes a patient‑reported list of seizure‑provoking and ‑inhibiting factors. Results illustrated individual and heterogeneous responses to cognitive tasks, with some modalities yielding statistically significant features, while others demonstrated expected directional trends. The findings support the validity and suitability of the proposed dataset for cognitive stress detection and the potential to map seizure‑related factors to cognitive stress events.

Background: Age-related muscle function decline is a major impediment to healthy ageing. We aimed to investigate the association between a panel of Alzheimer’s disease-related biomarkers and longitudinal trajectories of muscle strength, while exploring the influence of cognitive function. Methods In this cohort study, we gathered data from the Swedish National study on Aging and Care in Kungsholmen (SNAC‑K), an ongoing prospective study that includes adults aged 60 years and older, from central Stockholm, Sweden. We included data from baseline to the fourth follow-up (March 21, 2001, to Dec 31, 2016). Seven Alzheimer’s disease-related blood biomarkers were measured in dementia‑free, community dwelling participants: total tau, phosphorylated tau181 (p‑tau181), phosphorylated tau217 (p‑tau217), amyloid β 40 and 42, neurofilament light chain, and glial fibrillary acidic protein (GFAP). Muscle strength was measured through the handgrip strength and chair‑stand tests. Linear mixed models were used to explore the association between baseline Alzheimer’s disease-related biomarkers and muscle strength trajectories. Findings: The baseline SNAC‑K cohort included 3363 individuals, of whom 1953 participants were included in our analyses (mean age 70·2 [SD 9·1] years; 780 [39·9%] male and 1173 [60·1%] female participants). In adjusted models, higher concentrations of p‑tau181 (β per year 0·93 [95% CI 0·71 to 1·16]; p<0·0001), p‑tau217 (β per year 1·31 [1·03 to 1·58]; p<0·0001), neurofilament light chain (β per year 0·76 [0·56 to 0·96]; p<0·0001), and GFAP (β per year 0·37 [0·21 to 0·53]; p<0·0001) were associated with an accelerated decline of chair‑stand performance over time. The adjustment for Mini‑Mental State Examination (MMSE) score led to the attenuation of these associations. Higher concentrations of p‑tau181 (β per year −0·12 [95% CI −0·17 to −0·07]; p<0·0001), p‑tau217 (β per year −0·13 [−0·20 to −0·07]; p<0·0001), and neurofilament light chain (β per year −0·05 [−0·09 to −0·001]; p=0·047) were also associated with faster handgrip strength decline, with no attenuation after adjusting for MMSE score. Sex-specific differences were observed, with female participants showing a stronger association between biomarker concentrations and muscle strength decline than male participants, particularly in the chair‑stand test. Interpretation: Our findings suggest that blood Alzheimer’s disease-related biomarkers might help estimate progressive muscle strength decline among older adults, elucidating the influence of brain pathology and cognitive ageing on this association. These Alzheimer’s disease-related biomarkers could aid in identifying individuals for early intervention to prevent sarcopenia. Funding: The Swedish Research Council, the Swedish Ministry of Health and Social Affairs, and the County Councils and Municipalities.

Corticobasal syndrome (CBS) is characterized not only by parkinsonism but also by higher-order cortical dysfunctions, such as apraxia. However, the electrophysiological mechanisms underlying these symptoms remain poorly understood. To explore the pathophysiology of CBS, we recorded magnetoencephalographic (MEG) data from 17 CBS patients and 20 age-matched controls during an observe-to-imitate task. This task involved observing a tool-use video (action observation), withholding movement upon a Go cue (movement preparation), and subsequently imitating the tool-use action. We analyzed spectral power modulations at the source level. During action observation, event‑related beta power (13-30 Hz) suppression was weaker in CBS patients compared to controls. This reduction was evident bilaterally in superior parietal, primary motor, premotor and inferior frontal cortex. During movement preparation, beta power suppression was also reduced in CBS patients, correlating with longer reaction times. Immediately prior to movement onset, however, beta suppression was comparable between groups. Our findings suggest that action observation induces beta suppression, likely indicative of motor cortical disinhibition, which is impaired in CBS patients. This alteration may represent a neural correlate of disrupted visuo‑motor mapping in CBS. The altered timing of beta suppression to the Go cue suggests deficits in learning the task’s temporal structure rather than in movement initiation itself.

Editorial on the exposome and social determinants of health in mild cognitive impairment and dementia, highlighting how neighborhood disadvantage, air pollution, green space, and structural racism drive cognitive decline. Calls for population‑level policies, urban planning, and inclusive research to address health inequities.

