title: Diffusion tensor and volumetric magnetic resonance imaging using an MR-compatible hand-induced robotic device suggests training-induced neuroplasticity in patients with chronic stroke.
abstract: Stroke is the third leading cause of mortality and a frequent cause of long-term adult impairment. Improved strategies to enhance motor function in individuals with chronic disability from stroke are thus required. Post‑stroke therapy may improve rehabilitation and reduce long-term disability; however, objective methods for evaluating the specific impact of rehabilitation are rare. Brain imaging studies on patients with chronic stroke have shown evidence for reorganization of areas showing functional plasticity after a stroke. In this study, we hypothesized that brain mapping using a novel magnetic resonance (MR)-compatible hand device in conjunction with state‑of‑the‑art magnetic resonance imaging (MRI) can serve as a novel biomarker for brain plasticity induced by rehabilitative motor training in patients with chronic stroke. This hypothesis is based on the premises that robotic devices, by stimulating brain plasticity, can assist in restoring movement compromised by stroke-induced pathological changes in the brain and that these changes can then be monitored by advanced MRI. We serially examined 15 healthy controls and 4 patients with chronic stroke. We employed a combination of diffusion tensor imaging (DTI) and volumetric MRI using a 3-tesla (3T) MRI system using a 12-channel Siemens Tim coil and a novel MR-compatible hand‑induced robotic device. DTI data revealed that the number of fibers and the average tract length significantly increased after 8 weeks of hand training by 110% and 64%, respectively (p<0.001). New corticospinal tract (CST) fibers projecting progressively closer to the motor cortex appeared during training. Volumetric data analysis showed a statistically significant increase in the cortical thickness of the ventral postcentral gyrus areas of patients after training relative to pre-training cortical thickness (p<0.001). We suggest that rehabilitation is possible for a longer period of time after stroke than previously thought, showing that structural plasticity is possible even after 6 months due to retained neuroplasticity. Our study is an example of personalized medicine using advanced neuroimaging methods in conjunction with robotics in the molecular medicine era.
authors: NMR Surgical Laboratory, Department of Surgery, Massachusetts General Hospital and Shriners Burn Institute, Harvard Medical School, Boston, MA, USA.
authors: Asimina
authors: A
authors: Lazaridou
authors: Loukas
authors: L
authors: Astrakas
authors: Dionyssios
authors: D
authors: Mintzopoulos
authors: Azadeh
authors: A
authors: Khanicheh
authors: Aneesh B
authors: AB
authors: Singhal
authors: Michael A
authors: MA
authors: Moskowitz
authors: Bruce
authors: B
authors: Rosen
authors: Aria A
authors: AA
authors: Tzika
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009473:Neuronal Plasticity / Q000502:physiology*; D012371:Robotics / Q000379:methods*; D020521:Stroke / Q000175:diagnosis*
references: Neurobiol Learn Mem. 2002 Jan;77(1):63-77
references: 11749086
references: Arch Phys Med Rehabil. 2004 Jul;85(7):1106-11
references: 15241758
references: Neuroscientist. 2003 Feb;9(1):64-75
references: 12580341
references: Int J Stroke. 2007 Nov;2(4):245-64
references: 18705925
references: Clin Rehabil. 2013 Jan;27(1):75-81
references: 22801472
references: Brain. 2006 Oct;129(Pt 10):2722-33
references: 16921177
references: Eura Medicophys. 2007 Jun;43(2):241-54
references: 17589415
references: Semin Nucl Med. 2003 Jan;33(1):56-76
references: 12605357
references: Neurosci Lett. 1998 Jun 26;250(1):5-8
references: 9696052
references: J Magn Reson Imaging. 2009 Jan;29(1):39-51
references: 19097077
references: Brain. 2010 Nov;133(11):3373-84
references: 20688810
references: Neurology. 2010 Jan 26;74(4):280-7
references: 20101033
