[Brain stimulation for treating stroke-related motor deficits]

The Effects of Shock Wave Therapy on Spasticity and Walking Ability in People with Stroke: A Comparative Study of Different Application Sites

BACKGROUND

This study was conducted to investigate the effects of extracorporeal shock wave therapy on the improvement of walking ability through a reduction in spasticity in stroke patients.

METHODS

Thirty-three patients diagnosed with ischemic stroke by a rehabilitation medicine specialist were randomly assigned to three groups. The patients were divided into experimental group 1 in which shock waves were applied to the muscle-tendon junction, experimental group 2 in which shock waves were applied to the middle of the muscle, and experimental group 3 in which shock waves were applied to both the muscle-tendon junction and the middle of the muscle. The MAS was used to evaluate spasticity in the subjects, and the Dartfish software was used to measure knee and ankle angles during heel-off when walking.

RESULTS

Based on the results of the study, a significant decrease in spasticity and increased joint angles were found in experimental groups 1 and 3 compared to experimental group 2, and the change in joint angle was significantly greater in experimental group 3 than in experimental groups 1 and 2.

CONCLUSIONS

These results indicate that treatment effect may vary depending on the application site of the shock wave, and to obtain the best treatment effect, the shock wave should be applied to both the muscle-tendon junction and the middle part of the muscle.

Recovery from stroke: current concepts and future perspectives

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.