1
|
Pereira AC, Alakbarzade V, Shribman S, Crossingham G, Moullaali T, Werring D. Stroke as a career option for neurologists. Pract Neurol 2024:pn-2024-004111. [PMID: 38908861 DOI: 10.1136/pn-2024-004111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2024] [Indexed: 06/24/2024]
Abstract
Stroke is one of the most common acute neurological disorders and a leading cause of disability worldwide. Evidence-based treatments over the last two decades have driven a revolution in the clinical management and design of stroke services. We need a highly skilled, multidisciplinary workforce that includes neurologists as core members to deliver modern stroke care. In the UK, the dedicated subspecialty training programme for stroke medicine has recently been integrated into the neurology curriculum. All neurologists will be trained to contribute to each aspect of the stroke care pathway. We discuss how training in stroke medicine is evolving for neurologists and the opportunities and challenges around practising stroke medicine in the UK and beyond.
Collapse
Affiliation(s)
- Anthony C Pereira
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Vafa Alakbarzade
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Samuel Shribman
- Department of Neurology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Ginette Crossingham
- Department of Neurology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Tom Moullaali
- Centre for Clinical Brain Sciences, University of Edinburgh Division of Medical and Radiological Sciences, Edinburgh, UK
| | - David Werring
- Stroke Research Group, UCL Queen Square Institute of Neurology, London, UK
| |
Collapse
|
2
|
Germann M, Maffitt NJ, Poll A, Raditya M, Ting JSK, Baker SN. Pairing Transcranial Magnetic Stimulation and Loud Sounds Produces Plastic Changes in Motor Output. J Neurosci 2023; 43:2469-2481. [PMID: 36859307 PMCID: PMC10082460 DOI: 10.1523/jneurosci.0228-21.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 11/29/2022] [Accepted: 12/09/2022] [Indexed: 03/03/2023] Open
Abstract
Most current methods for neuromodulation target the cortex. Approaches for inducing plasticity in subcortical motor pathways, such as the reticulospinal tract, could help to boost recovery after damage (e.g., stroke). In this study, we paired loud acoustic stimulation (LAS) with transcranial magnetic stimulation (TMS) over the motor cortex in male and female healthy humans. LAS activates the reticular formation; TMS activates descending systems, including corticoreticular fibers. Two hundred paired stimuli were used, with 50 ms interstimulus interval at which LAS suppresses TMS responses. Before and after stimulus pairing, responses in the contralateral biceps muscle to TMS alone were measured. Ten, 20, and 30 min after stimulus pairing ended, TMS responses were enhanced, indicating the induction of LTP. No long-term changes were seen in control experiments which used 200 unpaired TMS or LAS, indicating the importance of associative stimulation. Following paired stimulation, no changes were seen in responses to direct corticospinal stimulation at the level of the medulla, or in the extent of reaction time shortening by a loud sound (StartReact effect), suggesting that plasticity did not occur in corticospinal or reticulospinal synapses. Direct measurements in female monkeys undergoing a similar paired protocol revealed no enhancement of corticospinal volleys after paired stimulation, suggesting no changes occurred in intracortical connections. The most likely substrate for the plastic changes, consistent with all our measurements, is an increase in the efficacy of corticoreticular connections. This new protocol may find utility, as it seems to target different motor circuits compared with other available paradigms.SIGNIFICANCE STATEMENT Induction of plasticity by neurostimulation protocols may be promising to enhance functional recovery after damage such as following stroke, but current protocols mainly target cortical circuits. In this study, we developed a novel paradigm which may generate long-term changes in connections between cortex and brainstem. This could provide an additional tool to modulate and improve recovery.
