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Effects of repetitive transcranial magnetic stimulation combined with action-observation-execution on social interaction and communication in autism spectrum disorder: Feasibility study
(2023-04-01)
Kaokhieo, Jirapimon
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Tretriluxana, Jarugool
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Chaiyawat, Pakaratee
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Siripornpanich, Vorasith
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Permpoonputtana, Kannika
Objective: To investigate the feasibility of a combined high-frequency rTMS (HF-rTMS) with action observation and execution (AOE) on social interaction and communication in children with Autistic Spectrum Disorder (ASD). Materials and methods: Fifteen children underwent 10 sessions of 5-Hz HF-rTMS on the right inferior frontal gyrus combined with AOE. An experimental group received the real HF-rTMS while the control group received the sham one. For the AOE protocol, they were instructed to watch and imitate a video showing the procedure, including reaching and grasping tasks, gustatory tasks, and facial expressions. Their behavioural outcomes were evaluated using the Vineland Adaptive Behaviour Scale (VABS) and electroencephalograms (EEGs) recorded at three time points: baseline, immediately after each treatment, and at the 1-week follow-up after the 10th treatment. Results: There was a reduction in the VABS subitem scores of the experimental group, including the receptive, expressive, domestic, and community scores but no such reductions were observed in the control group. For the EEG, the beta rhythm at C3 and C4 increased in the experimental group. Additionally, positive correlations were observed between changes in the scores for the expressive subitem and changes in the beta rhythm on the C4 electrode at baseline and immediately after treatment in the experimental group. The control group showed no significant differences in any items for both observation and imitation times. Conclusion: Ten sessions of HF-rTMS combined with AOE could improve both the subitems of communication and daily living skills domain in children aged 7–12 years with ASD. Although it is still inconclusive, this behavioural improvement may be partly attributable to increased cortical activity, as evidenced by beta rhythms.
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Task Oriented Training Activities Post Stroke Will Produce Measurable Alterations in Brain Plasticity Concurrent with Skill Improvement
(2022-01-01)
Rungseethanakul, Somchanok
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Tretriluxana, Jarugool
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Piriyaprasarth, Pagamas
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Pakaprot, Narawut
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Jitaree, Khanitha
Background: Task-oriented training with upper extremity (UE) skilled movements has been established as a method to regain function post stroke. Although improved UE function has been shown after this type of therapy, there is minimal evidence that brain plasticity is associated with this training. The accelerated skill acquisition program (ASAP) is an example of an approach for promoting UE function using targeting movements. Objective: To investigate the effects of a single 2-hour session of ASAP in individuals with stroke on measures of brain plasticity as represented by corticospinal excitability (CE) and determine associations with reach-to-grasp (RTG) performance. Methods: Eighteen post-acute stroke patients were randomized to two groups. Experimental group (n = 9) underwent ASAP for 2 hours, while the control group (n = 9) received dose equivalent usual and customary care. Both groups were evaluated for CE and RTG performance prior to the session and then four times after training: immediately, 1 day, 6 days, and 12 days. Results: Significant alterations in CE were found in the peak-to-peak of Motor Evoked Potential amplitude of elbow and wrist extensor muscles in the lesioned hemisphere. The experimental group also demonstrated improved execution (shortened total movement time, TMT), feed-forward mechanism (deceleration time, DT) and planning (lengthened relative time to maximum hand aperture, RTApmax) compared to the control group Conclusion: Alterations in brain plasticity occur concurrently with improvements in RTG performance in post-acute stroke patients with mild impairment after a single 2-hour session of task-oriented training and persist for at least 12 days.
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Reach-to-Grasp Motion Tracking System Using Single Smart Phone Camera
(2022-01-01)
Thongprasan, Sahawatchara
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Liangsorn, Natsakorn
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Raden-Ahmad, Chafik
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Kongkaew, Kotchakorn
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Tretriluxana, Jarugool
Assessment of human movement is necessary for physical therapy management. This article presents a development of motion tracking system for human Upper Extremity (UE) function analysis. We proposed the optical motion capture system made by a single smart phone camera. It was used to capture the Reach-to-Grasp (RTG) movement of participants in sitting position. Image processing were used to detect color markers placed on chosen hand anatomical landmarks. With our simple camera calibration technique, the 3D coordinates of hand movement were obtained. Two clinical parameters, grasp aperture and hand transport velocity were computed. These results were compared with the outputs, collected at the same time, from the higher accuracy Electromagnetic Motion (EM) tracking system. Qualitatively, the result patterns from two systems were parallel to each other. Our ongoing work is to improve the algorithms according to the feedback from clinicians. This system may provide implication for physical therapist to assess the clients' movement in the clinical setting.
