Stroke Rehabilitation: Insights from Neuroscience and Imaging

Hardcover | July 11, 2012

EditorLeeanne M. Carey

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Stroke Rehabilitation: Insights from Neuroscience and Imaging informs and challenges neurologists, rehabilitation therapists, imagers, and stroke specialists to adopt more restorative and scientific approaches to stroke rehabilitation based on new evidence from neuroscience and neuroimagingliteratures. The fields of cognitive neuroscience and neuroimaging are advancing rapidly and providing new insights into human behavior and learning. Similarly, improved knowledge of how the brain processes information after injury and recovers over time is providing new perspectives on what can beachieved through rehabilitation. Stroke Rehabilitation explores the potential to shape and maximize neural plastic changes in the brain after stroke from a multimodal perspective. Active skill based learning is identified as a central element of a restorative approach to rehabilitation. The evidence behind core learning principlesas well as specific learning strategies that have been applied to retrain lost functions of movement, sensation, cognition and language are also discussed. Current interventions are evaluated relative to this knowledge base and examples are given of how active learning principles have beensuccessfully applied in specific interventions. The benefits and evidence behind enriched environments is reviewed with examples of potential application in stroke rehabilitation. The capacity of adjunctive therapies, such as transcranial magnetic stimulation, to modulate receptivity of the damagedbrain to benefit from behavioral interventions is also discussed in the context of this multimodal approach. Focusing on new insights from neuroscience and imaging, the book explores the potential to tailor interventions to the individual based on viable brain networks. This book is intended for clinicians, rehabilitation specialists and neurologists who are interested in using these new discoveries to achieve more optimal outcomes. Equally as important, it is intended for neuroscientists, clinical researchers, and imaging specialists to help frame importantclinical questions and to better understand the context in which their discoveries may be used.

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Stroke Rehabilitation: Insights from Neuroscience and Imaging informs and challenges neurologists, rehabilitation therapists, imagers, and stroke specialists to adopt more restorative and scientific approaches to stroke rehabilitation based on new evidence from neuroscience and neuroimagingliteratures. The fields of cognitive neuroscie...

Leeanne M. Carey, PhD is Head, Neurorehabilitation and Recovery at the National Stroke Research Institute, Florey Neuroscience Institutes at the Melbourne Brain Centre, and Professor in the Department of Occupational Therapy, School of Allied Health, Faculty of Health Sciences at La Trobe University, Victoria, Australia.

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Format:HardcoverDimensions:280 pages, 11 × 8.5 × 0.98 inPublished:July 11, 2012Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0199797889