Collapse
Affiliation(s)
- Maria Germann
- Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Natalie J Maffitt
- Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Annie Poll
- Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Marco Raditya
- Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Jason S K Ting
- Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Stuart N Baker
- Medical School, Newcastle University, Newcastle upon Tyne, NE2 4HH, United Kingdom
| |
Collapse
|
3
|
De Laet C, Herman B, Riga A, Bihin B, Regnier M, Leeuwerck M, Raymackers JM, Vandermeeren Y. Bimanual motor skill learning after stroke: Combining robotics and anodal tDCS over the undamaged hemisphere: An exploratory study. Front Neurol 2022; 13:882225. [PMID: 36061986 PMCID: PMC9433746 DOI: 10.3389/fneur.2022.882225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSince a stroke can impair bimanual activities, enhancing bimanual cooperation through motor skill learning may improve neurorehabilitation. Therefore, robotics and neuromodulation with transcranial direct current stimulation (tDCS) are promising approaches. To date, tDCS has failed to enhance bimanual motor control after stroke possibly because it was not integrating the hypothesis that the undamaged hemisphere becomes the major poststroke hub for bimanual control.ObjectiveWe tested the following hypotheses: (I) In patients with chronic hemiparetic stroke training on a robotic device, anodal tDCS applied over the primary motor cortex of the undamaged hemisphere enhances bimanual motor skill learning compared to sham tDCS. (II) The severity of impairment correlates with the effect of tDCS on bimanual motor skill learning. (III) Bimanual motor skill learning is less efficient in patients than in healthy individuals (HI).MethodsA total of 17 patients with chronic hemiparetic stroke and 7 healthy individuals learned a complex bimanual cooperation skill on the REAplan® neurorehabilitation robot. The bimanual speed/accuracy trade-off (biSAT), bimanual coordination (biCo), and bimanual force (biFOP) scores were computed for each performance. In patients, real/sham tDCS was applied in a crossover, randomized, double-blind approach.ResultsCompared to sham, real tDCS did not enhance bimanual motor skill learning, retention, or generalization in patients, and no correlation with impairment was noted. The healthy individuals performed better than patients on bimanual motor skill learning, but generalization was similar in both groups.ConclusionA short motor skill learning session with a robotic device resulted in the retention and generalization of a complex skill involving bimanual cooperation. The tDCS strategy that would best enhance bimanual motor skill learning after stroke remains unknown.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT02308852, identifier: NCT02308852.
Collapse
Affiliation(s)
- Chloë De Laet
- Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Benoît Herman
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Materials and Civil Engineering (iMMC), Institute of Mechanics, UCLouvain, Louvain-la-Neuve, Belgium
| | - Audrey Riga
- Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Clinical Division (NEUR), Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
| | - Benoît Bihin
- Scientific Support Unit, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Maxime Regnier
- Scientific Support Unit, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Maria Leeuwerck
- Department of Physical Medicine and Rehabilitation, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
| | - Jean-Marc Raymackers
- Department of Neurology and Neurosurgery, Clinique Saint-Pierre, Ottignies-Louvain-la-Neuve, Belgium
| | - Yves Vandermeeren
- Stroke Unit/NeuroModulation Unit (NeMU), Department of Neurology, CHU UCL Namur (Mont-Godinne), UCLouvain, Yvoir, Belgium
- Louvain Bionics, UCLouvain, Louvain-la-Neuve, Belgium
- Clinical Division (NEUR), Institute of NeuroScience (IoNS), UCLouvain, Brussels, Belgium
- *Correspondence: Yves Vandermeeren
| |
Collapse
|
4
|
Grigoras IF, Stagg CJ. Recent advances in the role of excitation-inhibition balance in motor recovery post-stroke. Fac Rev 2021; 10:58. [PMID: 34308424 PMCID: PMC8265564 DOI: 10.12703/r/10-58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Stroke affects millions of people worldwide each year, and stroke survivors are often left with motor deficits. Current therapies to improve these functional deficits are limited, making it a priority to better understand the pathophysiology of stroke recovery and find novel adjuvant options. The excitation-inhibition balance undergoes significant changes post-stroke, and the inhibitory neurotransmitter γ-aminobutyric acid (GABA) appears to play an important role in stroke recovery. In this review, we summarise the most recent studies investigating GABAergic inhibition at different stages of stroke. We discuss the proposed role of GABA in counteracting glutamate-mediated excitotoxicity in hyperacute stroke as well as the evidence linking decreased GABAergic inhibition to increased neuronal plasticity in early stroke. Then, we discuss two types of interventions that aim to modulate the excitation-inhibition balance to improve functional outcomes in stroke survivors: non-invasive brain stimulation (NIBS) and pharmacological interventions. Finding the optimal NIBS administration or adjuvant pharmacological therapies would represent an important contribution to the currently scarce therapy options.
