Serum BDNF's Role as a Biomarker for Motor Training in the Context of AR-Based Rehabilitation after Ischemic Stroke.

Ekaterina S Koroleva,Svetlana A Ivanova,Valentina M Alifirova,Anastasiia S Boiko,Lyudmila A Levchuk,Ivan V Tolmachev,Anton J M Loonen

doi:10.3390/brainsci10090623

Abstract

Background: brain-derived neurotrophic factor (BDNF) may play a role during neurorehabilitation following ischemic stroke. This study aimed to elucidate the possible role of BDNF during early recovery from ischemic stroke assisted by motor training. Methods: fifty patients were included after acute recovery from ischemic stroke: 21 first received classical rehabilitation followed by ‘motor rehabilitation using motion sensors and augmented reality’ (AR-rehabilitation), 14 only received AR-rehabilitation, and 15 were only observed. Serum BDNF levels were measured on the first day of stroke, on the 14th day, before AR-based rehabilitation (median, 45th day), and after the AR-based rehabilitation (median, 82nd day). Motor impairment was quantified clinically using the Fugl–Meyer scale (FMA); functional disability and activities of daily living (ADL) were measured using the Modified Rankin Scale (mRS). For comparison, serum BDNF was measured in 50 healthy individuals. Results: BDNF levels were found to significantly increase during the phase with AR-based rehabilitation. The pattern of the sequentially measured BDNF levels was similar in the treated patients. Untreated patients had significantly lower BDNF levels at the endpoint. Conclusions: the fluctuations of BDNF levels are not consistently related to motor improvement but seem to react to active treatment. Without active rehabilitation treatment, BDNF tends to decrease.

Highlights

In 2015, neurological disorders accounted for 10.2% of lost disability-adjusted life-years (DALYs) and 16.8% of deaths globally [1], making them the leading and second-leading causes of DALY loss and death, respectively [1,2]
In order to assess the impact of visual stimuli on motor function, we developed specialized software (NeuroRAR—software for the motor rehabilitation of neurological patients using motion sensors and augmented reality; certificate of state registration of a computer program no. 2019619570; dated 19 July 2019)
The detailed characteristics of the patient groups—including those according to the criteria of Trial of Org 10,172 in Acute Stroke Treatment (TOAST) [34]—are described by Koroleva and colleagues [33]

Summary

Introduction

In 2015, neurological disorders accounted for 10.2% of lost disability-adjusted life-years (DALYs) and 16.8% of deaths globally [1], making them the leading and second-leading causes of DALY loss and death, respectively [1,2]. In 2017, the age-standardized ischemic stroke incidence, DALY loss and death rates in the Russian federation were 139.7 (126.0–155.6), 93.0 (91.4–96.0), and 1571.0 (1483.1–1654.6). Virtual Reality (VR)-based rehabilitation is an economical and safe method for improving motor and cognitive functions, facilitating brain plasticity, and regenerative processes [7]. It is based on training regarding the integration of the sensory information supplied by visual, auditory, tactile, and somatosensory perception during the execution of motor activities [8,9]. A systematic literature review and meta-analysis showed that the VR-based rehabilitation of patients with stroke was more effective than conventional treatment for improving ADL and upper limb function [5,11]. Vourvopoulos et al showed beneficial effects of EEG-based VR and brain–computer interfaces (BCIs) in patients with severe motor impairments [12]

Objectives

Methods

Results

Discussion

Conclusion