Objective: Although there is a strong correlation between stroke and sarcopenia, there has been a lack of research into the potential risks associated with post-stroke sarcopenia. Predictors of sarcopenia are yet to be identified. We aimed at developing a nomogram able to predict sarcopenia in patients with stroke. Methods: The National Health and Nutrition Examination Survey (NHANES) cycle year of 2011 to 2018 was divided into two groups of 209 participants-one receiving training and the other validation-in a random manner. The Lasso regression analysis was used to identify the risk factors of sarcopenia, and a nomogram model was created to forecast sarcopenia in the stroke population. The model was assessed based on its discrimination area under the receiver operating characteristic curve, calibration curves, and clinical utility decision curve analysis curves. Results: In this study, we identified several predictive factors for sarcopenia: Gender, Body Mass Index (kg/m2), Standing Height (cm), Alkaline Phosphatase (ALP) (IU/L), Total Calcium (mg/dL), Creatine Phosphokinase (CPK) (IU/L), Hemoglobin (g/dL), and Waist Circumference (cm). Notably, female patients with stroke exhibited a higher risk of sarcopenia. The variables positively associated with increasing risk included Alkaline Phosphatase, Body Mass Index, Waist Circumference, and Hemoglobin, while those negatively associated with risk included Height, Total Calcium, and Creatine Phosphokinase. The nomogram model demonstrated remarkable accuracy in distinguishing between training and validation sets, with areas under the curve of 0.97 and 0.90, respectively. The calibration curve showcased outstanding calibration, and the analysis of the decision curve revealed a broad spectrum of beneficial clinical outcomes. Conclusion: This study creates a new nomogram which can be used to predict pre-sarcopenia in stroke. The new screening device is accurate, precise, and cost-effective, enabling medical personnel to identify patients at an early stage and take action to prevent and treat illnesses.

In this narrative review, we delve into the evolving concept of brain health, as recognized by the WHO, focusing on its intersection with cognitive decline. We emphasize the imperative need for preventive strategies, particularly in older adults. We describe the target population that might benefit the most from risk-based approaches—namely, people with subjective cognitive decline. Additionally, we consider universal prevention in cognitively unimpaired middle-aged and older adults. Delving into multidomain personalized preventive strategies, we report on empirical evidence surrounding modifiable risk factors and interventions crucial in mitigating cognitive decline. Next, we highlight the emergence of brain health services (BHS). We explain their proposed role in risk assessment, risk communication, and tailored interventions to reduce the risk of dementia. Commenting on ongoing BHS pilot experiences, we present the inception and framework of our own BHS in Monza, Italy, outlining its operational structure and care pathways. We emphasize the need for global collaboration and intensified research efforts to address the intricate determinants of brain health and their potential impact on healthcare systems worldwide.

Stroke survivors frequently report increased perceived challenge of walking (PCW) in complex environments, restricting their daily ambulation. PCW is conventionally measured through subjective questionnaires or, more recently, through objective quantification of sympathetic nervous system activity during walking tasks. However, how these measurements of PCW reflect daily walking activity post-stroke is unknown. We aimed to compare the subjective and objective assessments of PCW in predicting home and community ambulation. In 29 participants post-stroke, we measured PCW subjectively with the Activities‑specific Balance Confidence (ABC) Scale and objectively through electrodermal activity, quantified by change in skin conductance levels (SCL) and skin conductance responses (SCR) between outdoor‑complex and indoor‑steady‑state walking. High‑PCW participants were categorized into high‑change SCL (ΔSCL ≥ 1.7 µs), high‑change SCR (ΔSCR ≥ 0.2 µs) and low ABC (ABC < 72 %) groups, while low‑PCW participants were categorized into low‑change SCL (ΔSCL < 1.7 µs), low‑change SCR (ΔSCR < 0.2 µs) and high‑ABC (ABC ≥ 72 %) groups. Number and location of daily steps were quantified with accelerometry and Global Positioning System devices. Compared to low‑change SCL group, the high‑change SCL group took fewer steps in home and community (p = 0.04). Neither ABC nor SCR groups differed in home or community steps/day. Objective measurement of PCW via electrodermal sensing more accurately represents home and community ambulation compared to the subjective questionnaire.

Eye tracking is becoming increasingly available in head‑mounted virtual reality displays with various headsets with integrated eye trackers already commercially available. The applications of eye tracking in virtual reality are highly diversified and span multiple disciplines. As a result, the number of peer‑reviewed publications that study eye tracking applications has surged in recent years. We performed a broad review to comprehensively search academic literature databases with the aim of assessing the extent of published research dealing with applications of eye tracking in virtual reality, and highlighting challenges, limitations and areas for future research.

A wide plethora of intervention procedures, tissue plasminogen activators, mechanical thrombectomy, and several neuroprotective drugs were reported in stroke research over the last decennium. However, against this vivid background of newly emerging pieces of evidence, there is little to no advancement in the overall functional outcomes. With the advancement of epigenetic tools and technologies associated with intervention medicine, stroke research has entered a new fertile. The stroke involves an overabundance of inflammatory responses arising in part due to the body’s immune response to brain injury. Neuroinflammation contributes to significant neuronal cell death and the development of functional impairment and even death in stroke patients. Recent studies have demonstrated that epigenetics plays a key role in post-stroke conditions, leading to inflammatory responses and alteration of the microenvironment within the injured tissue. In this review, we summarize the progress of epigenetics which provides an overview of recent advancements on the emerging key role of secondary brain injury in stroke. We also discuss potential epigenetic therapies related to clinical practice.

