Effects of combined physiotherapy and acupuncture treatment on RSFC in ischaemic stroke patients
Poster No:
1577
Submission Type:
Abstract Submission
Authors:
Soné Fouché1, Hai Lu2, Fleur Warton1, Frances Robertson3, Yu Wang4, Sebnem Er1, Jiu Chen2, Nelleke Langerak1, Marc Combrinck1, Xuesheng Ma5, Xuesong Ren4, Ernesta Meintjes1, Chunhong Zhang4, Jia Fan1
Institutions:
1University of Cape Town, Cape Town, Western Cape, 2Nanjing University, Nanjing, Jiangsu, 3Cape Universities Body Imaging Centre, University of Cape Town, Cape Town, South Africa, 4First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, Tianjin, 5University of the Western Cape, Cape Town, Western Cape
First Author:
Co-Author(s):
Frances Robertson, Phd
Cape Universities Body Imaging Centre, University of Cape Town
Cape Town, South Africa
Cape Universities Body Imaging Centre, University of Cape Town
Cape Town, South Africa
Yu Wang
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
Xuesong Ren
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
Chunhong Zhang
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
First Teaching Hospital of Tianjin University of Traditional Chinese Medicine
Tianjin, Tianjin
Introduction:
Stroke patients often have lasting physical and cognitive impairments. Acupuncture has been reported to stimulate the central nervous system as well as promote functional recovery[1] and is recommended by the WHO as an adjunctive treatment after stroke [2]. However, the exact mechanisms of acupuncture remain unknown [3] and brain changes following an extended rehabilitation programme have not been established. Rs-fMRI is a non-invasive technique used to identify brain regions that are temporally correlated when the subject is not performing any explicit task [4]. Resting state functional connectivity (RSFC) therefore measures the connectedness and functional integration of the brain and has been used as a measure of disease burden [5]. In the present study we compared treatment-related changes in brain RSFC in ischaemic stroke patients with unilateral limb dysfunction randomised to receive either 1) True Acupuncture (TA), 2) TA and Physiotherapy (PT), or 3) PT and Sham Acupuncture (SA).
Methods:
Participants were recruited from the Tianjin University of Traditional Chinese Medicine, including 23 stroke patients (58.5±8.0 yr) and 9 healthy controls (53.9±6.9 yr). Stroke patients were assigned to one of the three treatment arms mentioned above and received either 5 TA or 5 SA sessions per week for 3 weeks. Rs-fMRI scans were performed on a 3T Skyra Scanner (Siemens, Erlangen, Germany) using a gradient echo EPI sequence both before commencing and after completing the 3-week rehabilitation programme; healthy controls were scanned only once and did not receive any treatment. T1-weighted structural images were acquired using an MPRAGE sequence. Pre-processing was conducted using afni_proc.py in AFNI. All images were registered to a 3x3x3 mm3 Talairach-Tournoux (TT) standard space. Independent component analysis (ICA) and dual regression were performed in FSL. Eleven resting-state networks (RSNs) were identified from 20 group components using FSL-MELODIC in data from the 9 healthy controls. FSL-randomise was used to find clusters within the identified resting state networks (RSNs) showing treatment-related differences (at p<0.01; cluster size threshold α<0.05) on the post-treatment scans of the stroke patients. Values for mean z-scores were obtained in each cluster on both the pre- and post-treatment scans of each patient to assess for differences before treatment for these clusters.
Results:
Higher RSFC were seen after the 3-week rehabilitation treatment, in 5 regions within 3 RSNs in patients who received TA and PT compared to patients receiving TA alone or PT and SA (Fig 1). These regions include the right (R) Cingulate Gyrus and medial (M) precuneus within the default mode network (DMN), left (L) orbitofrontal cortex within the executive control network, and R lingual gyrus and R cuneus within the visual network. Cluster size, peak coordinates, and location of each region of interest (ROI) are shown in Table 1. There were no significant differences in RSFC between groups in these 5 regions before treatment.
Conclusions:
Greater RSFC increases in the DMN suggests that TA and PT combined may lead to improved information-processing, memory, self-awareness, and cognitive, language, and motor function [6]. This is consistent with studies showing acupuncture improves depression symptoms and cognitive deficits of stroke patients, to improve recovery [7]. Greater FC increases in the executive control network may contribute to improved attention and working memory [8]. TA has previously been shown to improve alertness and attention of stroke survivors [9,10]. Greater RSFC increases in the visual network point to improved alertness, visual processing, and visual-motor control such as visually guided movements [9]. Specifically, the cuneus controls the vestibular-ocular reflex, and the lingual gyrus, which is involved in locating objects in space to determine their positions relative to body parts, plays a role in vision-motion coordination.
Modeling and Analysis Methods:
Connectivity (eg. functional, effective, structural) 1
Task-Independent and Resting-State Analysis 2
Keywords:
ADULTS
Data analysis
FUNCTIONAL MRI
MRI
Physical Therapy
Treatment
Other - Gray Matter
1|2Indicates the priority used for review
Provide references using author date format
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