Search Our Scientific Publications & Authors

J Neurosci Methods 2021 May 7:109216. Epub 2021 May 7.

Department of Exercise Science, University of South Carolina, Columbia, SC, 29201, USA. Electronic address:

Background: Fractional anisotropy (FA) and mean diffusivity (MD) are measures derived from diffusion-weighted imaging that represent the integrity of the corticospinal tract (CST) after stroke. Some studies of the motor system after stroke extract FA and MD from native space while others extract from standard space making comparison across studies challenging.

New Method: The purpose was to compare CST integrity measures extracted from standard versus native space in individuals with chronic stroke. Read More

Front Hum Neurosci 2021 20;15:644335. Epub 2021 Apr 20.

Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, United States.

Stroke continues to be a leading cause of disability. Basic neurorehabilitation research is necessary to inform the neuropathophysiology of impaired motor control, and to develop targeted interventions with potential to remediate disability post-stroke. Despite knowledge gained from basic research studies, the effectiveness of research-based interventions for reducing motor impairment has been no greater than standard of practice interventions. Read More

J Rehabil Med 2021 Apr 29. Epub 2021 Apr 29.

Clinical Neuroscience, Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. E-mail:

Objective: To determine to what extent accelerometer-based arm, leg and trunk activity is associated with sensorimotor impairments, walking capacity and other factors in subacute stroke.

Design: Cross-sectional study.

Patients: Twenty-six individuals with stroke (mean age 55. Read More

Eur J Phys Rehabil Med 2021 May 5. Epub 2021 May 5.

Rehabilitation Unit, ULSS (Local Health Authority) Euganea - Camposampiero Hospital, Padua, Italy.

Introduction: Stroke is the third leading cause of adult disability world-wide, and lower extremity motor impairment is one of the major determinants of long-term disability. Although robotic therapy is becoming more and more utilized in research protocols for lower limb stroke rehabilitation, the gap between research evidence and its use in clinical practice is still significant. The aim of this study was to determine the scope, quality, and consistency of guidelines for robotic lower limb rehabilitation after stroke, in order to provide clinical recommendations. Read More

Brain Sci 2021 Apr 30;11(5). Epub 2021 Apr 30.

IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy.

Cognitive decline is often present in stroke survivors, with a significant impact on motor recovery. However, how specific cognitive domains could impact motor recovery after robotic rehabilitation in patients with stroke is still not well understood. In this study, we analyzed the relationship between cognitive impairment and the outcome of a robot-mediated upper limb rehabilitation intervention in a sample of 51 subacute stroke patients. Read More

J Biochem Mol Toxicol 2021 May 3:e22796. Epub 2021 May 3.

Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Giza, Egypt.

Eprosartan (EPRO), an angiotensin receptor type-1 (AT-1) blocker, exhibited neuroprotective activities in ischemic stroke resulting from focal cerebral ischemia in rats. The current study aimed to clarify the neuroprotective role of EPRO in middle carotid artery occlusion (MCAO)-induced ischemic stroke in rats. Fifty-six male Wistar rats were divided into four groups (n = 14 per group): sham-operated group, sham receiving EPRO (60 mg/kg/day, po) group, ischemia-reperfusion (IR) group, and IR receiving EPRO (60 mg/kg/day, po) group. Read More

Hum Brain Mapp 2021 May 3. Epub 2021 May 3.

Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.

Magnetic resonance spectroscopy (MRS) measures cerebral metabolite concentrations, which can inform our understanding of the neurobiological processes associated with stroke recovery. Here, we investigated whether metabolite concentrations in primary motor and somatosensory cortices (sensorimotor cortex) are impacted by stroke and relate to upper-extremity motor impairment in 45 individuals with chronic stroke. Cerebral metabolite estimates were adjusted for cerebrospinal fluid and brain tissue composition in the MRS voxel. Read More

Brain Commun 2021 12;3(2):fcab074. Epub 2021 Apr 12.

Department of Rehabilitation Sciences, KU Leuven-University of Leuven, 3001 Leuven, Belgium.

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Front Neurol 2021 15;12:626021. Epub 2021 Apr 15.

Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto, ON, Canada.