Introduction: Sarcopenia, a age-related disease characterized by loss of muscle mass accompanied by loss of function, is associated with nutrition imbalance, physical inactivity, insulin resistance, inflammation, metabolic syndrome, and atherosclerosis which are risk factors for cardiovascular disease. However, its association with outcomes after ischemic stroke has not been well-established. This study investigated whether functional outcomes of patients with acute ischemic stroke is associated with sarcopenia. Methods: Data were collected from 568 consecutive patients with acute ischemic stroke with National Institute of Health Stroke Scale 0-5 or transient ischemic attack who underwent bioelectrical impedance analysis between March 2018 and March 2021. Sarcopenia was defined, as low muscle mass, as measured by bioelectrical impedance analysis, and low muscle strength, as indicated by the Medical Research Council score. Unfavorable functional outcome was defined as mRS score of 2-6 at 90 days after discharge. The relationship between functional outcomes and the presence of sarcopenia or its components was determined. Results: Of the 568 patients included (mean age 65.5 ± 12.6 years, 64.6% male), sarcopenia was detected in 48 (8.5%). After adjusting for potential confounders, sarcopenia was independently and significantly associated with unfavorable functional outcome (odds ratio 2.37, 95% confidence interval 1.15-4.73 for unfavorable functional outcome, odds ratio 2.10, 95% confidence interval 1.18-3.71 for an increase in the mRS score). Each component of sarcopenia was also independently associated with unfavorable functional outcome (odds ratio 1.76, 95% confidence interval 1.05-2.95 with low muscle mass, odds ratio 2.64, 95% confidence interval 1.64-4.23 with low muscle strength). The impact of low muscle mass was larger in men than in women, and in patients with lower muscle mass of the lower extremities than in those with lower muscle mass of the upper extremities. Conclusions: In this study, the prevalence of sarcopenia in patients with stroke was lower than most of previous studies and patients with sarcopenia showed higher likelihood for unfavorable functional outcomes at 90 days after acute ischemic stroke or TIA. Further investigation of the interventions for treating sarcopenia and its impact on the outcome of ischemic stroke patients is needed.

Background: A comprehensive evaluation of dysarthria is required to make an accurate differential diagnosis with other communication disorders and plan effective rehabilitation programs. The Frenchay Dysarthria Assessment-2 (FDA-2) is a valid, reliable and widely used protocol for the assessment of dysarthria. An Italian version of the FDA-2 is currently lacking. Aim: To perform a cross-cultural adaptation of the FDA-2 in Italian and to validate the Italian version of the FDA-2. Design: Validation study. Setting: Inpatient rehabilitation center. Population: 69 patients with dysarthria and 112 healthy controls. Methods: The FDA-2 was translated and cross-culturally adapted to Italian. The validation study was carried out in 4 steps: (1) 42 audio-recorded samples of FDA-2 items from 11 patients with dysarthria were independently assessed by 7 speech and language pathologists for interrater reliability and re‑assessed after 6 weeks for intrarater reliability; (2) 11 patients were simultaneously assessed by 3 speech and language therapists for inter‑rater reliability of the whole Italian version of the FDA-2 and re‑assessed within 24 hours for test‑retest reliability; (3) the Italian version of the FDA-2 was administered to 112 healthy volunteers to gain normative data; (4) 49 patients with different types of dysarthria were assessed using the Italian version of the FDA-2, the Therapy Outcome Measure impairment scale and the Robertson Profile for the validity analysis. Results: Interrater and intrarater reliability ranged from good to excellent (ICC >0.75) except for 3 audio‑recorded items. The overall protocol demonstrated excellent (ICC >0.9) inter‑rater and test‑retest reliability for all the sections and the total score. Normative data were gained for 6 age groups. For the validity analysis, a statistically significant difference was found between dysarthric patients and healthy subjects for all sections and the total score. The FDA‑2 significantly correlated to the therapy outcome measure (r=0.75) and the Robertson Profile (r=0.81). Conclusions: The Italian version of the FDA-2 yield satisfactory reliability and validity, comparable to the psychometric properties of the original version. Clinical rehabilitation impact: Speech and language pathologists can rely on a valid and reliable tool in Italian for the assessment of dysarthria in both clinical and research practice.

Metabolic bone is highly innervated by both sensory and sympathetic nerves. In addition to skeletal development, neural regulation participates in local bone remodeling, which is important for successful osseointegration of titanium implants. Neurectomy is a model used to investigate the lack of neural function on bone homeostasis, but the relative impacts of direct denervation to bone or denervation-induced muscle paralysis are less well defined. To investigate this difference, we used two nerve intervention models, sciatic and femoral neurectomy (SFN) v. botox-induced muscle paralysis (BTX) and assessed the resulting femoral bone phenotype and Ti implant osseointegration. Male Sprague Dawley rats (19) were randomly divided into three groups: implant control (n = 5), SFN (n = 7), and BTX (n = 7). Ti implants (microrough/hydrophilic [modSLA], Institut Straumann AG) were placed in the distal metaphysis of each femur on day 24 post-SFN or BTX. Bone and muscle were examined on day 28 after implant insertion. Both nerve intervention models impaired osseointegration. MicroCT and histology indicated that both models had reduced trabecular bone formation. Only BTX reduced cortical bone formation and increased cortical bone porosity. BTX resulted in more bone loss characterized by the least trabecular and cortical bone, as well as osseointegration. Osteoblasts isolated from the tibia exhibited a model-specific phenotype when they were grown on Ti substrates in vitro. Neurectomy caused more severe muscle atrophy than botox injection. These results indicate that neural regulation directly modulates bone formation and osseointegration. Muscle paralysis modulated the effects of loss of neural inputs into bone, supporting the hypothesis that mechanical loading of bone is a factor in achieving successful osseointegration. The different effects of botox and neurectomy on bone phenotype indicated that the sensory and sympathetic nerves had a role in the osseointegration process.

