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Nicolo Pierre

Professeur HES Assistant (PAPTC)

Hauptkompetenzen

Experience induced brain plasticity

Cognitive and sensorimotor function

Professeur HES Assistant (PAPTC)

Haute école de santé - Genève
Avenue de Champel 47, 1206 Genève, CH

Bereich
Santé

Hauptstudiengang
Physiothérapie

BSc HES-SO en Physiothérapie - Haute école de santé - Genève

Neuro-réhabilitation
Apprentissage moteur
Méthodologie de recherche
Travaux de Bachelor
Neuroanatomie

MSc HES-SO/UNIL en Sciences de la santé - HES-SO Master

Neuro-réhabilitation
Directeur travaux de master

Laufend

Stimulations cérébrales non-invasives innovantes dans la réhabilitation à la marche après AVC

Rolle: Hauptgesuchsteller/in

Financement: HUG privé

Description du projet :

La restauration des capacités de déambulation et l’indépendance à la marche sont des enjeux
majeurs chez les personnes après accident vasculaire cérébrale (AVC) (Jang 2010). En effet,
20% à 25% des patients sont incapables de marcher sans assistance (Hendricks, van Limbeek
et al. 2002). Ces patients présentent une vitesse et une périmètre maximale de marche qui ne
permettent pas des activités en dehors du domicile et impactent grandement leur qualité de vie
(Dobkin 2005). L’effet de nos thérapies de restauration à la marche demeure donc limité et un
besoin urgent de développement de nouvelles approches est capital.
Récemment, des résultats émergeant de la recherche en neurosciences et en réhabilitation, ont
démontré que les stimulations cérébrales non-invasives tel que la stimulation transcrânienne à
courant continu (tDCS) combinée aux thérapies est capable de moduler l’activité cérébrale et
d’accélérer l’acquisition de la fonction locomotrice (Xu, Hou et al. 2015). De plus, une métaanalyse,
en préparation par le requérant principal de ce projet, montre que les effets les plus
encourageants peuvent être obtenus avec l’application d’une tDCS à visée excitatrice (type
anodale) au-dessus de l’hémisphère lésé (Picelli, Chemello et al. 2015, Seo, Lee et al. 2017).
Toutefois, les effets mesurés demeurent inconsistants, possiblement dû à une dispersion nonfocal
du courant électrique par la configuration traditionnelle de la tDCS anodale. L’application
d’une tDCS anodale à haute définition (HD) serait donc un moyen de surmonter ce
désavantage et produirait une stimulation de zone corticale plus profonde. De plus, ce type de
montage permettrait une augmentation de l’excitabilité comparée à la configuration
traditionnelle (Kuo, Bikson et al. 2013). Cependant, à notre connaissance, il n’existe aucune
étude montrant l’impact d’une tDCS HD sur les capacités de marche chez les patients après
AVC.
C’est pourquoi, ce projet propose de tester les effets de l’application de sessions multiples de
stimulation transcrânienne à courant continu (tDCS) excitatrice (tDCS anodale et tDCS HD
anodale) combinée à une rééducation locomotrice sur les capacités de déambulation chez les
patients post AVC au stade chronique comparativement à une stimulation placebo (tDCS
anodale placebo).

Forschungsteam innerhalb von HES-SO: Nicolo Pierre

Montant global du projet: 44'700 CHF

Statut: Laufend

Abgeschlossen

Innovative brain stimulation for induction of learning plasticity

Rolle: Hauptgesuchsteller/in

Financement: Spark

Description du projet :

Background: Recent studies have identified new neurobiological biomarker (i.e. functional connectivity
of the parietal cortex) of motor learning among healthy people. This enables to refine our current model
of motor learning wherein specific cortical processes are key factors for motor acquisition. Furthermore,
recent evidence suggests that new technical approaches such as repetitive magnetic stimulation (rTMS)
can efficiently influence this key factor. However, up to now, no rTMS studies have target this new
biomarker. Therefore, the effect of rTMS are unknown. Hence, we want to develop a new rTMS setup
able to induce specific brain processes in healthy individuals that are likely to benefit. This has the
potential to obtain critical information in order to improve treatment of motor re-learning in patients
with neurological diseases.
Objective: This project proposes to test a new rTMS paradigm resulting from recent advances in the
understanding of motor skill acquisition in healthy subjects.
In this work, we will test the hypothesis that rTMS applied over critical brain area and combined with
motor learning will enhance cortical processes. This in turn should lead to improved long-term motor
gains.

