Functional MRI evaluation of hyperbaric oxygen therapy effect on hand motor recovery in a chronic post-stroke patient: a case report and physiological discussion
Impairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been correlated with low quality of life. In the current case report, we used both task-based and resting state functional MRI (fMRI) tools to investiga...
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Published in | Frontiers in neurology Vol. 14; p. 1233841 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
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29.09.2023
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Abstract | Impairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been correlated with low quality of life. In the current case report, we used both task-based and resting state functional MRI (fMRI) tools to investigate the neural response mechanisms and functional reorganization underlying hyperbaric oxygen therapy (HBOT)-induced motor rehabilitation in a chronic post-stroke patient suffering from severe upper-limb motor impairment.
We studied motor task fMRI activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb, 2 years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and at the end of the treatment using the Fugl-Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC).
Following HBOT, the FMA score improved from 17 (severe impairment) to 31 (moderate impairment). Following the intervention during trials involving the affected hand, there was an observed increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity (
= 0.002) and a between-network connectivity increase (
-score: 0.35 ± 0.21 to 0.41 ± 0.21,
< 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex, and the premotor cortex.
This study provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients. |
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AbstractList | Introduction
Impairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been correlated with low quality of life. In the current case report, we used both task-based and resting state functional MRI (fMRI) tools to investigate the neural response mechanisms and functional reorganization underlying hyperbaric oxygen therapy (HBOT)-induced motor rehabilitation in a chronic post-stroke patient suffering from severe upper-limb motor impairment.
Methods
We studied motor task fMRI activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb, 2 years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and at the end of the treatment using the Fugl–Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC).
Results
Following HBOT, the FMA score improved from 17 (severe impairment) to 31 (moderate impairment). Following the intervention during trials involving the affected hand, there was an observed increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity (
P
= 0.002) and a between-network connectivity increase (
z
-score: 0.35 ± 0.21 to 0.41 ± 0.21,
P
< 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex, and the premotor cortex.
Conclusion
This study provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients. IntroductionImpairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been correlated with low quality of life. In the current case report, we used both task-based and resting state functional MRI (fMRI) tools to investigate the neural response mechanisms and functional reorganization underlying hyperbaric oxygen therapy (HBOT)-induced motor rehabilitation in a chronic post-stroke patient suffering from severe upper-limb motor impairment.MethodsWe studied motor task fMRI activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb, 2 years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and at the end of the treatment using the Fugl–Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC).ResultsFollowing HBOT, the FMA score improved from 17 (severe impairment) to 31 (moderate impairment). Following the intervention during trials involving the affected hand, there was an observed increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity (P = 0.002) and a between-network connectivity increase (z-score: 0.35 ± 0.21 to 0.41 ± 0.21, P < 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex, and the premotor cortex.ConclusionThis study provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients. Impairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been correlated with low quality of life. In the current case report, we used both task-based and resting state functional MRI (fMRI) tools to investigate the neural response mechanisms and functional reorganization underlying hyperbaric oxygen therapy (HBOT)-induced motor rehabilitation in a chronic post-stroke patient suffering from severe upper-limb motor impairment. We studied motor task fMRI activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb, 2 years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and at the end of the treatment using the Fugl-Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC). Following HBOT, the FMA score improved from 17 (severe impairment) to 31 (moderate impairment). Following the intervention during trials involving the affected hand, there was an observed increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity ( = 0.002) and a between-network connectivity increase ( -score: 0.35 ± 0.21 to 0.41 ± 0.21, < 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex, and the premotor cortex. This study provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients. Impairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been correlated with low quality of life. In the current case report, we used both task-based and resting state functional MRI (fMRI) tools to investigate the neural response mechanisms and functional reorganization underlying hyperbaric oxygen therapy (HBOT)-induced motor rehabilitation in a chronic post-stroke patient suffering from severe upper-limb motor impairment.IntroductionImpairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been correlated with low quality of life. In the current case report, we used both task-based and resting state functional