Review of mechanobiology describing how mechanical forces are sensed and transduced in cells, highlighting key components such as integrins, ECM, cytoskeleton, focal adhesions, and technologies like AFM and traction force microscopy, with implications for disease and therapy.

Many neurocognitive studies endeavor to understand neural mechanisms of basic creative activities in strictly controlled experiments. However, little evidence is available regarding the neural mechanisms of interactions between basic activities underlying creativity in such experiments. Moreover, strictly controlled experiments might limit flexibility/freedom needed for creative exploration. Thus, this study investigated the whole-brain neuronal networks’ interactions between three modes of thinking: idea generation, idea evolution, and evaluation in a loosely controlled creativity experiment. The loosely controlled creativity experiment will provide a degree of flexibility/freedom for participants to incubate creative ideas through extending response time from a few seconds to 3 min. In the experiment, participants accomplished a modified figural Torrance Test of Creative Thinking (TTCT-F) while their EEG signals were recorded. During idea generation, a participant was instructed to complete a sketch that was immediately triggered by a sketch stimulus at first sight. During idea evolution, a participant was instructed to complete a sketch that is radically distinctive from what was immediately triggered by the sketch stimulus. During the evaluation, a participant was instructed to evaluate difficulties of thinking and drawing during idea generation and evolution. It is expected that participants would use their experience to intuitively complete a sketch during idea generation while they could use more divergent and imaginative thinking to complete a possible creative sketch during idea evolution. Such an experimental design is named as a loosely controlled creativity experiment, which offers an approach to studying creativity in an ecologically valid manner. The validity of the loosely controlled creativity experiment could be verified through comparing its findings on phenomena that have been effectively studied by validated experimental research. It was found from our experiment that alpha power decreased significantly from rest to the three modes of thinking. These findings are consistent with that from visual creativity research based on event-related (de)synchronization (ERD/ERS) and task-related power changes (TRP). Specifically, in the lower alpha band (8-10 Hz), the decreases of alpha power were significantly lower over almost the entire scalp during idea evolution compared to the other modes of thinking. This finding indicated that idea evolution requires less general attention demands than the other two modes of thinking since the lower alpha ERD has been reported as being more likely to reflect general task demands such as attentional processes. In the upper alpha band (10-12 Hz), the decreases of alpha power were significantly higher over central sites during the evaluation compared to idea evolution. This finding indicated that evaluation involves more task-specific demands since the upper alpha ERD has been found as being more likely to reflect task-specific demands such as memory and intelligence, as was defined in the literature. In addition, new findings were obtained since the loosely controlled creativity experiment could activate multiple brain networks to accomplish the tasks involving the three modes of thinking. EEG microstate analysis was used to structure the unstructured EEG data to detect the activation of multiple brain networks. Combined EEG-fMRI and EEG source localization studies have indicated that EEG microstate classes are closely associated with the resting-state network as identified using fMRI. It was found that the default mode network was more active during idea evolution compared to the other two modes of thinking, while the cognitive control network was more active during the evaluation compared to the other two modes of thinking. This finding indicated that idea evolution might be more associated with unconscious and internal directed attention processes. Taken together, the loosely controlled creativity experiment with the support of EEG microstate analysis appears to offer an effective approach to investigating the real-world complex creativity activity.

Parkinson’s disease is a neurological disorder with cardinal motor signs of resting tremor, bradykinesia and lead-pipe rigidity. In addition, many patients display non-motor symptoms, including a diminished sensation of smell, gastrointestinal problems, various disorders of sleep and some cognitive impairment. These clinical features manifest after a progressive death of many dopaminergic neurones in the brain. This book focuses on two therapies that are readily available for the patients of today. They involve the use of exercise and light (i.e. photobiomodulation, the use of red to infrared light therapy on body tissues). Part of IOP Series in Photomedicine and Biophotonics