Forschungsteam innerhalb von HES-SO: Nicolo Pierre

Durée du projet: 01.03.2020 - 31.10.2020

Montant global du projet: 93'417 CHF

Statut: Abgeschlossen

2021

Mesure du contrôle postural en position debout bipodale par plateforme stabilométrique

Professionnel ArODES

Aline Reinmann, Pierre Nicolo, Anne-Violette Bruyneel, Thomas Pourchet, Simone Gafner, Simone Chantal Gafner

Kinésithérapie, la Revue, 2021, vol. 21, no. 231, pp. 30-32

Link zur Publikation

2020

A multimodal approach to capture post-stroke temporal dynamics of recovery

Scientifique ArODES

Pierre Nicolo, Camilla Pierella, Elvira Pirondini, Nawal Kinany, Martina Coscia, Christian Giang, Jenifer Miehlbradt, Cécile Magnin, Stefania Dalise, Giada Sgherri, Carmelo Chisari, Dimitri Van De Ville, Adrian Guggisberg, Silvestro Micera

Journal of Neural Engineering, 2020, vol. 17, no. 4, article 045002

Link zur Publikation

Zusammenfassung:

Objective. Several training programs have been developed in the past to restore motor functions after stroke. Their efficacy strongly relies on the possibility to assess individual levels of impairment and recovery rate. However, commonly used clinical scales rely mainly on subjective functional assessments and are not able to provide a complete description of patients' neuro-biomechanical status. Therefore, current clinical tests should be integrated with specific physiological measurements, i.e. kinematic, muscular, and brain activities, to obtain a deep understanding of patients' condition and of its evolution through time and rehabilitative intervention. Approach. We proposed a multivariate approach for motor control assessment that simultaneously measures kinematic, muscle and brain activity and combines the main physiological variables extracted from these signals using principal component analysis (PCA). We tested it in a group of six sub-acute stroke subjects evaluated extensively before and after a four-week training, using an upper-limb exoskeleton while performing a reaching task, along with brain and muscle measurements. Main results. After training, all subjects exhibited clinical improvements correlating with changes in kinematics, muscle synergies, and spinal maps. Movements were smoother and faster, while muscle synergies increased in numbers and became more similar to those of the healthy controls. These findings were coupled with changes in cortical oscillations depicted by EEG-topographies. When combining these physiological variables using PCA, we found that (i) patients' kinematic and spinal maps parameters improved continuously during the four assessments; (ii) muscle coordination augmented mainly during treatment, and (iii) brain oscillations recovered mostly pre-treatment as a consequence of short-term subacute changes. Significance. Although these are preliminary results, the proposed approach has the potential of identifying significant biomarkers for patient stratification as well as for the design of more effective rehabilitation protocols.

Motor improvement estimation and task adaptation for personalized robot-aided therapy :

Scientifique ArODES

a feasibility study

Pierre Nicolo, Christian Giang, Elvira Pirondini, Nawal Kinany, Camilla Pierella, Alessandro Panarese, Martina Coscia, Jenifer Miehlbradt, Cécile Magnin, Adrian Guggisberg, Silvestro Micera

BioMedical Engineering OnLine, 2020, vol. 19, article 33

Link zur Publikation

Zusammenfassung:

Background: In the past years, robotic systems have become increasingly popular in upper limb rehabilitation. Nevertheless, clinical studies have so far not been able to confirm superior efficacy of robotic therapy over conventional methods. The personalization of robot-aided therapy according to the patients’ individual motor deficits has been suggested as a pivotal step to improve the clinical outcome of such approaches. Methods : Here, we present a model-based approach to personalize robot-aided rehabilitation therapy within training sessions. The proposed method combines the information from different motor performance measures recorded from the robot to continuously estimate patients’ motor improvement for a series of point-to-point reaching movements in different directions. Additionally, it comprises a personalization routine to automatically adapt the rehabilitation training. We engineered our approach using an upper-limb exoskeleton. The implementation was tested with 17 healthy subjects, who underwent a motor-adaptation paradigm, and two subacute stroke patients, exhibiting different degrees of motor impairment, who participated in a pilot test undergoing rehabilitative motor training. Results : The results of the exploratory study with healthy subjects showed that the participants divided into fast and slow adapters. The model was able to correctly estimate distinct motor improvement progressions between the two groups of participants while proposing individual training protocols. For the two pilot patients, an analysis of the selected motor performance measures showed that both patients were able to retain the improvements gained during training when reaching movements were reintroduced at a later stage. These results suggest that the automated training adaptation was appropriately timed and specifically tailored to the abilities of each individual. Conclusions : The results of our exploratory study demonstrated the feasibility of the proposed model-based approach for the personalization of robot-aided rehabilitation therapy. The pilot test with two subacute stroke patients further supported our approach, while providing encouraging results for the applicability in clinical settings.