Collapse
Affiliation(s)
- Ioana-Florentina Grigoras
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford; Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Charlotte J Stagg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford; Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Germann M, Baker SN. Evidence for Subcortical Plasticity after Paired Stimulation from a Wearable Device. J Neurosci 2021; 41:1418-1428. [PMID: 33441436 PMCID: PMC7896019 DOI: 10.1523/jneurosci.1554-20.2020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022] Open
Abstract
Existing non-invasive stimulation protocols can generate plasticity in the motor cortex and its corticospinal projections; techniques for inducing plasticity in subcortical circuits and alternative descending pathways such as the reticulospinal tract (RST) are less well developed. One possible approach developed by this laboratory pairs electrical muscle stimulation with auditory clicks, using a wearable device to deliver stimuli during normal daily activities. In this study, we applied a variety of electrophysiological assessments to male and female healthy human volunteers during a morning and evening laboratory visit. In the intervening time (∼6 h), subjects wore the stimulation device, receiving three different protocols, in which clicks and stimulation of the biceps muscle were paired at either low or high rate, or delivered at random. Paired stimulation: (1) increased the extent of reaction time shortening by a loud sound (the StartReact effect); (2) decreased the suppression of responses to transcranial magnetic brain stimulation (TMS) following a loud sound; (3) enhanced muscle responses elicited by a TMS coil oriented to induce anterior-posterior (AP) current, but not posterior-anterior (PA) current, in the brain. These measurements have all been suggested to be sensitive to subcortical, possibly reticulospinal, activity. Changes were similar for either of the two paired stimulus rates tested, but absent after unpaired (control) stimulation. Taken together, these results suggest that pairing clicks and muscle stimulation for long periods does indeed induce plasticity in subcortical systems such as the RST.SIGNIFICANCE STATEMENT Subcortical systems such as the reticulospinal tract (RST) are important motor pathways, which can make a significant contribution to functional recovery after cortical damage such as stroke. Here, we measure changes produced after a novel non-invasive stimulation protocol, which uses a wearable device to stimulate for extended periods. We observed changes in electrophysiological measurements consistent with the induction of subcortical plasticity. This protocol may prove an important tool for enhancing motor rehabilitation, in situations where insufficient cortical tissue survives to be a plausible substrate for recovery of function.
Collapse
Affiliation(s)
- Maria Germann
- Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| | - Stuart N Baker
- Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, United Kingdom
| |
Collapse
|
6
|
Huot-Lavoie M, Ethier C, Ting W, Burns D. Assessment of Corticospinal Excitability in Awake Rodents Using EMG-Controlled Intracortical Stimulation. Bio Protoc 2021; 11:e4267. [DOI: 10.21769/bioprotoc.4267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/18/2021] [Accepted: 07/29/2021] [Indexed: 11/02/2022] Open
|
7
|
Habekost B, Germann M, Baker SN. Plastic changes in primate motor cortex following paired peripheral nerve stimulation. J Neurophysiol 2020; 125:458-475. [PMID: 33427573 PMCID: PMC8476207 DOI: 10.1152/jn.00288.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Repeated paired stimulation of two peripheral nerves can produce lasting changes in motor cortical excitability, but little is known of the underlying neuronal basis. Here, we trained two macaque monkeys to perform selective thumb and index finger abduction movements. Neural activity was recorded from the contralateral primary motor cortex during task performance, and following stimulation of the ulnar and median nerves, and the nerve supplying the extensor digitorum communis (EDC) muscle. Responses were compared before and after 1 h of synchronous or asynchronous paired ulnar/median nerve stimulation. Task performance was significantly enhanced after asynchronous and impaired after synchronous stimulation. The amplitude of short latency neural responses to median and ulnar nerve stimulation was increased after asynchronous stimulation; later components were reduced after synchronous stimulation. Synchronous stimulation increased neural activity during thumb movement and decreased it during index finger movement; asynchronous stimulation decreased activity during both movements. To assess how well neural activity could separate behavioral or sensory conditions, linear discriminant analysis was used to decode which nerve was stimulated, or which digit moved. Decoding accuracy for nerve stimulation was decreased after synchronous and increased after asynchronous paired stimulation. Decoding accuracy for task performance was decreased after synchronous but was unchanged after asynchronous paired stimulation. Paired stimulation produces changes in motor cortical circuits that outlast the stimulation. Some of these changes depend on precise stimulus timing. NEW & NOTEWORTHY Paired stimulation of peripheral nerves for 1 h induced lasting changes in neural responses within the motor cortex to nerve stimulation and to performance of a behavioral task. These changes were sufficient to alter the efficiency with which activity could encode stimulus type. Stimuli that can be easily applied noninvasively in human subjects can alter central motor circuits.