During recovery from stroke, the contralesional motor cortex (M1) may undergo maladaptive changes that contribute to impaired interhemispheric inhibition (IHI). Transcranial direct current stimulation (tDCS) with the cathode over contralesional M1 may inhibit this maladaptive plasticity, normalize IHI, and enhance motor recovery. The objective of this systematic review and meta-analysis was to evaluate available evidence to determine whether cathodal tDCS on contralesional M1 enhances motor re-learning or recovery post-stroke more than sham tDCS. Read More

Sci Rep 2021 Apr 28;11(1):9131. Epub 2021 Apr 28.

Physical Medicine and Rehabilitation Service, Doctor Peset University Hospital, 46017, Valencia, Spain.

More solid data are needed regarding the application of neuromuscular electrical stimulation (NMES) in the paretic hand following a stroke. A randomised clinical trial was conducted to compare the effects of two NMES protocols with different stimulation frequencies on upper limb motor impairment and function in older adults with spastic hemiparesis after stroke. Sixty nine outpatients were randomly assigned to the control group or the experimental groups (NMES with 50 Hz or 35 Hz). Read More

Stroke 2021 Apr 29:STROKEAHA120032545. Epub 2021 Apr 29.

Health Economics Clinical Research Unit (URC Eco), APHP, Paris, France (A.L.J., I.D.-Z.).

Background And Purpose: Additional therapy may improve poststroke outcomes. Self-rehabilitation is a useful means to increase rehabilitation time. Mechanized systems are usual means to extend time for motor training. Read More

Phys Ther 2021 Apr 28. Epub 2021 Apr 28.

Department of Rehabilitation, Saitama Medical University International Medical Center 1397-1, Yamane, Hidaka, Saitama 350-1298, Japan.

Objective: This study aimed to clarify whether an exercise involving weight shifting to the nonparetic side while standing on an inclined surface improves standing balance in the early phase after stroke.

Methods: This assessor-blinded, randomized controlled trial included people undergoing inpatient rehabilitation at a university hospital. Participants (n = 52) with hemiparesis caused by a stroke were randomly assigned to an experimental group (n = 26) or control group (n = 26). Read More

IEEE Trans Neural Syst Rehabil Eng 2021 Apr 26;PP. Epub 2021 Apr 26.

Muscle networks describe the functional connectivity between muscles quantified through the decomposition of intermuscular coherence (IMC) to identify shared frequencies at which certain muscles are co-modulated by common neural input. Efforts have been devoted to characterizing muscle networks in healthy subjects but stroke-linked alterations to muscle networks remain unexplored. Muscle networks were assessed for eight key upper extremity muscles during isometric force generation in stroke survivors with mild, moderate, and severe impairment and compared against healthy controls to identify stroke-specific alterations in muscle connectivity. Read More

Front Neurosci 2021 7;15:646698. Epub 2021 Apr 7.

Université de Paris, INCC UMR 8002, CNRS, Paris, France.

For reaching and grasping, as well as for manipulating objects, optimal hand motor control arises from the integration of multiple sources of sensory information, such as proprioception and vision. For this reason, proprioceptive deficits often observed in stroke patients have a significant impact on the integrity of motor functions. The present targeted review attempts to reanalyze previous findings about proprioceptive upper-limb deficits in stroke patients, as well as their ability to compensate for these deficits using vision. Read More

Lancet 2021 Apr;397(10284):1545-1553

Department of Neurology, Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA.

Background: Long-term loss of arm function after ischaemic stroke is common and might be improved by vagus nerve stimulation paired with rehabilitation. We aimed to determine whether this strategy is a safe and effective treatment for improving arm function after stroke.

Methods: In this pivotal, randomised, triple-blind, sham-controlled trial, done in 19 stroke rehabilitation services in the UK and the USA, participants with moderate-to-severe arm weakness, at least 9 months after ischaemic stroke, were randomly assigned (1:1) to either rehabilitation paired with active vagus nerve stimulation (VNS group) or rehabilitation paired with sham stimulation (control group). Read More

J Neuroeng Rehabil 2021 Apr 23;18(1):70. Epub 2021 Apr 23.

UBIC, Departament de Fisioteràpia, Universitat de València, Valencia, Spain.