2018

Transcranial direct current stimulation reduces secondary white-matter degradation after stroke

Scientifique ArODES

Pierre Nicolo, Cécile Magnin, Elena Pedrazzini, Anh Nguyen-Danse, Adrian Guggisberg

Brain Stimulation, 2018, vol. 11, no. 6, pp. 1417-1419

Link zur Publikation

Modulating functional connectivity after stroke with neurofeedback :

Scientifique ArODES

effect on motor deficits in a controlled cross-over study

Anaïs Mottaz, Pierre Nicolo, Tiffany Corbet, Naz Doganci, Cécile Magnin, Armin Schnider, Adrian Guggisberg

NeuroImage: Clinical, 2018, vol. 20, pp. 336-346

Link zur Publikation

Zusammenfassung:

Synchronization of neural activity as measured with functional connectivity (FC) is increasingly used to study the neural basis of brain disease and to develop new treatment targets. However, solid evidence for a causal role of FC in disease and therapy is lacking. Here, we manipulated FC of the ipsilesional primary motor cortex in ten chronic human stroke patients through brain-computer interface technology with visual neurofeedback. We conducted a double-blind controlled crossover study to test whether manipulation of FC through neurofeedback had a behavioral effect on motor performance. Patients succeeded in increasing FC in the motor cortex. This led to improvement in motor function that was significantly greater than during neurofeedback training of a control brain area and proportional to the degree of FC enhancement. This result provides evidence that FC has a causal role in neurological function and that it can be effectively targeted with therapy.

Comparison of neuroplastic responses to cathodal transcranial direct current stimulation and continuous theta burst stimulation in subacute stroke

Scientifique ArODES

Anaïs Mottaz, Pierre Nicolo, Cécile Magnin, Elena Pedrazzini, Gijs Plomp, Armin Schnider, Adrian Guggisberg

Archives of physical medicine and rehabilitation, 2018, vol. 99, no. 5, pp. 862-872

Link zur Publikation

Zusammenfassung:

Objective : To investigate the effects of cathodal transcranial direct current stimulation (tDCS) and continuous theta burst stimulation (cTBS) on neural network connectivity and motor recovery in individuals with subacute stroke. Design : Double-blinded, randomized, placebo-controlled study. Setting : University hospital rehabilitation unit. Participants : Inpatients with stroke (N=41; mean age, 65y; range, 28–85y; mean weeks poststroke, 5; range, 2–10) with resultant paresis in the upper extremity (mean Fugl-Meyer score, 14; range, 3–48). Interventions : Subjects with stroke were randomly assigned to neuronavigated cTBS (n=14), cathodal tDCS (n=14), or sham transcranial magnetic stimulation/sham tDCS (n=13) over the contralesional primary motor cortex (M1). Each subject completed 9 stimulation sessions over 3 weeks, combined with physical therapy. Main Outcome Measures : Brain function was assessed with directed and nondirected functional connectivity based on high-density electroencephalography before and after stimulation sessions. Primary clinical end point was the change in slope of the multifaceted motor score composed of the upper extremity Fugl-Meyer Assessment score, Box and Block test score, 9-Hole Peg Test score, and Jamar dynamometer results between the baseline period and the treatment time. Results : Neither stimulation treatment enhanced clinical motor gains. Cathodal tDCS and cTBS induced different neural effects. Only cTBS was able to reduce transcallosal influences from the contralesional to the ipsilesional M1 during rest. Conversely, tDCS enhanced perilesional beta-band oscillation coherence compared with cTBS and sham groups. Correlation analyses indicated that the modulation of interhemispheric driving and perilesional beta-band connectivity were not independent mediators for functional recovery across all patients. However, exploratory subgroup analyses suggest that the enhancement of perilesional beta-band connectivity through tDCS might have more robust clinical gains if started within the first 4 weeks after stroke. Conclusions : The inhibition of the contralesional M1 or the reduction of interhemispheric interactions was not clinically useful in the heterogeneous group of subjects with subacute stroke. An early modulation of perilesional oscillation coherence seems to be a more promising strategy for brain stimulation interventions.