ISBN - 13:9780199797882

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Table of Contents

Part A: Core Concepts1. Leeanne M. Carey: Introduction1.1 Stroke Rehabilitation: An ongoing window of opportunity1.2 The scope of the problem: Prevalence and impact of stroke and increasing need for Stroke Rehabilitation1.3 Recovery and Rehabilitation: Definitions1.4 Neural plasticity and learning as a basis for stroke rehabilitation1.5 Neuroimaging and how it may inform stroke rehabilitation1.6 Paradigm shift in stroke rehabilitation2. Leeanne M. Carey, Helene J. Polatajko, Lisa Tabor Connor and Carolyn M. Baum: Stroke Rehabilitation: A Learning Perspective2.1 Stroke Rehabilitation: facilitation of adaptive learning2.2 A common language for rehabilitation science2.3 Experience and learning-dependent plasticity: Implications for rehabilitation2.4 Role of brain networks in information processing and recovery2.5 Skill acquisition - a learning perspective2.5.1 Explicit, task-specific and goal-driven2.5.2 Involve active-problem solving and be responsive to environmental demands2.6 Application in context of recovery after stroke2.7 Rehabilitation Learning Model: Rehab-Learn2.8 Selected learning-based approaches to rehabilitation2.8.1 Cognitive Orientation to daily Occupational Performance (CO-OP)2.8.2 SENSe: A perceptual learning approach to rehabilitation of body sensations after stroke2.8.3 Language: Constraint-Induced Aphasia Therapy2.9 Measuring response to learning-based rehabilitation2.10 Summary and Conclusion3. Michael Nilsson, Milos Pekny and Marcela Pekna: Neural Plasticity as a basis for Stroke Rehabilitation3.1 Neural plasticity after brain and spinal cord injury3.1.1 Experience-dependent plasticity of the cerebral cortex3.1.2 Spontaneous recovery of function after stroke3.1.3 Cortical map rearrangements3.1.4 Contralateral hemisphere involvement3.1.5 Contralesional axonal remodelling of the corticospinal system3.2 Implications for stroke rehabilitation3.3 Increasing neural plasticity through behavioural manipulations and adjuvant therapies3.3.1 Enriched environment and multimodal stimulation3.3.2 Non-invasive brain stimulation3.3.3 Pharmacological modulators of neural plasticity3.3.4 Emerging targets3.4 Individualized therapy4. J-Donald Tournier, Richard Masterton and Rudiger J. Seitz: Imaging techniques provide new insights4.1 Introduction to neuroimaging techniques and their potential to provide new insight4.2 What neuroimaging can tell us4.2.1 Measuring brain perfusion4.2.2 Measuring water diffusion (Diffusion weighted imaging)4.2.3 Measuring regional cerebral metabolism4.2.4 Assessing structural brain lesions4.3 Measuring brain function with MRI4.3.1 The BOLD image contrast4.3.2 The BOLD response to neuronal activity4.3.2.1 The time-course of evoked BOLD signal changes4.3.2.2 Neurovascular coupling4.3.3 fMRI experimental design and analysis4.3.3.1 Task-related activation studies4.3.3.2 "Resting-state" studies of brain function4.3.4 Applications of fMRI in stroke rehabilitation4.4 Structural connectivity, including tractography4.4.1 Modelling diffusion in white matter4.4.1.1 Diffusion tensor imaging4.4.1.2 Higher-order models4.4.2 Estimating biologically relevant parameters4.4.2.1 Estimating fibre orientations4.4.2.1 Tractography4.4.3 Application to stroke recovery5. Cathrin M. Buetefisch and Aina Puce: Multimodal neurophysiological investigations5.1 Introduction5.2 Magnetoencephalography (MEG) and Electroencephalography (EEG)5.2.1 Methodological considerations5.2.1.1 Site of recording in EEG and MEG5.2.1.2 Source modelling of EEG and MEG data5.2.1.3 Considerations when studying reorganization the motor system with multimodal MEG/EEG5.2.1.4 Neurophysiological rhythms and potential insights into stroke recovery5.2.2 Multimodal MEG / EEG studies of activity in primary sensorimotor cortex in stroke recovery5.3 Transcranial Magnetic Stimulation (TMS)5.3.1 Methodological considerations5.3.2 TMS measures of motor cortex5.3.2.1 Motor threshold5.3.2.2 MEP amplitude5.3.2.3 MEP latency and central motor conduction time5.3.2.4 Cortical silent period5.3.2.5 Input-output curves5.3.2.6 Short Interval Cortical Inhibition (SICI) Intracortical facilitation (ICF) Interhemispheric inhibition (IHI)5.3.3 Repetitive transcranial magnetic stimulation (TMS)5.3.4 Multimodal TMS/brain imaging studies of stroke recovery5.4 The future? Neurorehabilitative studies of stroke recovery and the brain-computer interfacePart B: Stroke pathophysiology and recovery6. Rudiger J. Seitz and Geoffrey A. Donnan: Stroke: Pathophysiology, Recovery potential and Timelines for Recovery and Rehabilitation6.1 Introduction6.2 Pathophysiology6.2.1 From Cerebral Ischemia towards Brain Infarction6.2.2 Reversal of Ischemia6.2.3 Patterns of Residual Brain Infarcts after Thrombolysis6.2.4 Functional Consequences of Brain Infarcts6.3 