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Sutter EN, Casey CP, Gillick BT. Single-pulse transcranial magnetic stimulation for assessment of motor development in infants with early brain injury. Expert Rev Med Devices 2024; 21:179-186. [PMID: 38166497 PMCID: PMC10947901 DOI: 10.1080/17434440.2023.2299310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/21/2023] [Indexed: 01/04/2024]
Abstract
INTRODUCTION Single-pulse transcranial magnetic stimulation (TMS) has many applications for pediatric clinical populations, including infants with perinatal brain injury. As a noninvasive neuromodulation tool, single-pulse TMS has been used safely in infants and children to assess corticospinal integrity and circuitry patterns. TMS may have important applications in early detection of atypical motor development or cerebral palsy. AREAS COVERED The authors identified and summarized relevant studies incorporating TMS in infants, including findings related to corticospinal development and circuitry, motor cortex localization and mapping, and safety. This special report also describes methodologies and safety considerations related to TMS assessment in infants, and discusses potential applications related to diagnosis of cerebral palsy and early intervention. EXPERT OPINION Single-pulse TMS has demonstrated safety and feasibility in infants with perinatal brain injury and may provide insight into neuromotor development and potential cerebral palsy diagnosis. Additional research in larger sample sizes will more fully evaluate the utility of TMS biomarkers in early diagnosis and intervention. Methodological challenges to performing TMS in infants and technical/equipment limitations require additional consideration and innovation toward clinical implementation. Future research may explore use of noninvasive neuromodulation techniques as an intervention in younger children with perinatal brain injury to improve motor outcomes.
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Affiliation(s)
- Ellen N. Sutter
- Waisman Center, University of Wisconsin-Madison
- Department of Rehabilitation Medicine, University of Minnesota-Twin Cities
| | | | - Bernadette T. Gillick
- Waisman Center, University of Wisconsin-Madison
- Department of Pediatrics, University of Wisconsin-Madison
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McGloon K, Humanitzki E, Brennan J, Summers P, Brennan A, George MS, Badran BW, Cribb AR, Jenkins D, Coker-Bolt P. Pairing taVNS and CIMT is feasible and may improve upper extremity function in infants. Front Pediatr 2024; 12:1365767. [PMID: 38415207 PMCID: PMC10896996 DOI: 10.3389/fped.2024.1365767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 02/29/2024] Open
Abstract
In this study we combined non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) with 40 h of constraint induced movement therapy (CIMT) in infants. All infants completed the full intervention with no adverse events. Therapists were able to maintain high treatment fidelity and reported high ratings for ease of use and child tolerance. Preliminary results show promising gains on motor outcomes: Mean QUEST increase 19.17 (minimal clinically important difference, MCID 4.89); Mean GMFM increase 13.33 (MCID 1%-3%). Infants also exceeded expectations on Goal Attainment Scores (+1). Early data is promising that taVNS paired with intensive motor CIMT is feasible, reliable, and safe in young infants with hemiplegia, and may help harness activity-dependent plasticity to enhance functional movement.
