Effects of physiotherapy and acupuncture treatment on basal ganglia network in stroke rehabilitation
Poster No:
1580
Submission Type:
Abstract Submission
Authors:
Jia Fan1, Soné Fouché1, Hai Lu2, Fleur Warton1, Frances Robertson1, Yu Wang3, Sebnem Er1, Jiu Chen2, Nelleke Langerak1, Xuesong Ren3, Xuesheng Ma4, Marc Combrinck1, Chunhong Zhang3, Ernesta Meintjes1
Institutions:
1University of Cape Town, Cape Town, Western Cape, 2Nanjing University, Nanjin, Jiangsu, 3First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, Tianjin, 4University of the Western Cape, Cape Town, Western Cape
First Author:
Co-Author(s):
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 occurs when blood supply to an area of the brain is interrupted by either occlusion or haemorrhage. Typically, a multidisciplinary team comprising a physiotherapist, occupational therapist, and/or speech therapist will be involved in stroke rehabilitation depending on the patient's needs [1]. The benefits of physiotherapy are widely recognised [2]. Acupuncture on particular acupoints may be excitable muscle/skin-nerve complexes containing a high density of nerve endings and activates afferent fibres that send signals to the spinal cord [3]. Therefore, acupuncture may have effect on regulation of cerebral blood flow via angiogenesis and modulation of vasoactive mediators [4]. However, the exact mechanisms of acupuncture in the treatment of stroke remain unclear. Resting-state functional MRI (rs-fMRI) allows us to identify brain regions that are temporally correlated when the subject is not performing any explicit task. The current study aims to compare treatment-related changes in resting state function connectivity (RSFC) within the basal ganglia (BG) network in ischaemic stroke patients with unilateral limb dysfunction.
Methods:
Twenty-three right-handed stroke patients with unilateral limb dysfunction (mean±sd age: 58.5±8.0 yr) were recruited from the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine. These participants were assigned to three different treatment arms: (1) True Acupuncture (TA), (2) TA and Physiotherapy (PT), and (3) PT and Sham Acupuncture (SA). MRI scans were performed on a 3T Skyra Scanner (Siemens, Erlangen, Germany) after stroke patients who received 5 TA or 5 SA sessions per week with/without PT for 3 weeks, including a gradient echo EPI sequence (TR=2000 ms, TE=30 ms, flip angle=90˚, FOV=220 mm, voxel size 3.4×3.4×3.0 mm3) and an MPRAGE sequence (TR=2000 ms, TE=1.97 ms, flip angle=8˚, FOV=256 mm, voxel size 1.0×1.0×1.0 mm3). Pre-processing was conducted using afni_proc.py in AFNI including the following standard procedures: realignment, regression, and blurring. All images were registered to a 3x3x3 mm3 Talairach-Tournoux (TT) standard space. BG seeds were spherical regions of interest (ROIs) (radius = 3 mm, coordinates (+/- 3.5, 4, -0.3)) bilaterally in the caudate putamen [5]. The average ROI time series of the seed was used to perform whole-brain correlation analysis. FSL-randomise was used to find clusters within the identified resting state networks (RSNs) showing treatment-related differences. We only report results that survived at a cluster threshold of p<0.01 and α<0.05.
Results:
Patients who received TA and PT (TA+PT) showed higher RSFC between the seed in the left (L) caudate putamen and clusters in the left (L) and right (R) anterior cingulate, and between the seed in the R caudate putamen and clusters in the R anterior cingulate and L Thalamus compared others who received TA or SA and PT (SA+PT) (Figure 1). The 2 clusters in the R Anterior cingulate were overlapped. The cluster size, peak coordinate, and location of each region of interest (ROI) are shown in Table 1.
Conclusions:
This study examined the potential benefits of combined TA and PT treatment on RSFC in the BG network in stoke patients with unilateral limb dysfunction compared to others who received either TA alone or SA + PT. Higher RSFC in bilaterally in anterior cingulate and L thalamus were found in stroke patients who received TA+PT. Anterior cingulate is responsible for emotional expression, attention allocation, and mood regulation, and mediates reward-based behaviors together with orbital frontal cortex [6]. Previously, higher RSFC in the anterior cingulate were seen in palsy patients who received acupuncture treatment [7]. Thalamus can be segregated into discrete loops for motor, oculomotor, prefrontal, and limbic functions [8]. Greater RSFC in thalamus may suggest better motor behaviors where better thalamus activation was seen in individuals who received TA [9] or PT [10].
Modeling and Analysis Methods:
Connectivity (eg. functional, effective, structural) 1
fMRI Connectivity and Network Modeling 2
Keywords:
ADULTS
Basal Ganglia
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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