Recovery Potential6.3.1 The Role of the Penumbra6.3.2 Perilesional Plasticity6.3.3 Infarct induced Disconnections6.3.4 Regenerative Therapies using Stem Cell Approaches6.3.5 Rehabilitative Effect of Physical Training6.3.6 Rehabilitative Effect of Mental Training6.4 Timelines for Recovery and Rehabilitation6.5 ConclusionsPart C: Stroke Rehabilitation: Creating the right learning conditions for rehabilitation7. Dominique Cadilhac, Tara Purvis, Julie Bernhardt and Nicole Korner-Bitinsky: Organisation of care7.1 Introduction7.2 Models of stroke rehabilitation services7.2.1 Inpatient care7.2.2 Community based rehabilitation as an alternative to inpatient rehabilitation7.2.3 Current perspectives on the way forward for providing stroke rehabilitation7.2.4 Characteristics of stroke rehabilitation services7.3 Factors affecting access to organised stroke rehabilitation7.3.1 Staffing Resources and the Interdisciplinary Approach to Rehabilitation7.4 Ensuring the quality of care7.4.1 Monitoring and improving the quality of care in rehabilitation for stroke7.4.2 What do clinical audits tell us about quality of rehabilitation7.4.3 Establishing programs to increase the uptake of evidence into clinical practice7.5 Innovations in rehabilitation and application in clinical practice7.6 Summary of key messages8. Thomas Linden and Michael Nilsson: Motivation, mood and the right environment8.1 Introduction8.1.1 Frequency and nature of post-stroke depression8.1.2 Impact of post-stroke depression8.1.3 Etiology of depression after stroke8.2 Is post-stroke depression a specific disorder?8.3 Predictors of post6-stroke depression8.4 Functional and structural brain changes with depression8.4.1 Functional brain changes8.4.2 Morphological brain changes8.4.3 Depression, cognition and brain networks8.5 Treatment of depression in stroke patients8.5.1 Non-pharmacological treatment options8.5.2 Enriched environment8.5.3 Cortical stimulation and depression8.5.4 Physical activity9. Paulette van Vliet, Thomas A. Matyas and Leeanne M. Carey: Training principles to enhance learning-based rehabilitation and neuroplasticity9.1 Introduction9.2 Task-specific activation of brain regions9.3 Influence of task characteristics on sensorimotor performance9.4 Task-specific nature of motor learning9.5 Task complexity9.6 Behavioural evidence for task-specific training9.7 Mental practice of tasks to enhance motor learning9.8 Increasing repetitions to enhance motor learning9.9 Transfer of training effects9.10 Implicit and explicit learning9.11 Key clinical messages10. Charlotte J. Stagg and Heidi Johansen-Berg: Adjunctive therapies10.1 Introduction and Rationale10.1.1 Insights from animal models10.1.1.1 The need for multiple sessions of stimulation10.1.1.2 Combination with physical therapy10.2 Pharmacological studies10.2.1 Amphetamines10.2.2 Dopaminergic Agents10.2.3 Cholinergic Agents10.2.4 Serotoninergic Agents10.3 Transcranial stimulation techniques10.3.1 Abnormal interhemispheric balance10.3.2 Introduction to the techniques10.3.2.1 Transcranial Magnetic Stimulation (TMS) Transcranial direct current stimulation (tDCS) Placebo controls10.3.3 rTMS trials10.3.3.1 Acute Stroke10.3.3.2 Chronic Stroke10.3.4 tDCS trials10.3.5 The necessity for individually targeted treatments10.3.6 Safety of transcranial stimulation approaches10.4 Novel therapeutic Approaches10.4.1 Direct Cortical Stimulation10.4.2 Robotic Therapy/Neuroprosthetics10.4.3 Stem Cell Therapy10.4.4 Growth Factors10.5 ConclusionsPart D: Rehabilitation of common functions11. Cathy Stinear and Isobel Hubbard: Movement11.1 Introduction11.2 Repetitive Task-Specific Training11.2.1 Description11.2.2 Behavioural Effects11.2.3 Neural Mechanisms11.2.4 Summary11.3 Constraint-Induced Movement Therapy11.3.1 Description11.3.2 Behavioural Effects11.3.3 Neural Mechanisms11.3.4 Summary11.4 Mental Practice11.4.1 Description11.4.2 Behavioural Effects11.4.3 Neural Mechanisms11.4.4 Summary11.5 Electrostimulation and EMG Biofeedback11.5.1 Description11.5.2 Behavioural Effects11.5.3 Neural Mechanisms11.5.4 Summary11.6 Robot-Assisted Training11.6.1 Description11.6.2 Behavioural Effects11.6.3 Neural Mechanisms11.6.4 Summary11.7 Virtual Reality and Visuomotor Tracking Training11.7.1 Description11.7.2 Behavioural Effects11.7.3 Neural Mechanisms11.7.4 Summary11.8 Other Approaches11.9 Conclusions12. Leeanne M. Carey: Touch and body sensations12.1 Somatosensory function12.2 Somatosensory Loss after Stroke12.3 Central processing of somatosensory information12.3.1 A model of somatosensory processing12.3.2 Key features of central processing of somatosensory information12.4 Neural correlates of sensory recovery after stroke12.5 Treatment Principles and Strategies Arising from Neuroscience12.5.1 Goal-directed attention and deliberate anticipation12.5.2 Calibration across modality and within modality12.5.3 Graded progression