2017

Longitudinal structural and functional differences between proportional and poor motor recovery after stroke

Scientifique ArODES

Pierre Nicolo, Adrian Guggisberg, Leonardo G. Cohen, Armin Schnider, Ethan Buch

Neurorehabilitation and Neural Repair, 2017, vol. 31, no. 12, pp. 1029-1041

Link zur Publikation

Zusammenfassung:

Background : Evolution of motor function during the first months after stroke is stereotypically bifurcated, consisting of either recovery to about 70% of maximum possible improvement (“proportional recovery, PROP”) or in little to no improvement (“poor recovery, POOR”). There is currently no evidence that any rehabilitation treatment will prevent POOR and favor PROP. Objective : To perform a longitudinal and multimodal assessment of functional and structural changes in brain organization associated with PROP. Methods : Fugl-Meyer Assessments of the upper extremity and high-density electroencephalography (EEG) were obtained from 63 patients, diffusion tensor imaging from 46 patients, at 2 and 4 weeks (T0) and at 3 months (T1) after stroke onset. Results : We confirmed the presence of 2 distinct recovery patterns (PROP and POOR) in our sample. At T0, PROP patients had greater integrity of the corticospinal tract (CST) and greater EEG functional connectivity (FC) between the affected hemisphere and rest of the brain, in particular between the ventral premotor and the primary motor cortex. POOR patients suffered from degradation of corticocortical and corticofugal fiber tracts in the affected hemisphere between T0 and T1, which was not observed in PROP patients. Better initial CST integrity correlated with greater initial global FC, which was in turn associated with less white matter degradation between T0 and T1. Conclusions : These findings suggest links between initial CST integrity, systems-level cortical network plasticity, reduction of white matter atrophy, and clinical motor recovery after stroke. This identifies candidate treatment targets.

2022

Effets de la Stimulation Magnétique Transcrânienne Répétitive (SMTr) non-invasive sur l'apprentissage moteur et l'activation cérébrale

Conference

Pierre Nicolo

Swiss Congress for Health Professions 2022, 01.09.2022 - 02.09.2022, Neuchâtel

Link zur Konferenz

Zusammenfassung:

Introduction : L’apprentissage moteur est un enjeu crucial dans l’acquisition de nouvelles habiletés motrices ou la récupération motrice. La stimulation magnétique répétitive transcrânienne (SMTr) peut majorer les effets de l’apprentissage. Toutefois, l’aire cérébrale à stimuler et les effets induits restent à déterminer. Notre étude a pour objectif d’investiguer l’application d’une stimulation par thêta burst intermittent (iTBS, forme de SMTr) de l’aire pariétale gauche (APG) combinée à un apprentissage moteur sur la performance motrice et la réorganisation cérébrale chez des participants « sains ».

Méthodes : 20 participants ont été inclus et randomisés dans deux groupes : 1) iTBS actif sur l’APG et 2) iTBS placebo sur l’APG. Les participants ont effectué une session de stimulation iTBS suivi de l’apprentissage. La tâche motrice consistait à réaliser un dessin en miroir sur ordinateur, dans laquelle les mouvements de la souris étaient inversés. Un jour avant et après l'apprentissage, les participants ont effectué un électroencéphalogramme de repos afin d'évaluer l’activité cérébrale (index de connectivité fonctionnelle). La performance motrice a été mesurée deux fois, soit 10 minutes et 24 heures après apprentissage (rétention ; sur le nombre d’erreurs).

Résultats : Le groupe bénéficiant d’une stimulation active a amélioré leur performance motrice 10 minutes après l’apprentissage plus fortement que le groupe ayant eu le placebo (iTBS actif : -36.9±26.4% ; iTBS placebo -12.1±31.1%). La différence entre les groupes approche le seuil de significativité (ttest non-appariés, t(18)=-1.92, p=0.07). 10 minutes après l’apprentissage, plus la connectivité fonctionnelle de l’APG avait diminué, moins les participants commettaient d’erreurs lors (r=0.51, p=0.02). De plus, le degré de connectivité fonctionnelle de l’APG avant l’apprentissage était associé significativement avec la performance motrice lors de cette rétention (r=-0.64, p=0.002). En revanche, 24 heures après l’apprentissage, aucun groupe n’a démontré de supériorité sur la performance motrice (ttest non-appariés, t(18)=0.92, p=0.37)

Conclusions : Les résultats montrent que l’iTBS sur l’APG pourrait accélérer, du moins transitoirement, la rétention d’apprentissage. La rétention semble être majorée chez les participants ayant une haute connectivité fonctionnelle avant l’apprentissage et une diminution de celle-ci après l’apprentissage suggérant une signature neurophysiologique pertinente.

2021

MPR et AVC à la phase aigüe

Conference

Pierre Nicolo

49e édition des Entretiens de médecine physique et de réadaptation (EMPR), 17.03.2021 - 17.03.2021, En ligne

Link zur Konferenz

Errungenschaften

Suche

Nicolo Pierre

Professeur HES Assistant (PAPTC)

Hauptkompetenzen

Neurorehabilitation

Experience induced brain plasticity

Imagerie Biomédicale

Sciences du mouvement

Physiotherapy

Cognitive and sensorimotor function

Research management

Professeur HES Assistant (PAPTC)