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Affiliation(s)
- Kelly McGloon
- Department of Rehabilitation Science, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Elizabeth Humanitzki
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Julia Brennan
- Department of Health Science and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Philip Summers
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Alyssa Brennan
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Mark S. George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Bashar W. Badran
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Anne R. Cribb
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Dorothea Jenkins
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Patricia Coker-Bolt
- Department of Rehabilitation Science, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
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Alashram AR. Effects of robotic therapy associated with noninvasive brain stimulation on motor function in individuals with incomplete spinal cord injury: A systematic review of randomized controlled trials. J Spinal Cord Med 2024:1-16. [PMID: 38265422 DOI: 10.1080/10790268.2024.2304921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
CONTEXT Motor deficits are among the most common consequences of incomplete spinal cord injury (SCI). These impairments can affect patients' levels of functioning and quality of life. Combined robotic therapy and non-invasive brain stimulation (NIBS) have been used to improve motor impairments in patients with corticospinal tract lesions. OBJECTIVES To examine the effects of combined robotic therapy and NIBS on motor function post incomplete SCI. METHODS PubMed, SCOPUS, MEDLINE, PEDro, Web of Science, REHABDATA, CINAHL, and EMBASE were searched from inception until July 2023. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate the selected studies quality. RESULTS Of 557 studies, five randomized trials (n = 122), with 25% of participants being females, were included in this review. The PEDro scores ranged from eight to nine, with a median score of nine. There were variations in treatment protocols and outcome measures, resulting in heterogeneous findings. The findings showed revealed evidence for the impacts of combined robotic therapy and NIBS on motor function in individuals with incomplete SCI. CONCLUSIONS Combined robotic training and NIBS may be safe for individuals with incomplete SCI. The existing evidence concerning its effects on motor outcomes in individuals with SCI is limited. Further experimental studies are needed to understand the effects of combined robotic training and NIBS on motor impairments in SCI populations.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Amman, Jordan
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
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Hu Y, Hu L, Wang Y, Luo X, Zhao X, He L. The effects of non-invasive brain stimulation on disorder of consciousness in patients with brain injury: A systematic review and meta-analysis of randomized controlled trial. Brain Res 2024; 1822:148633. [PMID: 37839670 DOI: 10.1016/j.brainres.2023.148633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 10/17/2023]
Abstract
INTRODUCTION Disorders of consciousness (DOC) result from neural system injury and manifest as changes in arousal or awareness. This systematic review and meta-analysis aimed to investigate the therapeutic effects of non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), on consciousness dysfunction in patients with brain disorders. METHODS Literature was systematically searched in Medline, Embase, Cochrane database, Web of Science, EBSCO from inception to May 2023. Only randomized controlled trial with NIBS as an intervention and participants with DOC were included. RESULTS A total of 7 studies with 313 participants were included for meta-analysis. Compared with sham- or placebo-stimulation, NIBS can improve the Coma Recovery Scale-Revised scores significantly (mean difference [MD] = 1.96, 95 % confidence interval [CI] = [1.49; 2.43], P <.0001). CONCLUSION NIBS has a significant positive effect in enhancing the symptoms of DOC. Nevertheless, it is imperative for further investigations comprising high-quality research designs and larger sample sizes in order to comprehensively elucidate the effects of NIBS techniques on diverse targets of stimulation within the population of individuals suffering from DOC.
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Affiliation(s)
- Yu Hu
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Linzhe Hu
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Yuchan Wang
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Xiaozhou Luo
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Xin Zhao
- Department of Rehabilitation Medicine, The Third People's Hospital of Chengdu, Affiliated Hospital of Southwest Jiaotong University, 82 Qinglong Street, Chengdu 610014, China.
| | - Lin He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, GuoXueXiang 37, Chengdu 610041, China.
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Chang CH, Chou PH, Chuang HY, Yao CY, Chen WJ, Tsai HC. Efficacy of Non-Invasive Brain Stimulation for Treating Depression in Patients with Traumatic Brain Injury: A Meta-Analysis and Meta-Regression of Randomized Controlled Trials. J Clin Med 2023; 12:6030. [PMID: 37762970 PMCID: PMC10531948 DOI: 10.3390/jcm12186030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE This meta-analysis aimed to ascertain the efficacy of non-invasive brain stimulation (NIBS)-comprising repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)-for depression in traumatic brain injury (TBI) patients. METHODS Comprehensive searches were conducted in PubMed, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials up to 28 January 2023. Random-effects models assessed the treatment effects, and heterogeneity was evaluated through I2 statistics and funnel plot inspection. RESULTS From 10 trials (234 participants; 8 rTMS, 2 tDCS), NIBS was found significantly more effective than sham in alleviating depressive symptoms (SMD: 0.588, 95% CI: 0.264-0.912; p < 0.001). rTMS, specifically, showed higher efficacy (SMD: 0.707, 95% CI: 0.306-1.108; p = 0.001) compared to sham, whereas tDCS outcomes were inconclusive (SMD: 0.271, 95% CI: -0.230 to 0.771; p = 0.289). Meta-regression found no correlation with the number of sessions, treatment intensity, or total dose. Notably, while post-treatment effects were significant, they diminished 1-2 months post intervention. Adverse events associated with NIBS were minimal, with no severe outcomes like seizures and suicide reported. CONCLUSIONS rTMS emerged as a potent short-term intervention for depression in TBI patients, while tDCS findings remained equivocal. The long-term efficacy of NIBS is yet to be established, warranting further studies. The low adverse event rate reaffirms NIBS's potential safety.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung 406040, Taiwan;
- Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung 404327, Taiwan
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan; (C.-Y.Y.); (W.-J.C.)