references: Arch Neurol. 1997 Apr;54(4):443-6
references: 9109746
references: J Neurophysiol. 1998 Apr;79(4):2119-48
references: 9535973
references: Cortex. 2013 Jan;49(1):336-9
references: 22938845
references: J Rehabil Res Dev. 2006 Mar-Apr;43(2):171-84
references: 16847784
references: Int J Mol Med. 2012 Jun;29(6):963-73
references: 22426741
references: PLoS One. 2009;4(4):e5101
references: 19340289
references: Neuroimage. 2001 Jun;13(6 Pt 1):1146-54
references: 11352620
references: J Neuroeng Rehabil. 2009 Feb 25;6:5
references: 19243614
references: Neurology. 2003 Dec 9;61(11):1604-7
references: 14663051
references: Neurology. 2000 May 23;54(10):1938-44
references: 10822433
references: Exp Neurol. 2005 Jun;193(2):291-311
references: 15869933
references: Brain. 2007 Jan;130(Pt 1):170-80
references: 17148468
references: Neuroscience. 2010 Sep 29;170(1):123-37
references: 20600639
references: Neurorehabil Neural Repair. 2002 Dec;16(4):326-38
references: 12462764
references: Brain. 2003 Jul;126(Pt 7):1650-9
references: 12805118
references: Neuroreport. 1999 Mar 17;10(4):807-10
references: 10208552
references: Top Stroke Rehabil. 2002 Winter;8(4):40-53
references: 14523729
references: Annu Rev Med. 2009;60:55-68
references: 18928333
references: Proc Natl Acad Sci U S A. 2001 Oct 23;98(22):12766-71
references: 11606760
references: J Neurosci. 2003 Jan 15;23(2):510-7
references: 12533611
references: Curr Atheroscler Rep. 2002 Jul;4(4):270-6
references: 12052277
references: J Neurol Neurosurg Psychiatry. 2012 Feb;83(2):146-51
references: 22019548
references: Neurorehabil Neural Repair. 2008 Mar-Apr;22(2):111-21
references: 17876068
references: J Neuropsychol. 2010 Sep;4(Pt 2):121-45
references: 19818210
references: J Rehabil Res Dev. 2005 Nov-Dec;42(6):723-36
references: 16680610
references: Arch Phys Med Rehabil. 2003 Jun;84(6):915-20
references: 12808550
references: Nat Neurosci. 2005 Feb;8(2):140-2
references: 15657598
references: Neurology. 1999 Nov 10;53(8):1874-6
references: 10563646
references: J Rehabil Res Dev. 2005 Nov-Dec;42(6):717-22
references: 16680609
references: Clin Imaging. 2005 Jul-Aug;29(4):283-7
references: 15967322
references: Neurology. 2004 Apr 27;62(8):1323-32
references: 15111669
references: Curr Opin Neurol. 2001 Dec;14(6):745-52
references: 11723383
references: Ann Neurol. 2006 May;59(5):735-42
references: 16634041
references: J Rehabil Res Dev. 2005 Sep-Oct;42(5):683-92
references: 16586194
references: IEEE Trans Neural Syst Rehabil Eng. 2008 Feb;16(1):91-8
references: 18303810
references: Postgrad Med J. 2005 Aug;81(958):510-4
references: 16085742
references: Prog Neurobiol. 2005 Apr;75(5):309-20
references: 15885874
references: Brain. 2007 Apr;130(Pt 4):898-914
references: 17121742
references: Neurorehabil Neural Repair. 2012 Jan;26(1):7-19
references: 21803932
references: J Neuroeng Rehabil. 2006 Oct 06;3:24
references: 17022828
references: Neuroimage. 2005 Jul 1;26(3):771-6
references: 15955486
references: Neurol Sci. 2008 Oct;29(5):313-9
references: 18941933
references: Tidsskr Nor Laegeforen. 2007 May 3;127(9):1228-31
references: 17479145
references: Stroke. 2000 Jun;31(6):1210-6
references: 10835434
references: Curr Opin Neurobiol. 2006 Dec;16(6):638-44
references: 17084614
references: IEEE Trans Neural Syst Rehabil Eng. 2001 Sep;9(3):308-18
references: 11561668
references: Brain. 2002 Dec;125(Pt 12):2731-42
references: 12429600
references: Curr Neurol Neurosci Rep. 2005 Nov;5(6):465-70
references: 16263058
references: NeuroRehabilitation. 2012;31(2):207-13
references: 22951715
references: Stud Health Technol Inform. 2009;145:25-39
references: 19592784
references: Hum Brain Mapp. 2003 Apr;18(4):306-21
references: 12632468
references: Stroke. 2001 Jan;32(1):107-12
references: 11136923
references: Minim Invasive Neurosurg. 2003 Feb;46(1):61-4
references: 12640588
references: Stroke. 1997 Oct;28(10):1861-6
references: 9341685
references: J Stroke Cerebrovasc Dis. 2012 Nov;21(8):652-8
references: 21458296