within sensory attributes and across sensory attributes and tasks12.6 Current approaches to sensory rehabilitation12.6.1 Passive stimulation and bombardment12.6.2 Attended stimulation of specific body sites12.6.3 Graded sensory exercises with feedback12.6.4 Eclectic approach involving sensorimotor exercises12.6.5 Perceptual learning and neuroscience based approach: Stimulus Specific and Transfer Enhanced Training12.7 Towards a neuroscience-based model of sensory rehabilitation13. Amy Brodtmann: Vision13.1 Introduction13.2 Anatomy of visual pathways13.2.1 The retinogeniculate pathway13.2.2 The geniculostriate pathway13.2.3 Extrageniculostriate pathways13.3 Ipsilateral representation of the visual hemifield13.4 Striate-extrastriate connections - the "what" and "where" pathways13.5 Ventral extrastriate cortex: visual object recognition and processing13.6 Colour and movement13.6.1 Dorsal extrastriate cortex: visual motion perception13.7 Visual syndromes caused by stroke13.7.1 Visual field deficits following stroke13.7.1.1 Monocular visual deficits13.7.2 Homonymous visual deficits13.7.2.1 Lateral geniculate nucleus lesions13.7.2.2 Quandrantanopic visual field defects13.7.2.3 Hemianopic visual field defects13.7.3 Disorders of higher visual cognition commonly caused by stroke13.8 Mechanisms of recovery following stroke13.8.1 Neural plasticity post-stroke13.8.2 Mechanisms of recovery following injury to the visual system13.8.3 Cross-modal plasticity in the visual system13.8.3.1 The dorsal extrastriate pathway - a possible site for surrogacy13.9 Visual recovery hypotheses13.9.1 Experiments in visual recovery following stroke13.9.1.1 PET studies in the visual system following stroke13.9.1.2 MRI studies in the visual system following stroke13.10 Restorative therapies: rehabilitating the human visual system13.11 Summary14. Sheila Gillard Crewther, Nahal Goharpy, Louise Bannister and Gemma Lamp: Goal driven Attention in Recovery Post-Stroke14.1 Introduction14.1.1 General background to stroke rehabilitation14.1.2 Goal directed action and the visual system14.2 What is attention?14.2.1 Neuroanatomical interaction between the attention and visual systems14.2.2 Attention and multisensory integration14.3 Learning needs attention, working memory and motivation14.3.1 Neural Plasticity: Learning in the brain14.3.2 Attention and working memory14.3.3 Selective attention is also guided by emotive and motivational evaluation of the target stimuli14.3.4 The case of depression14.4 The effect of brain lesions on attention14.5 Rehabilitation post-stroke14.5.1 Training attention post-stroke14.6 Summary and conclusion15. Jason Mattingley: Space and body awareness16. Susan M. Fitzpatrick and Carolyn M. Baum: Executive functions16.1 Stroke Rehabilitation: The Role of Executive Functions16.2 Overview of a multi-level understanding of executive functions16.3 Neural Substrates of Executive Functions16.3.1 Neural Measures and Interventions16.4 Behavioural measures and interventions16.4.1 Measures to Identify Brain Related Behaviours16.4.2 Measures to identify the Behavioural Consequences of Stroke16.4.3 Performance Based Tests16.5 Behavioural and Performance Interventions16.5.1 Interventions at the Behavioural Level16.5.2 Intervention at the Performance LevelLisa Tabor Connor: 16.6 Conclusions17. Language17.1 Neuroscience of Language: Neuropsychological and lesion-symptom mapping evidence17.2 Functional Neuroimaging of Language and Recovery17.2.1 White matter tractography17.2.2 Functional connectivity MRI17.3 Current Models of Language Rehabilitation17.4 Treatment Principles/Strategies Arising from Neuroscience and Cognitive Neuroscience17.5 Toward a Neuroscientifically-Based Model of Aphasia RehabilitationPart E: New Perspectives and directions for stroke rehabilitation research18. Cathy Stinear and Winston Byblow): Targeting viable brain networks to improve outcomes after stroke18.1 Introduction18.2 Measuring Connectivity to Predict Motor Outcomes18.2.1 Functional Integrity of Motor Pathways18.2.1.1 Crossed Corticospinal Tract18.2.1.2 Uncrossed Corticospinal Tract18.2.1.3 Interhemispheric Pathways18.2.2 Structural Imaging of Motor Pathways18.2.3 Combined Approaches18.2.4 Algorithm for Predicting Upper Limb Motor Outcomes18.2.5 The Lower Limb18.2.6 Conclusions18.3 Priming Approaches18.4 Conclusions19. Leeanne M. Carey: Directions for stroke rehabilitation clinical practice and research19.1 Introduction19.2 Key findings for stroke rehabilitation clinical practice19.3 Beyond the lesion: Impact of focal lesion on brain networks and rehabilitation19.4 Use of network-based models of recovery in stroke rehabilitation19.5 Targeting of stroke rehabilitation to the individual19.6 Guidelines to facilitate the translation of evidence to clinical practice19.7 Perspectives and directions for stroke rehabilitation research19.8 Conclusion