Collapse
Affiliation(s)
- Bonne Habekost
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Maria Germann
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stuart N Baker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
8
|
Yamaguchi T, Beck MM, Therkildsen ER, Svane C, Forman C, Lorentzen J, Conway BA, Lundbye‐Jensen J, Geertsen SS, Nielsen JB. Transcutaneous spinal direct current stimulation increases corticospinal transmission and enhances voluntary motor output in humans. Physiol Rep 2020; 8:e14531. [PMID: 32812363 PMCID: PMC7435034 DOI: 10.14814/phy2.14531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/09/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
Optimization of motor performance is of importance in daily life, in relation to recovery following injury as well as for elite sports performance. The present study investigated whether transcutaneous spinal direct current stimulation (tsDCS) may enhance voluntary ballistic activation of ankle muscles and descending activation of spinal motor neurons in able-bodied adults. Forty-one adults (21 men; 24.0 ± 3.2 years) participated in the study. The effect of tsDCS on ballistic motor performance and plantar flexor muscle activation was assessed in a double-blinded sham-controlled cross-over experiment. In separate experiments, the underlying changes in excitability of corticospinal and spinal pathways were probed by evaluating soleus (SOL) motor evoked potentials (MEPs) following single-pulse transcranial magnetic stimulation (TMS) over the primary motor cortex, SOL H-reflexes elicited by tibial nerve stimulation and TMS-conditioning of SOL H-reflexes. Measures were obtained before and after cathodal tsDCS over the thoracic spine (T11-T12) for 10 min at 2.5 mA. We found that cathodal tsDCS transiently facilitated peak acceleration in the ballistic motor task compared to sham tsDCS. Following tsDCS, SOL MEPs were increased without changes in H-reflex amplitudes. The short-latency facilitation of the H-reflex by subthreshold TMS, which is assumed to be mediated by the fast conducting monosynaptic corticomotoneuronal pathway, was also enhanced by tsDCS. We argue that tsDCS briefly facilitates voluntary motor output by increasing descending drive from corticospinal neurones to spinal plantar flexor motor neurons. tsDCS can thus transiently promote within-session CNS function and voluntary motor output and holds potential as a technique in the rehabilitation of motor function following central nervous lesions.
Collapse
Affiliation(s)
- Tomofumi Yamaguchi
- Department of NeuroscienceUniversity of CopenhagenCopenhagen NDenmark
- Department of Physical Therapy, Faculty of Health ScienceJuntendo UniversityTokyoJapan
- JSPS Postdoctoral Fellow for Research AbroadTokyoJapan
| | - Mikkel M. Beck
- Department of Nutrition, Exercise and Sports (NEXS)University of CopenhagenCopenhagen NDenmark
| | | | - Christian Svane
- Department of NeuroscienceUniversity of CopenhagenCopenhagen NDenmark
| | - Christian Forman
- Department of NeuroscienceUniversity of CopenhagenCopenhagen NDenmark
| | - Jakob Lorentzen
- Department of NeuroscienceUniversity of CopenhagenCopenhagen NDenmark
- Elsass FoundationCharlottenlundDenmark
| | - Bernard A. Conway
- Department of Biomedical EngineeringUniversity of StrathclydeGlasgowUK
| | - Jesper Lundbye‐Jensen
- Department of NeuroscienceUniversity of CopenhagenCopenhagen NDenmark
- Department of Nutrition, Exercise and Sports (NEXS)University of CopenhagenCopenhagen NDenmark
| | - Svend S. Geertsen
- Department of NeuroscienceUniversity of CopenhagenCopenhagen NDenmark
- Department of Nutrition, Exercise and Sports (NEXS)University of CopenhagenCopenhagen NDenmark
| | - Jens B. Nielsen
- Department of NeuroscienceUniversity of CopenhagenCopenhagen NDenmark
- Elsass FoundationCharlottenlundDenmark
| |
Collapse
|
9
|
Grefkes C, Fink GR. Recovery from stroke: current concepts and future perspectives. Neurol Res Pract 2020; 2:17. [PMID: 33324923 PMCID: PMC7650109 DOI: 10.1186/s42466-020-00060-6] [Citation(s) in RCA: 165] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/22/2020] [Indexed: 12/31/2022] Open
Abstract
Stroke is a leading cause of acquired, permanent disability worldwide. Although the treatment of acute stroke has been improved considerably, the majority of patients to date are left disabled with a considerable impact on functional independence and quality of life. As the absolute number of stroke survivors is likely to further increase due to the demographic changes in our aging societies, new strategies are needed in order to improve neurorehabilitation. The most critical driver of functional recovery post-stroke is neural reorganization. For developing novel, neurobiologically informed strategies to promote recovery of function, an improved understanding of the mechanisms enabling plasticity and recovery is mandatory. This review provides a comprehensive survey of recent developments in the field of stroke recovery using neuroimaging and non-invasive brain stimulation. We discuss current concepts of how the brain reorganizes its functional architecture to overcome stroke-induced deficits, and also present evidence for maladaptive effects interfering with recovery. We demonstrate that the combination of neuroimaging and neurostimulation techniques allows a better understanding of how brain plasticity can be modulated to promote the reorganization of neural networks. Finally, neurotechnology-based treatment strategies allowing patient-tailored interventions to achieve enhanced treatment responses are discussed. The review also highlights important limitations of current models, and finally closes with possible solutions and future directions.