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Age-related changes in reach-to-grasp movements with partial visual occlusion
(2019-08-01)
Runnarong, Nuttakarn
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Tretriluxana, Jarugool
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Waiyasil, Watinee
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Sittisupapong, Preeyanuch
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Tretriluxana, Suradej
This study investigated the influence of age and visual occlusion on fast reach-to-grasp movements. The effect of visual occlusion on reach-to-grasp movement was examined using a task that heavily relies on feed-forward control. Three groups of healthy adults aged 22, 49 and 65 on average performed fast reach-to-grasp movements with full visual and partial visual occlusion conditions of the hand during the initial part of movement. Regarding the effect of age, the all parameters of reach-to-grasp movement were deteriorated with age, except relative time to maximum velocity and spatial coordination. Regarding the effect of visual condition, participants reached with prolonged movement time, lower peak velocity, and later occurrences of peak velocity and peak aperture, as well as decrease in spatial coordination. Regarding the effect of age on visual condition, visual occlusion resulted in a longer movement time and delayed time to maximum velocity in middle-aged and older groups compared to full vision, but the difference was not observed in the younger groups. Conclusion: Reach-to-grasp performance deteriorated with age and the performance was affected when vision of the hand at initial movement was occluded. Overall, movement performance in middle-aged and older adults was affected by visual occlusion, whereas it was unaffected in younger adults. The results indicate that visual feedback of the hand at initial movement is important to control reach-to-grasp movement of middle-aged and older adults during real tasks.
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The persisted effects of low-frequency repetitive transcranial magnetic stimulation to augment task-specific induced hand recovery following subacute stroke: Extended study
(2018-12-01)
Tretriluxana, Jarugool
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Thanakamchokchai, Jenjira
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Jalayondeja, Chutima
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Pakaprot, Narawut
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Tretriluxana, Suradej
Objective To examine the long-term effects of the low-frequency repetitive transcranial magnetic stimulation (LFrTMS) combined with task-specific training on paretic hand function following subacute stroke. Methods Sixteen participants were randomly selected and grouped into two: the experimental group (real LFrTMS) and the control group (sham LF-rTMS). All the 16 participants were then taken through a 1-hour taskspecific training of the paretic hand. The corticospinal excitability (motor evoke potential [MEP] amplitude) of the non-lesioned hemisphere, and the paretic hand performance (Wolf Motor Function Test total movement time [WMFT-TMT]) were evaluated at baseline, after the LF-rTMS, immediately after task-specific training, 1 and 2 weeks after the training. Results Groups comparisons showed a significant difference in the MEP after LF-rTMS and after the training. Compared to the baseline, the MEP of the experimental group significantly decreased after LF-rTMS and after the training and that effect was maintained for 2 weeks. Group comparisons showed significant difference in WMFT-TMT after the training. Only in the experimental group, the WMFT-TMT of the can lifting item significantly reduced compared to the baseline and the effect was sustained for 2 weeks. Conclusion The results of this study established that the improvement in paretic hand after task-specific training was enhanced by LF-rTMS and it persisted for at least 2 weeks.
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Differential effects of feedback in the virtual reality environment for arm rehabilitation after stroke
(2016-02-04)
Tretriluxana, Suradej
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Tretriluxana, Jarugool
Two types of augmented feedback (FB) were compared during reaching training in the Virtual Reality (VR) environment for chronic stroke patients. Six participants were assigned to receive either the Knowledge of Result (KR) or the Knowledge of Performance (KP) FB. They went through 12 training sessions, of which there were 75 Reach-to-Target trials in the VR. They were instructed to perform the actions as fast and accurate as possible. KR group were given audio feedback whereas KP group could see the hand path of their movement. To evaluate, the Wolf Motor Function Test (WMFT) were performed before (Baseline), after (Post training) and 1 week after (Post lweek) the training. Also the kinematics data, Total Movement Time (TMT), Peak Transport Velocity (VMax), and Relative timing of VMax (RP), were analyzed. Results show that only in KP group, the dexterity tasks of WMFT was improved after the training and maintained for at least 1 week. Additionally, VMax in KP group was higher and occurred later than that in KR group. These preliminary outcomes imply that different strategy of movement recovery after stroke result from different types of FB. More participants will be recruited in the future to confirm this finding.
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Improvement in Paretic Arm Reach-to-Grasp following Low Frequency Repetitive Transcranial Magnetic Stimulation Depends on Object Size: A Pilot Study
(2015-01-01)
Tretriluxana, Jarugool
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Kantak, Shailesh
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Tretriluxana, Suradej
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Wu, Allan D.