Identify the optimal energy delivered with a single application of the combination of photobiomodulation therapy (PBMT) combining different light sources (low-level laser therapy—LLLT and light emitting diode therapy—LEDT) and static magnetic field (sMF) in order to determine the acute effects on functional mobility of stroke survivors. Was conducted a randomized, placebo-controlled, crossover, triple-blind, clinical trial (RCT). Twelve patients were recruited, however ten concluded the study, they were randomly treated with four PBMT/sMF energies (sham—0 J, 10 J, 30 J, and 50 J per site irradiated), with 1-week interval washout between treatments. PBMT/sMF were administered after the pre-intervention (baseline) evaluation and the total energy delivered per site at each treatment was determined based on the results of the randomization procedure. PBMT/sMF were administered in direct contact with the skin and applied with slight pressure to nine sites on the knee extensors, six sites on the knee flexors, and two sites on the plantar flexors’ muscles in both lower limbs (bilaterally). The primary outcome measure was the 6-min walk test (6MWT) and the secondary outcome was the Timed Up and Go (TUG) test. Significant improvements were found in the 6MWT test using a total energy of 30 J per site compared with sham (0 J) (p < 0.05) and compared with the baseline evaluation (p < 0.01). And in the TUG test significant improvements were also found using a total energy per site of 30 J per site compared to sham (0 J) and baseline (p < 0.05). PBMT with different light sources (laser and LEDs) and wavelengths in combination with sMF with a total energy per site of 30 J has positive acute effects on functional mobility in stroke survivors.

Alzheimer’s disease (AD) is associated with severe cognitive impairments as well as some metabolic defects. Scant studies in animal models indicate a link between probiotics and cognitive function. This randomized, double‑blind, and controlled clinical trial was conducted among 60 AD patients to assess the effects of probiotic supplementation on cognitive function and metabolic status. The patients were randomly divided into two groups (n = 30 in each group) treating with either milk (control group) or a mixture of probiotics (probiotic group). The probiotic supplemented group took 200 ml/day probiotic milk containing Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum, and Lactobacillus fermentum (2 × 10^9 CFU/g for each) for 12 weeks. Mini‑mental state examination (MMSE) score was recorded in all subjects before and after the treatment. Pre‑ and post‑treatment fasting blood samples were obtained to determine the related markers. After 12 weeks intervention, compared with the control group (-5.03% ± 3.00), the probiotic treated (+27.90% ± 8.07) patients showed a significant improvement in the MMSE score (P < 0.001). In addition, changes in plasma malondialdehyde (-22.01% ± 4.84 vs. +2.67% ± 3.86 μmol/L, P < 0.001), serum high‑sensitivity C‑reactive protein (-17.61% ± 3.70 vs. +45.26% ± 3.50 μg/mL, P < 0.001), homeostasis model of assessment‑estimated insulin resistance (+28.84% ± 13.34 vs. +76.95% ± 24.60, P = 0.002), Beta cell function (+3.45% ± 10.91 vs. +75.62% ± 23.18, P = 0.001), serum triglycerides (-20.29% ± 4.49 vs. -0.16% ± 5.24 mg/dL, P = 0.003), and quantitative insulin sensitivity check index (-1.83 ± 1.26 vs. -4.66 ± 1.70, P = 0.006) in the probiotic group were significantly varied compared to the control group. We found that the probiotic treatment had no considerable effect on other biomarkers of oxidative stress and inflammation, fasting plasma glucose, and other lipid profiles. Overall, the current study demonstrated that probiotic consumption for 12 weeks positively affects cognitive function and some metabolic statuses in the AD patients.

Background. Trunk function is important for standing balance, mobility, and functional outcome after stroke, but few studies have evaluated the effects of exercises aimed at improving core stability in stroke patients. Objective. To investigate the effectiveness of core stability training on trunk function, standing balance, and mobility in stroke patients. Methods. An assessor‑blinded, randomized controlled trial was undertaken in a stroke rehabilitation ward, with 32 participants randomly assigned to an experimental group or a control group (n = 16 each). The experimental group received 400 minutes of core stability training in place of conventional programs within total training time, while the control group received only conventional programs. Primary outcome measures were evaluated using the Trunk Impairment Scale (TIS), which reflects trunk function. Secondary outcome measures were evaluated by pelvic tilt active range of motion in the sagittal plane, the Balance Evaluation Systems Test‑brief version (Brief‑BESTest), Functional Reach test, Timed Up‑and‑Go test (TUG), and Functional Ambulation Categories (FAC). A general linear repeated‑measures model was used to analyze the results. Results. A treatment effect was found for the experimental group on the dynamic balance subscale and total score of the TIS (P = .002 and P < .001, respectively), pelvic tilt active range of motion (P < .001), Brief‑BESTest (P < .001), TUG (P = .008), and FAC (P = .022). Conclusions. Core stability training has beneficial effects on trunk function, standing balance, and mobility in stroke patients. Our findings might provide support for introducing core stability training in stroke rehabilitation.

The feeling of synchrony is fundamental for most social activities and prosocial behaviors. However, little is known about the behavioral correlates of this feeling and its modulation by intergroup differences. We previously showed that the subjective feeling of synchrony in subjects involved in a mirror imitation task was modulated by objective behavioral measures, as well as contextual factors such as task difficulty and duration of the task performance. In the present study, we extended our methodology to investigate possible interindividual differences. We hypothesized that being in a romantic relationship or being a professional musician can modulate both implicit and explicit synchronization and the feeling of synchrony as well as the ability to detect synchrony from a third person perspective. Contrary to our hypothesis, we did not find significant differences between people in a romantic relationship and control subjects. However, we observed differences between musicians and control subjects. For the implicit synchrony (spontaneous synchronization during walking), the results revealed that musicians that had never met before spontaneously synchronized their movements earlier among themselves than control subjects, but not better than people sharing a romantic relationship. Moreover, in explicit behavioral synchronization tasks (mirror game), musicians reported earlier feeling of synchrony and had less speed errors than control subjects. This was in interaction with tasks difficulty as these differences appeared only in tasks with intermediate difficulty. Finally, when subjects had to judge synchrony from a third person perspective, musicians had a better performance to identify if they were present or not in the videos. Taken together, our results suggest that being a professional musician can play a role in the feeling of synchrony and its underlying mechanisms.