Background: The assessment of upper-limb motor impairments after stroke is usually performed using clinical scales and tests, which may lack accuracy and specificity and be biased. Although some instruments exist that are capable of evaluating hand functions and grasping during functional tasks, hand mobility and dexterity are generally either not specifically considered during clinical assessments or these examinations lack accuracy. This study aimed to determine the convergent validity, reliability, and sensitivity to impairment severity after a stroke of a dedicated, multi-touch app, named the Hand Assessment Test. Read More

PLoS One 2021 22;16(4):e0250100. Epub 2021 Apr 22.

Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.

Background: Walking speed is often used in the clinic to assess the level of gait impairment following stroke. Nonetheless, post-stroke individuals may employ the same walking speed but at a distinct movement quality. The main objective of this study was to explore a novel movement quality metric, the estimation of gait smoothness by the spectral arc length (SPARC), in individuals with a chronic stroke displaying mild/moderate or severe motor impairment while walking in an outdoor environment. Read More

Cureus 2021 Mar 19;13(3):e14001. Epub 2021 Mar 19.

Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

Although around 83% of individuals survive a stroke, they usually experience a significant loss in their motor execution (ME) capabilities due to their acquired cortical infarction. The loss of significant ME capabilities due to stroke damage was previously thought to be irreversible. Active movement therapies show considerable promise but depend on motor performance, excluding many otherwise eligible patients. Read More

Fluids Barriers CNS 2021 Apr 19;18(1):20. Epub 2021 Apr 19.

Department of Neurosurgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.

Idiopathic normal pressure hydrocephalus (iNPH) is considered an age-dependent chronic communicating hydrocephalus associated with cerebrospinal fluid (CSF) malabsorption; however, the aetiology of ventricular enlargement in iNPH has not yet been elucidated. There is accumulating evidence that support the hypothesis that various alterations in CSF dynamics contribute to ventricle dilatation in iNPH. This review focuses on CSF dynamics associated with ventriculomegaly and summarises the current literature based on three potential aetiology factors: genetic, environmental and hydrodynamic. Read More

Front Neurol 2021 31;12:634065. Epub 2021 Mar 31.

Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Stockholm, Sweden.

Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. Read More

Clin Neurophysiol 2021 Mar 26. Epub 2021 Mar 26.

School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada; Center for Interdisciplinary Research in Rehabilitation (CRIR), Montreal, Canada.

Objective: To determine inter-rater reliability, minimal detectable change and responsiveness of Tonic Stretch Reflex Threshold (TSRT) as a quantitative measure of elbow flexor spasticity.

Methods: Elbow flexor spasticity was assessed in 55 patients with sub-acute stroke by determining TSRT, the angle of spasticity onset at rest (velocity = 0°/s). Elbow flexor muscles were stretched 20 times at different velocities. Read More

Neurology 2021 Apr 15. Epub 2021 Apr 15.

David J. Lin, (1) Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (2) Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA (3) Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA (4) VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI; Kimberly S. Erler, (5) Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA; Samuel B. Snider, (6) Division of Neurocritical Care, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Anna K. Bonkhoff, (7) J Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, MA; Julie A. DiCarlo, (1) Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Nicole Lam, (1) Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (5) Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA; Jessica Ranford, (1) Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (8) Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA; Kristin Parlman, (1) Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (9) Department of Physical Therapy, Massachusetts General Hospital, Boston, MA; Audrey Cohen, (1) Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (10) Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, MA; Jennifer Freeburn, (1) Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA (10) Department of Speech, Language, and Swallowing Disorders, Massachusetts General Hospital, Boston, MA; Seth P. Finklestein, (3) Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA; Lee H. Schwamm, (3) Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA; Leigh R. Hochberg, (1) Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, (2) Division of Neurocritical Care, Department of Neurology, Massachusetts General Hospital, Boston, MA, (3) Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA (4) VA RR&D Center for Neurorestoration and Neurotechnology, Rehabilitation R&D Service, Department of VA Medical Center, Providence, RI, (11) School of Engineering, Brown University, Providence RI; Steven C. Cramer, (12) Department of Neurology, University of California, Los Angeles, (13) California Rehabilitation Hospital, Los Angeles, CA.

Objective: To test the hypothesis that cognitive demands influence motor performance during recovery from acute stroke, we tested acute stroke patients on two motor tasks with different cognitive demands and related task performance to cognitive impairment and neuroanatomic injury.