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Fisher, Beth E.
Introduction. Low frequency repetitive transcranial magnetic stimulation (LF-rTMS) delivered to the nonlesioned hemisphere has been shown to improve limited function of the paretic upper extremity (UE) following stroke. The outcome measures have largely included clinical assessments with little investigation on changes in kinematics and coordination. To date, there is no study investigating how the effects of LF-rTMS are modulated by the sizes of an object to be grasped. Objective. To investigate the effect of LF-rTMS on kinematics and coordination of the paretic hand reach-to-grasp (RTG) for two object sizes in chronic stroke. Methods. Nine participants received two TMS conditions: real rTMS and sham rTMS conditions. Before and after the rTMS conditions, cortico-motor excitability (CE) of the nonlesioned hemisphere, RTG kinematics, and coordination was evaluated. Object sizes were 1.2 and 7.2 cm in diameter. Results. Compared to sham rTMS, real rTMS significantly reduced CE of the non-lesioned M1. While rTMS had no effect on RTG action for the larger object, real rTMS significantly improved movement time, aperture opening, and RTG coordination for the smaller object. Conclusions. LF-rTMS improves RTG action for only the smaller object in chronic stroke. The findings suggest a dissociation between effects of rTMS on M1 and task difficulty for this complex skill.
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Low frequency repetitive transcranial magnetic stimulation to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance after chronic stroke
(2013-03-01)
Tretriluxana, Jarugool
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Kantak, Shailesh
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Tretriluxana, Suradej
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Wu, Allan D.
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Fisher, Beth E.
Purpose: To investigate the effect of inhibitory low frequency repetitive Transcranial Magnetic Stimulation (rTMS) applied to the non-lesioned hemisphere on kinematics and coordination of paretic arm reach-to-grasp (RTG) actions in individuals with stroke. Relevance: This study is designed as a phase I trial to determine the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The results have important implications for the use of rTMS in parallel with complex paretic arm skill practice. Participants: Nine adults, anterior circulation unilateral stroke. Their average age was 59 years, the average time since stroke was 4.8 years. Method and analysis: Two TMS treatments were performed on two separate days: active rTMS and sham rTMS. Cortico-motor excitability (CE) of the non-lesioned hemisphere as well as RTG kinematics of the paretic hand as participants reached for a dowel of 1.2 cm in diameter was assessed before and after the rTMS treatments. In the active condition, rTMS was applied over the "hot spot" of the extensor digitorum communis muscle (EDC) in primary motor cortex (M1) of the non-lesioned hemisphere at 90% resting motor threshold. TMS pulses were delivered at 1 Hz for 20 min. In the sham condition, a sham coil was positioned similar to the active condition; TMS clicking noise was produced but no TMS pulse was delivered. Dependent measures: CE was measured as peak-to-peak amplitude of the motor evoked potential at 120% of resting motor threshold. RTG kinematics included movement time, peak transport velocity, peak aperture, time of peak transport velocity and time of peak aperture. RTG coordination was captured by cross correlation coefficient between transport velocity and grasp aperture size. Results: While 1 Hz rTMS applied over non-lesioned M1 significantly decreased the MEP amplitude of non-paretic EDC, sham TMS did not have a significant effect on MEP amplitude. Active rTMS significantly decreased total movement time and increased peak grasp aperture. There were no changes in peak transport velocity or the time of peak transport velocity or the time of peak aperture after application of active rTMS. Additionally, the participants completed RTG actions with a more coordinated pattern after undergoing active rTMS. Following sham TMS, there were no changes in CE, RTG kinematics or coordination. While there were no significant correlation between changes in cortico-motor excitability and RTG kinematics, the decrease in cortico-motor excitability of the non-lesioned hemisphere showed a strong correlation with an increase in cross-correlation coefficient. Conclusions and implications: The findings demonstrate the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The inhibitory effect of low frequency rTMS resulted in improved paretic hand reach-to-grasp performance with faster movement time and more coordinated reach-to-grasp pattern. These results have important implications for the use of rTMS for stroke rehabilitation. Implications for Rehabilitation Low frequency repetitive transcranial magnetic stimulation (LF-rTMS) to the non-lesioned hemisphere improves paretic arm reach-to-grasp performance. The preliminary results have important implications for the use of LF-rTMS as conjunctive intervention for stroke rehabilitation. © 2013 Informa UK, Ltd.