Stroke rehabilitation is a progressive, dynamic, goal-orientated process aimed at enabling a person with impairment to reach their optimal physical, cognitive, emotional, communicative, social and/or functional activity level. After a stroke, patients often continue to require rehabilitation for persistent deficits related to spasticity, upper and lower extremity dysfunction, shoulder and central pain, mobility/gait, dysphagia, vision, and communication. Each year in Canada 62,000 people experience a stroke. Among stroke survivors, over 6500 individuals access in-patient stroke rehabilitation and stay a median of 30 days (inter-quartile range 19 to 45 days). The 2015 update of the Canadian Stroke Best Practice Recommendations: Stroke Rehabilitation Practice Guidelines is a comprehensive summary of current evidence-based recommendations for all members of multidisciplinary teams working in a range of settings, who provide care to patients following stroke. These recommendations have been developed to address both the organization of stroke rehabilitation within a system of care (i.e., Initial Rehabilitation Assessment; Stroke Rehabilitation Units; Stroke Rehabilitation Teams; Delivery; Outpatient and Community-Based Rehabilitation), and specific interventions and management in stroke recovery and direct clinical care (i.e., Upper Extremity Dysfunction; Lower Extremity Dysfunction; Dysphagia and Malnutrition; Visual-Perceptual Deficits; Central Pain; Communication; Life Roles). In addition, stroke happens at any age, and therefore a new section has been added to the 2015 update to highlight components of stroke rehabilitation for children who have experienced a stroke, either prenatally, as a newborn, or during childhood. All recommendations have been assigned a level of evidence which reflects the strength and quality of current research evidence available to support the recommendation. The updated Rehabilitation Clinical Practice Guidelines feature several additions that reflect new research areas and stronger evidence for already existing recommendations. It is anticipated that these guidelines will provide direction and standardization for patients, families/caregiver(s), and clinicians within Canada and internationally.

In stroke patients, excessive oxidative stress impairs brain function, whereas, on the other hand, rehabilitative exercise is necessary for functional improvement and maintenance after stroke, and exercises themselves increase reactive oxygen species production simultaneously. These influence oxidative stress in stroke patients. We assessed the effects of exercises on 29 Japanese stroke patients by examining changes in reactive oxygen metabolite (ROM) level (i.e., antioxidant capacity) in blood plasma. The exercise group performed two sets of 1-hour exercises 6 days/week for 56 days. The control group performed the same 1-hour exercises, but only on days 1 and 56. ROM and BAP levels were measured immediately before and after the exercises. ROM level significantly decreased and BAP level significantly increased in the exercise group. However, no significant change was observed in these levels in the control group. Therefore, it is essential to elucidate how exercises themselves increase reactive oxygen species production, which leads to atherosclerosis and initiation of thrombosis. These contradictory issues, namely, “therapeutic exercises are needed for functional improvement and functional maintenance” and “exercises themselves increase ROS production, which leads to atherosclerosis and initiation of thrombosis” are discussed.

Introduction. This study compared the balance by center of pressure (COP) and its relationship with gait parameters and functional independence in left (LH) and right (RH) chronic stroke patients. Methods. In this cross‑sectional study, twenty‑one hemiparetic stroke patients were assessed for Functional Independence Measure (FIM), balance with a force platform, and gait in the Motion Analysis Laboratory. Results. The amplitudes of the COP in the anteroposterior and mediolateral directions were similar in both groups. The anteroposterior direction was greater than the mediolateral direction. Only the temporal parameters showed any statistically significant differences. The LH showed a significant correlation between stride length, step length, and gait velocity with COP velocity sway for the healthy and paretic lower limbs. In both groups, the area of COP was significantly correlated with stride length. Motor FIM was significantly correlated with the COP in the LH group. Conclusion. There was no difference in the performance of balance, gait, and functional independence between groups. The correlation of the COP sway area with stride length in both groups can serve as a guideline in the rehabilitation of these patients where training the static balance may reflect the improvement of the stride length.