Collapse
Affiliation(s)
- Christian Grefkes
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425 Jülich, Germany
- Medical Faculty, University of Cologne & Department of Neurology, University Hospital Cologne, 50924 Cologne, Germany
| | - Gereon R. Fink
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, 52425 Jülich, Germany
- Medical Faculty, University of Cologne & Department of Neurology, University Hospital Cologne, 50924 Cologne, Germany
| |
Collapse
|
10
|
Virtual Reality and Noninvasive Brain Stimulation in Stroke: How Effective Is Their Combination for Upper Limb Motor Improvement?-A Meta-Analysis. PM R 2019; 10:1261-1270. [PMID: 30503233 DOI: 10.1016/j.pmrj.2018.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 09/06/2018] [Accepted: 10/04/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND Efforts to augment post-stroke upper limb (UL) motor improvement include the use of newer interventions such as noninvasive brain stimulation (NIBS) and task practice in virtual reality environments (VEs). Despite increasing interest in using a combination of these 2 interventions, the effectiveness of this combination to enhance UL motor improvement outcomes has not been examined. OBJECTIVE To evaluate the effectiveness of a combination of NIBS and task practice in a VE to augment post-stroke UL motor improvement. METHODS We conducted a systematic search of the published literature using standard methodology. The Down and Black checklist and the Physiotherapy Evidence Database Research Organization Scale were used to assess study quality. We compared changes in UL impairment and activity levels between active stimulation and sham or other interventions using standardized mean differences and derived a summary effect size. RESULTS We retrieved 5 studies that examined the role of a combination of NIBS and task practice in a VE to optimize UL motor improvement. These 5 studies included 3 randomized controlled trials, 1 cross-sectional study, and 1 crossover study. There was level 1a evidence that the combination was beneficial in subacute stroke. There was level 1b evidence that provision of real stimulation was not superior to sham stimulation in chronic stroke. Effect sizes favoring the combination were moderate for improvements in UL impairment and small for activity levels. CONCLUSIONS Preliminary evidence supports the effectiveness of this combination in subacute stroke. Emergent questions need to be addressed to derive maximum benefit of this combination to augment post-stroke UL motor improvement. LEVEL OF EVIDENCE I.
Collapse
|
11
|
Mrachacz-Kersting N, Stevenson AJT, Jørgensen HRM, Severinsen KE, Aliakbaryhosseinabadi S, Jiang N, Farina D. Brain state-dependent stimulation boosts functional recovery following stroke. Ann Neurol 2018; 85:84-95. [DOI: 10.1002/ana.25375] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Natalie Mrachacz-Kersting
- Department of Health Science and Technology, Faculty of Medicine; Aalborg University; Aalborg Øst Denmark
| | - Andrew J. T. Stevenson
- Department of Health Science and Technology, Faculty of Medicine; Aalborg University; Aalborg Øst Denmark
| | | | | | | | - Ning Jiang
- Department of Systems Design Engineering; University of Waterloo; Waterloo Ontario Canada
| | - Dario Farina
- Department of Bioengineering, Centre for Neurotechnologies; Imperial College London; London United Kingdom
| |
Collapse
|