MRI (fMRI) tools to investigate the neural response mechanisms and functional reorganization underlying hyperbaric oxygen therapy (HBOT)-induced motor rehabilitation in a chronic post-stroke patient suffering from severe upper-limb motor impairment.We studied motor task fMRI activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb, 2 years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and at the end of the treatment using the Fugl-Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC).MethodsWe studied motor task fMRI activation and resting-state functional connectivity (rsFC) in a 61-year-old right-handed male patient who suffered hemiparesis and physical weakness in the right upper limb, 2 years after his acute insult, pre- and post-treatment of 60 daily HBOT sessions. Motor functions were assessed at baseline and at the end of the treatment using the Fugl-Meyer assessment (FMA) and the handgrip maximum voluntary contraction (MVC).Following HBOT, the FMA score improved from 17 (severe impairment) to 31 (moderate impairment). Following the intervention during trials involving the affected hand, there was an observed increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity (P = 0.002) and a between-network connectivity increase (z-score: 0.35 ± 0.21 to 0.41 ± 0.21, P < 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex, and the premotor cortex.ResultsFollowing HBOT, the FMA score improved from 17 (severe impairment) to 31 (moderate impairment). Following the intervention during trials involving the affected hand, there was an observed increase in fMRI activation in both the supplementary motor cortex (SMA) and the premotor cortex (PMA) bilaterally. The lateralization index (LI) decreased from 1 to 0.63, demonstrating the recruitment of the contralesional hemisphere. The region of interest, ROI-to-ROI, analysis revealed increased post-intervention inter-hemispheric connectivity (P = 0.002) and a between-network connectivity increase (z-score: 0.35 ± 0.21 to 0.41 ± 0.21, P < 0.0001). Seed-to-voxel-based rsFC analysis using the right SMA as seed showed increased connectivity to the left posterior parietal cortex, the left primary somatosensory cortex, and the premotor cortex.This study provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients.ConclusionThis study provides additional insights into HBOT-induced brain plasticity and functional improvement in chronic post-stroke patients. |
Author | Hadanny, Amir Adler, Moran Elkarif, Vicktoria Parag, Yoav Catalogna, Merav Efrati, Shai |
AuthorAffiliation | 2 Sackler School of Medicine, Tel-Aviv University , Tel-Aviv , Israel 3 Sagol School of Neuroscience, Tel-Aviv University , Tel-Aviv , Israel 1 Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center , Zerifin , Israel |
AuthorAffiliation_xml | – name: 2 Sackler School of Medicine, Tel-Aviv University , Tel-Aviv , Israel – name: 1 Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center , Zerifin , Israel – name: 3 Sagol School of Neuroscience, Tel-Aviv University , Tel-Aviv , Israel |
Author_xml | – sequence: 1 givenname: Merav surname: Catalogna fullname: Catalogna, Merav organization: Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel – sequence: 2 givenname: Amir surname: Hadanny fullname: Hadanny, Amir organization: Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel – sequence: 3 givenname: Yoav surname: Parag fullname: Parag, Yoav organization: Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel – sequence: 4 givenname: Moran surname: Adler fullname: Adler, Moran organization: Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel – sequence: 5 givenname: Vicktoria surname: Elkarif fullname: Elkarif, Vicktoria organization: Sagol Center for Hyperbaric Medicine and Research, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel – sequence: 6 givenname: Shai surname: Efrati fullname: Efrati, Shai organization: Sagol School of Neuroscience, Tel-Aviv University, Tel-Aviv, Israel |
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Cites_doi | 10.1016/j.neuroimage.2012.10.046 10.1155/2018/3172679 10.1016/j.conb.2006.05.011 10.1177/1545968311427706 10.1177/026921559701100207 10.1161/STROKEAHA.113.001847 10.1161/01.STR.0000143326.36847.b0 10.3390/biom11101520 10.1111/jon.12668 10.1089/brain.2012.0073 10.3389/fnhum.2017.00508 10.1155/2016/9265621 10.1136/jnnp-2015-312738 10.1161/STR.0000000000000098 10.1093/brain/awg245 10.4103/2773-2398.339171 10.1155/2022/8307865 10.1002/ana.21905 10.1093/brain/awab469 10.3390/biom10060958 10.1177/1545968308322840 10.1038/jcbfm.1995.45 10.1016/j.nicl.2022.103218 10.3109/02699052.2012.667593 10.1161/STROKEAHA.113.003168 10.1016/j.neuroimage.2007.04.042 10.1161/01.STR.0000071761.36075.A6 10.1310/tsr1604-270 10.1371/journal.pone.0053716 10.1161/STROKEAHA.112.654228 10.2340/1650197771331 10.3233/RNN-150517 10.1016/j.neuroimage.2006.01.021 10.3389/fpsyg.2018.02495 10.3389/fneur.2022.1078544 10.1037/neu0000149 10.1177/1747493017714176 10.1586/14737175.2014.884928 10.3233/RNN-150585 10.1016/j.neuroimage.2011.10.023 10.3233/RNN-190959 10.3171/2009.7.JNS09363 10.1016/S0140-6736(11)60325-5 10.1016/S1052-3057(03)00042-9 10.1016/0003-9993(94)90161-9 10.1002/14651858.CD010820.pub2 10.1093/brain/awg145 10.1161/STROKEAHA.110.596155 10.1177/0883073807307084 10.1016/S1474-4422(21)00252-0 10.1016/j.clineuro.2020.105910 |
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Keywords | brain connectivity fMRI rehabilitation stroke HBOT upper extremity |
Language | English |
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Snippet | Impairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have been... Introduction Impairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically,... IntroductionImpairments in activities of daily living (ADL) are a major concern in post-stroke rehabilitation. Upper-limb motor impairments, specifically, have... |
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Title | Functional MRI evaluation of hyperbaric oxygen therapy effect on hand motor recovery in a chronic post-stroke patient: a case report and physiological discussion |
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