Stroke is the major cause of permanent disability and mortality in China. Apigenin-7-O-β-D-(-6”-p-coumaroyl)-glucopyranoside (APG) is a glycoside subtype of apigenin and has the antioxidant activity; however, whether and how it plays a neuroprotective role following cerebral ischemia remains unknown. In present study, we adopted the oxygen glucose/reperfusion model in PC12 cells, bilateral common carotid artery occlusion model in C57B6 mice and middle cerebral artery occlusion model in SD rats to observe the therapeutic effects of APG on ischemic stroke. We also discussed the underlying mechanism. Treatment with 0.4 μg/ml or 0.8 μg/ml APG promoted cell viability and proliferation, reduced LDH release and apoptotic cell death levels in PC12 cells. Treatment with 50 mg/kg or 100 mg/kg APG at 30 minutes after reperfusion improved neurological outcomes in vivo, as demonstrated by elevation of neurological scores in both mice and rats. It also increased the number of survival neurons in mice and reduced infarct volume in rats. APG also increased the contents of Mn-SOD and the phosphorylation level of STAT3, elevated the antioxidant activity and reduced oxidative productions. These findings revealed a neuroprotective effect of APG, which possibly induced by the STAT3 phosphorylation-mediated Mn-SOD up-regulation.

Tracking and predicting motor outcomes is important in determining effective stroke rehabilitation strategies. Diffusion tensor imaging (DTI) allows for evaluation of the underlying structural integrity of brain white matter tracts and may serve as a potential biomarker for tracking and predicting motor recovery. In this study, we examined the longitudinal relationship between DTI measures of the posterior limb of the internal capsule (PLIC) and upper-limb motor outcomes in 13 stroke patients (median 20-month post-stroke) who completed up to 15 sessions of intervention using brain–computer interface (BCI) technology. Patients’ upper-limb motor outcomes and PLIC DTI measures including fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) were assessed longitudinally at four time points: pre-, mid-, immediately post- and 1-month-post intervention. DTI measures and ratios of each DTI measure comparing the ipsilesional and contralesional PLIC were correlated with patients’ motor outcomes to examine the relationship between structural integrity of the PLIC and patients’ motor recovery. We found that lower diffusivity and higher FA values of the ipsilesional PLIC were significantly correlated with better upper-limb motor function. Baseline DTI ratios were significantly correlated with motor outcomes measured immediately post and 1-month-post BCI interventions. A few patients achieved improvements in motor recovery meeting the minimum clinically important difference (MCID). These findings suggest that upper-limb motor recovery in stroke patients receiving BCI interventions relates to the microstructural status of the PLIC. Lower diffusivity and higher FA measures of the ipsilesional PLIC contribute toward better motor recovery in the stroke-affected upper-limb. DTI-derived measures may be a clinically useful biomarker in tracking and predicting motor recovery in stroke patients receiving BCI interventions.

We evaluated the reliability of 8-hydroxy-2′-deoxyguanosine (8-OHdG), and determined its ability to predict functional outcomes in stroke survivors. The rehabilitation effect on 8-OHdG and functional outcomes were also assessed. Sixty-one stroke patients received a 4-week rehabilitation. Urinary 8-OHdG levels were determined by liquid chromatography-tandem mass spectrometry. The test-retest reliability of 8-OHdG was good (interclass correlation coefficient=0.76). Upper-limb motor function and muscle power determined by the Fugl-Meyer Assessment (FMA) and Medical Research Council (MRC) scales before rehabilitation showed significant negative correlation with 8-OHdG (r=-0.38, r=-0.30; p<0.05). After rehabilitation, we found a fair and significant correlation between 8-OHdG and FMA (r=-0.34) and 8-OHdG and pain (r=0.26, p<0.05). Baseline 8-OHdG was significantly correlated with post-treatment FMA, MRC, and pain scores (r=-0.34, -0.31, and 0.25; p<0.05), indicating its ability to predict functional outcomes. 8-OHdG levels were significantly decreased, and functional outcomes were improved after rehabilitation. The exploratory study findings conclude that 8-OHdG is a reliable and promising biomarker of oxidative stress and could be a valid predictor of functional outcomes in patients. Monitoring of behavioral indicators along with biomarkers may have crucial benefits in translational stroke research.

The purpose of this review is to provide a comprehensive approach for assessing the upper extremity (UE) after stroke. First, common upper extremity impairments and how to assess them are briefly discussed. While multiple UE impairments are typically present after stroke, the severity of one impairment, paresis, is the primary determinant of UE functional loss. Second, UE function is operationally defined and a number of clinical measures are discussed. It is important to consider how impairment and loss of function affect UE activity outside of the clinical environment. Thus, this review also identifies accelerometry as an objective method for assessing UE activity in daily life. Finally, the role that each of these levels of assessment should play in clinical decision making is discussed in order to optimize the provision of stroke rehabilitation services.

The execution of motor behavior influences concurrent visual action observation and especially the perception of biological motion. The neural mechanisms underlying this interaction between perception and motor execution are not exactly known. In addition, the available experimental evidence is partially inconsistent since previous studies have reported facilitation as well as impairments of action perception by concurrent execution. Exploiting a novel virtual reality paradigm, we investigated the spatio-temporal tuning of the influence of motor execution on the perception of biological motion within a signal-detection task. Human observers were presented with point-light stimuli that were controlled by their own movements. Participants had to detect a point-light arm in a scrambled mask, either while executing waving movements or without concurrent motor execution (baseline). The temporal and spatial coherence between the observed and executed movements was parametrically varied. We found a systematic tuning of the facilitatory vs. inhibitory influences of motor execution on biological motion detection with respect to the temporal and the spatial congruency between observed and executed movements. Specifically, we found a gradual transition between facilitatory and inhibitory interactions for decreasing temporal synchrony and spatial congruency. This result provides evidence for a spatio-temporally highly selective coupling between dynamic motor representations and neural structures involved in the visual processing of biological motion. In addition, our study offers a unifying explanation that reconciles contradicting results about modulatory effects of motor execution on biological motion perception in previous studies.