Methods: We assessed the contralesional and ipsilesional upper extremities of a cohort of 50 patients with weakness after unilateral acute ischemic stroke at three timepoints with two tasks: the Box & Blocks Test, a task with greater cognitive demand, and Grip Strength, a simple and ballistic motor task. We compared performance on the two tasks, related motor performance to cognitive dysfunction, and used voxel-based lesion symptom mapping to determine neuroanatomical sites associated with motor performance. Read More

Front Neurol 2021 24;12:585189. Epub 2021 Mar 24.

School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, NSW, Australia.

Cognitive impairment is a common and disruptive outcome for stroke survivors, which is recognized to be notoriously difficult to treat. Previously, we have shown that low oxygen post-conditioning (LOPC) improves motor function and limits secondary neuronal loss in the thalamus after experimental stroke. There is also emerging evidence that LOPC may improve cognitive function post-stroke. Read More

Trials 2021 Apr 9;22(1):265. Epub 2021 Apr 9.

School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, No. 1200, Cai-Lun Road, Shanghai, China.

Background: Statistics show that every year, 5.4 million people in the world suffer a stroke. Post-stroke cognitive impairment (PSCI) is one of the most common complications after stroke with a rate of 75%, which leads to decreased functions for independent living and reduced quality of life (QOL). Read More

Purinergic Signal 2021 Apr 9. Epub 2021 Apr 9.

Graduate Program in Biological Science: Biochemistry, Department of Biochemistry, ICBS, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.

Ischemic stroke is a major cause of morbidity and mortality worldwide and only few affected patients are able to receive treatment, especially in developing countries. Detailed pathophysiology of brain ischemia has been extensively studied in order to discover new treatments with a broad therapeutic window and that are accessible to patients worldwide. The nucleoside guanosine (Guo) has been shown to have neuroprotective effects in animal models of brain diseases, including ischemic stroke. Read More

J Neuroeng Rehabil 2021 Apr 7;18(1):58. Epub 2021 Apr 7.

Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daehak-ro 291, Yuseong-gu, Daejeon, 34141, Republic of Korea.

Background: Recent evidence suggests that disinhibition and/or hyperexcitation of the brainstem descending pathways and intraspinal motor network diffuse spastic synergistic activation patterns after stroke. This results in simplified or merged muscle sets (i.e. Read More

Sci Prog 2021 Apr-Jun;104(2):368504211004266

Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital); Institute of Cancer and Basic Medicine(IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, China.

Stroke is a global health problem, and survivors of a stroke often suffer from cognitive impairment, which has an essential impact on the rehabilitation of various functions. Repetitive Transcranial Magnetic Stimulation (rTMS) has been widely used in the rehabilitation treatment of stroke patients. There are many investigations into how rTMS impacts motor dysfunction, speech dysfunction and swallowing dysfunction after stroke, but the analysis of rehabilitation effect on stroke patients with cognitive dysfunction is lacking. Read More

Neurorehabil Neural Repair 2021 Apr 7:15459683211006713. Epub 2021 Apr 7.

University of British Columbia, Vancouver, British Columbia, Canada.

Objective: Activity patterns across brain regions that can be characterized at rest (ie, resting-state functional connectivity [rsFC]) are disrupted after stroke and linked to impairments in motor function. While changes in rsFC are associated with motor recovery, it is not clear how rsFC is modulated by skilled motor practice used to promote recovery. The current study examined how rsFC is modulated by skilled motor practice after stroke and how changes in rsFC are linked to motor learning. Read More

J Hand Ther 2021 Jan 26. Epub 2021 Jan 26.

Department of Rehabilitation and Physical Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. Electronic address:

Study Design: An open-label, randomized, controlled, observer-blinded trial.

Introduction: Repetitive facilitative exercise (RFE) is a movement therapy to recover from hemiparesis after stroke. However, improvement is inhibited by spasticity. Read More

NeuroRehabilitation 2021 ;48(3):375-383

Department of Rehabilitation Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.

Background: Impaired motor control, balance, muscle strength, and respiratory function may affect the exercise capacity related to motor performance and activities in individuals with stroke.

Objective: To identify a physical parameter that the exercise capacity has the most significant relationship among physical parameters related to motor function, trunk control, balance, and motor performance and activities in individuals with ischemic stroke.

Methods: In total, 241 ischemic stroke patients were recruited in this retrospective study. Read More