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu 302056, Taiwan
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Hao-Yu Chuang
- Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan 709204, Taiwan;
| | - Chi-Yu Yao
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan; (C.-Y.Y.); (W.-J.C.)
| | - Wei-Jen Chen
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan; (C.-Y.Y.); (W.-J.C.)
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970473, Taiwan
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Behboodi A, Lee WA, Hinchberger VS, Damiano DL. Determining optimal mobile neurofeedback methods for motor neurorehabilitation in children and adults with non-progressive neurological disorders: a scoping review. J Neuroeng Rehabil 2022; 19:104. [PMID: 36171602 PMCID: PMC9516814 DOI: 10.1186/s12984-022-01081-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Brain–computer interfaces (BCI), initially designed to bypass the peripheral motor system to externally control movement using brain signals, are additionally being utilized for motor rehabilitation in stroke and other neurological disorders. Also called neurofeedback training, multiple approaches have been developed to link motor-related cortical signals to assistive robotic or electrical stimulation devices during active motor training with variable, but mostly positive, functional outcomes reported. Our specific research question for this scoping review was: for persons with non-progressive neurological injuries who have the potential to improve voluntary motor control, which mobile BCI-based neurofeedback methods demonstrate or are associated with improved motor outcomes for Neurorehabilitation applications? Methods We searched PubMed, Web of Science, and Scopus databases with all steps from study selection to data extraction performed independently by at least 2 individuals. Search terms included: brain machine or computer interfaces, neurofeedback and motor; however, only studies requiring a motor attempt, versus motor imagery, were retained. Data extraction included participant characteristics, study design details and motor outcomes. Results From 5109 papers, 139 full texts were reviewed with 23 unique studies identified. All utilized EEG and, except for one, were on the stroke population. The most commonly reported functional outcomes were the Fugl-Meyer Assessment (FMA; n = 13) and the Action Research Arm Test (ARAT; n = 6) which were then utilized to assess effectiveness, evaluate design features, and correlate with training doses. Statistically and functionally significant pre-to post training changes were seen in FMA, but not ARAT. Results did not differ between robotic and electrical stimulation feedback paradigms. Notably, FMA outcomes were positively correlated with training dose. Conclusion This review on BCI-based neurofeedback training confirms previous findings of effectiveness in improving motor outcomes with some evidence of enhanced neuroplasticity in adults with stroke. Associative learning paradigms have emerged more recently which may be particularly feasible and effective methods for Neurorehabilitation. More clinical trials in pediatric and adult neurorehabilitation to refine methods and doses and to compare to other evidence-based training strategies are warranted.
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Affiliation(s)
- Ahad Behboodi
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | - Walker A Lee
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | | | - Diane L Damiano
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA.