Recent evidence indicates that the rat claustrum interconnects the motor cortical areas in both hemispheres. To elucidate the functional specificity of the interhemispheric connections between the claustrum and primary motor (MI) cortex, anterograde tracer injections in specific parts of MI were paired with retrograde tracer injections in homotopic sites of the opposite hemisphere. In addition to injecting the MI forepaw (Fp) region in both hemispheres, we injected the region associated with whisker retractions (Re) and the more caudal rhythmic whisking (RW) region. While the MI-Fp region has few connections with the claustrum of either hemisphere, both whisker regions project to the contralateral claustrum, with those from the MI-RW region being denser and more extensive than those originating from the MI-Re region. Retrograde tracer injections in the MI-RW region produced more labeled neurons in the ipsilateral claustrum than retrograde tracer injections in the MI-Re. Consistent with these patterns, the overlap of labeled terminals and soma in the claustrum was greatest when both tracers were injected into the MI-RW region. When retrograde tracers were injected into the claustrum, the highest density of labeled neurons in MI appeared in the contralateral RW region. Tracer injections in the claustrum also revealed hundreds of labeled neurons throughout its rostrocaudal extent, thereby establishing the presence of long-range intra-claustral connections. These results indicate that the intrinsic and extrinsic connections of the rat claustrum are structured for rapid, interhemispheric transmission of information needed for bilateral coordination of the MI regions that regulate whisker movements.

This article reviews the potential use of visual feedback, focusing on mirror visual feedback, introduced over 15 years ago, for the treatment of many chronic neurological disorders that have long been regarded as intractable such as phantom pain, hemiparesis from stroke and complex regional pain syndrome. Apart from its clinical importance, mirror visual feedback paves the way for a paradigm shift in the way we approach neurological disorders. Instead of resulting entirely from irreversible damage to specialized brain modules, some of them may arise from short-term functional shifts that are potentially reversible. If so, relatively simple therapies can be devised—of which mirror visual feedback is an example—to restore function.

The purpose of this study was to quantify the long‑term loss of independent finger movements in humans with lesions relatively restricted to motor cortex or corticospinal tract. We questioned whether damage to the motor cortex or corticospinal tract would permanently affect the ability to move each finger to the same degree or would affect some fingers more than others. People with pure motor hemiparesis due to ischemic cerebrovascular accident were used as our experimental sample. Pure motor hemiparetic and control subjects were tested for their ability to make cyclic flexion/extension movements of each finger independently. We recorded their finger joint motion using an instrumented glove. The fingers of control subjects and of the unaffected hands (ipsilateral to the lesion) of hemiparetic subjects moved relatively independently. The fingers of the affected hands (contralateral to the lesion) of hemiparetic subjects were differentially impaired in their ability to make independent finger movements. The independence of the thumb was normal; the independence of the index finger was slightly impaired, while the independence of the middle, ring, and little fingers was substantially impaired. The differential long‑term effects of motor cortical or corticospinal damage on finger independence may result from rehabilitative training emphasizing tasks requiring independent thumb and index movements, and from a greater ability of the spared components of the neuromuscular system to control the thumb independently compared with the other four fingers.

In rhesus monkeys, the dynamic properties of the torsional vestibulo-ocular reflex (VOR) are modified by otolith input: compared with torsional oscillations about an earth-vertical axis (canal-only stimulation), the phase lead observed at frequencies below 0.1 Hz is cancelled when the animals are rotated about an earth-horizontal axis (canal-and-otolith stimulation); the gains of the torsional VOR, however, are nearly identical in both conditions. To test whether or not canal-otolith interaction in humans is similar to that in rhesus monkeys, we examined ten healthy human subjects on a three-axis servo-controlled motor-driven turntable. The subjects were oscillated in upright or supine position in complete darkness over a similarly wide range of frequencies (0.05–1.0 Hz) with peak velocities < 40°/s. Eye movements were recorded using the three-dimensional search coil technique. Compared with the torsional vestibulo-ocular gains during canal-stimulation only (earth-vertical axis), the gains obtained during combined canal-otolith-stimulation (earth-horizontal axis) were significantly higher throughout the entire frequency range (P < 0.05). The gain increased by 0.100 ± 0.074 (SD), independent of frequency. During the earth-horizontal axis stimulation, the phase remained always around zero, which is in contrast to the canal-stimulation only, during which one finds an increasing phase lead as frequency decreases. We conclude that, in healthy humans as in rhesus monkeys, the phase lead from the canal signals at low frequencies is effectively cancelled by the otolith input. In contrast to rhesus monkeys, however, otolith signals in healthy humans increase the gain of the torsional VOR at frequencies from 0.05 to 1.0 Hz. This normal database is crucial for the interpretation of results obtained in patients with vestibular disorders.