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Feasibility investigation of the accelerated skill acquisition program (ASAP): Insights into reach-to-grasp coordination of individuals with postacute stroke
(2013-01-01)
Tretriluxana, Jarugool
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Runnarong, Nuttakarn
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Tretriluxana, Suradej
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Prayoonwiwat, Naraporn
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Vachalathiti, Roongtiwa
Background: Skill acquisition, capacity building, and motivational enhancements are the basis of the Accelerated Skill Acquisition Program (ASAP) and form the foundation for effective incorporation of the paretic upper extremity into life activities. This is the first phase I trial to deliver ASAP during the postacute interval in mildly to moderately impaired stroke survivors and to include an assessment of paretic reach-to-grasp (RTG) coordination using RTG task and cross-correlation analyses. Methods: Two baseline and posttreatment evaluations consisted of RTG actions, the Wolf Motor Function Test (WMFT), and the Stroke Impact Scale (SIS). An individualized arm therapy program using ASAP principles was administered for a total of 30 hours, 2 hours per day, for 2 to 4 days per week over 5 weeks. Dependent measures were kinematics of RTG actions, RTG coordination, total time score of WMFT, and stroke recovery score of SIS. Results: All participants tolerated ASAP well, and none reported any adverse effects during or after the protocol. When the 2 baseline evaluations were compared, there were no changes in any RTG kinematics or RTG coordination. In contrast, after 30 hours of ASAP, total movement time and deceleration time of RTG actions markedly decreased, maximum reach (transport) velocity strikingly increased, and time of maximum aperture was accomplished later. Additionally, the maximal RTG correlation coefficient increased with a shorter associated time lag. A similar pattern was observed for the clinical outcome measures of WMFT and SIS. Conclusions: The findings demonstrate the feasibility of using an ASAP protocol for patients 1 to 3 months post stroke. Under ASAP, WMFT tasks and RTG actions were performed faster with higher peak transport velocity and a more coordinated RTG pattern. The next step is to determine whether the immediate gains in the skilled RTG actions persist 6 months alter. © 2013 Thomas Land Publishers, Inc.
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Low frequency repetitive transcranial magnetic stimulation to the non-lesioned hemisphere improved paretic arm reach-to-grasp performance after chronic stroke
(2011-12-28)
Tretriluxana, Jarugool
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Tretriluxana, Suradej
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Kantak, Shailesh
;
Wu, Allan D.
;
Fisher, Beth E.
Purpose: To investigate the effect of inhibitory low frequency repetitive Transcranial Magnetic Stimulation (rTMS) applied to the non-lesioned hemisphere on kinematics and coordination of paretic arm reach-to-grasp (RTG) actions in individuals with stroke. Relevance: This study is designed as a phase I trial to determine the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The results have important implications for the use of rTMS in parallel with complex paretic arm skill practice. Participants: Nine adults, anterior circulation unilateral stroke. Their average age was 59 years, the average time since stroke was 4.8 years. Method and analysis: Two TMS treatments were performed on two separate days: active rTMS and sham rTMS. Cortico-motor excitability (CE) of the non-lesioned hemisphere as well as RTG kinematics of the paretic hand as participants reached for a dowel of 1.2 cm in diameter was assessed before and after the rTMS treatments. In the active condition, rTMS was applied over the "hot spot" of the extensor digitorum communis muscle (EDC) in primary motor cortex (M1) of the non-lesioned hemisphere at 90% resting motor threshold. TMS pulses were delivered at 1 Hz for 20 minutes. In the sham condition, a sham coil was positioned similar to the active condition; TMS clicking noise was produced but no TMS pulse was delivered. Dependent measures: CE was measured as peak-to-peak amplitude of the motor evoked potential at 120% of resting motor threshold. RTG kinematics included movement time, peak transport velocity, peak aperture, time of peak transport velocity and time of peak aperture. RTG coordination was captured by cross correlation coefficient between transport velocity and grasp aperture size. Results: While 1 Hz rTMS applied over non-lesioned M1 significantly decreased the MEP amplitude of non-paretic EDC, sham TMS did not have a significant effect on MEP amplitude. Active rTMS significantly decreased total movement time and increased peak grasp aperture. There were no changes in peak transport velocity or the time of peak transport velocity or the time of peak aperture after application of active rTMS. Additionally, the participants completed RTG actions with a more coordinated pattern after undergoing active rTMS. Following sham TMS, there were no changes in CE, RTG kinematics or coordination. Conclusions and implications: The findings demonstrate the feasibility and efficacy of low frequency rTMS applied to the non-lesioned hemisphere for the recovery of reach-to-grasp actions in individuals with hemiparesis secondary to stroke. The inhibitory effect of low frequency rTMS resulted in improved paretic hand reach-to-grasp performance with faster movement time and more coordinated reach-to-grasp pattern. These results have important implications for the use of rTMS for stroke rehabilitation.

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