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He W, Huang Y, He L, Liu L, Zeng P, Qiu H, Wang X, Zhou H, Chen Z, Xu Y, Zhao J, Wang W, Tang H, Xu K. Safety and effects of transcranial direct current stimulation on hand function in preschool children with hemiplegic cerebral palsy: A pilot study. Front Behav Neurosci 2022; 16:925122. [PMID: 36160682 PMCID: PMC9500382 DOI: 10.3389/fnbeh.2022.925122] [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: 04/21/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has shown a promising prospect in improving function and spasticity in school-aged children with cerebral palsy, but little is known in preschool children. The aim of this study was to explore the safety and effects of tDCS on hand function in preschool children (aged 3–6 years) with hemiplegic cerebral palsy (HCP). We designed a crossover, single-blind, sham-controlled study in 30 preschool children with HCP, who were recruited to receive one session of sham and one session of active anodal tDCS (1.5 mA, 20 min) on the primary motor cortex of the affected hemisphere, with a 24-h interval between the two sessions. Questionnaire was completed by each participant and their attendants immediately, 90 min, and 24 h after each session to monitor common adverse events of tDCS, such as skin irritation, skin erythema, burning sensation, headache, dizziness, etc. Box and Block Test, Selective Control of the Upper Extremity Scale, Modified Ashworth Scale, and Melbourne Assessment 2 were conducted at baseline, immediately, and 90 min after each session. No severe adverse event occurred during the study and only a few of them felt transient and slight discomfort. Results also showed that all participants performed better at Box and Block Test of the hemiplegic hand immediately after a single anodal tDCS (P < 0.05) and this improvement lasted at least 90 min and more than 24 h. However, there was no significant improvement in Selective Control of the Upper Extremity Scale of both hands, Box and Block Test of the non-hemiplegic hand, Modified Ashworth Scale, and Melbourne Assessment 2 of the hemiplegic upper limb (P > 0.05). Shortly, this study supported the safety and effects of a single anodal tDCS on improving the manual dexterity of the hemiplegic hand for preschool children with HCP. Further researches with larger samples about the optimal dose and treatment cycle of tDCS for preschool children with HCP are warranted. This study gained the approval of ethics committee of the organization and was registered at chictr.org (ChiCTR2000031141).
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Affiliation(s)
- Wenjie He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuan Huang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Lu He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liru Liu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Peishan Zeng
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Qiu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoyue Wang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongyu Zhou
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhaofang Chen
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yi Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jingyi Zhao
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenda Wang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongmei Tang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Hongmei Tang
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Kaishou Xu
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Jang SH, Cho MJ. Role of the Contra-Lesional Corticoreticular Tract in Motor Recovery of the Paretic Leg in Stroke: A Mini-Narrative Review. Front Hum Neurosci 2022; 16:896367. [PMID: 35721363 PMCID: PMC9204517 DOI: 10.3389/fnhum.2022.896367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
This review discusses the role of the contra-lesional corticoreticular tract (CRT) in motor recovery of the paretic leg in stroke patients by reviewing related diffusion tensor tractography studies. These studies suggest that the contra-lesional CRT can contribute to the motor recovery of the paretic leg in stroke patients, particularly in patients with complete injuries of the ipsilesional corticospinal tract and CRT. Furthermore, a review study reported that the motor recovery of the paretic ankle dorsiflexor, which is mandatory for achieving a good gait pattern without braces in hemiparetic stroke patients, was closely related to the contra-lesional CRT. These results could be clinically important in neuro-rehabilitation. For example, the contra-lesional CRT could be a target for neuromodulation therapies in patients with complete injuries of the ipsilesional corticospinal tract and CRT. On the other hand, only three studies were reviewed in this review and one was a case report. Although the CRT has been suggested to be one of the ipsilateral motor pathways from the contra-lesional cerebral cortex to the paretic limbs in stroke, the role of the CRT has not been elucidated clearly. Therefore, further prospective follow-up studies combining functional neuroimaging and transcranial magnetic stimulation for the paretic leg with diffusion tensor tractography will be useful for elucidating the role of the contra-lesional CRT in stroke patients.
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