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Lapenta OM, Rêgo GG, Boggio PS. Transcranial electrical stimulation for procedural learning and rehabilitation. Neurobiol Learn Mem 2024; 213:107958. [PMID: 38971460 DOI: 10.1016/j.nlm.2024.107958] [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: 01/16/2024] [Revised: 06/26/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
Procedural learning is the acquisition of motor and non-motor skills through a gradual process that increases with practice. Impairments in procedural learning have been consistently demonstrated in neurodevelopmental, neurodegenerative, and neuropsychiatric disorders. Considering that noninvasive brain stimulation modulates brain activity and boosts neuroplastic mechanisms, we reviewed the effects of coupling transcranial direct current stimulation (tDCS) with training methods for motor and non-motor procedural learning to explore tDCS potential use as a tool for enhancing implicit learning in healthy and clinical populations. The review covers tDCS effects over i. motor procedural learning, from basic to complex activities; ii. non-motor procedural learning; iii. procedural rehabilitation in several clinical populations. We conclude that targeting the primary motor cortex and prefrontal areas seems the most promising for motor and non-motor procedural learning, respectively. For procedural rehabilitation, the use of tDCS is yet at an early stage but some effectiveness has been reported for implicit motor and memory learning. Still, systematic comparisons of stimulation parameters and target areas are recommended for maximising the effectiveness of tDCS and its robustness for procedural rehabilitation.
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Affiliation(s)
- Olivia Morgan Lapenta
- Psychological Neuroscience Laboratory, Psychology Research Center, School of Psychology, University of Minho - Rua da Universidade, 4710-057 Braga, Portugal.
| | - Gabriel Gaudencio Rêgo
- Social and Cognitive Neuroscience Laboratory, Mackenzie Presbyterian University - Rua Piauí, 181, 01241-001 São Paulo, Brazil; National Institute of Science and Technology on Social and Affective Neuroscience (INCT-SANI), São Paulo, Brazil
| | - Paulo Sérgio Boggio
- Social and Cognitive Neuroscience Laboratory, Mackenzie Presbyterian University - Rua Piauí, 181, 01241-001 São Paulo, Brazil; National Institute of Science and Technology on Social and Affective Neuroscience (INCT-SANI), São Paulo, Brazil
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Tangjade A, Suputtitada A, Pacheco-Barrios K, Fregni F. Noninvasive Neuromodulation Combined With Rehabilitation Therapy Improves Balance and Gait Speed in Patients With Stroke: A Systematic Review and Network Meta-analysis. Am J Phys Med Rehabil 2024; 103:789-796. [PMID: 38363653 DOI: 10.1097/phm.0000000000002439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE This study aimed to determine repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and cranial nerve noninvasive neuromodulation affect functional balance, gait speed, and walking cadence in stroke patients. METHODS We searched PubMed, Embase, Cochrane, and Scopus (June 22, 2022) for randomized controlled trials. Three reviewers independently performed data extraction and assessed the risk of bias. Network and pairwise meta-analyses were performed to assess indirect and direct comparisons. RESULTS We included 34 studies ( N = 915 patients). Sixty percent had moderate-to-high methodological quality. The meta-analyses showed positive effects of repetitive transcranial magnetic stimulation combined with rehabilitation therapy compared with sham on gait speed, walking cadence, and balance function with weighted mean differences and 95% confidence interval of 0.08 (0.03 to 0.13), 7.16 (3.217 to 11.103), and 3.05 (0.52 to 5.57), respectively. Transcranial direct current stimulation showed improvement on the time up and go test (-0.88 [-1.68 to -0.08]). From the surface under the cumulative ranking analyses, repetitive transcranial magnetic stimulation is the best ranked treatment for gait speed and functional balance improvement compared with transcranial direct current stimulation and sham interventions. There were not enough studies to include cranial nerve noninvasive neuromodulation in the meta-analysis. CONCLUSIONS Walking cadence and speed, functional balance significantly improved after repetitive transcranial magnetic stimulation with short-term effects, which were superior to that of transcranial direct current stimulation and sham treatments. Transcranial direct current stimulation showed short-term beneficial effects on the Time Up and Go test.
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Affiliation(s)
- Anamon Tangjade
- From the Department of Rehabilitation Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand (AT); Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA (AT, KP-B, FF); Principles and Practice of Clinical Research (PPCR) Program, Harvard T.H. Chan School of Public Health, Harvard Medical School, Boston, Massachusetts, USA (AS, FF); Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand (AS); Excellent Center for Gait and Motion, King Chulalongkorn Memorial Hospital, Bangkok, Thailand (AS); Interdisplinary Program of Biomedical Engineering, Faculty of Engineering Chulalongkorn University, Bangkok, Thailand (AS); and Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru (KP-B)
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Zeng Y, Ye Z, Zheng W, Wang J. Efficacy of Cerebellar Transcranial Magnetic Stimulation for Post-stroke Balance and Limb Motor Function Impairments: Meta-analyses of Random Controlled Trials and Resting-State fMRI Studies. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1678-1696. [PMID: 38280142 DOI: 10.1007/s12311-024-01660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 01/29/2024]
Abstract
This study aimed to investigate the potential therapeutic effects of cerebellar transcranial magnetic stimulation (TMS) on balance and limb motor impairments in stroke patients. A meta-analysis of randomized controlled trials was conducted to assess the effects of cerebellar TMS on balance and motor impairments in stroke patients. Additionally, an activation likelihood estimation (ALE) meta-analysis was performed on resting-state functional magnetic resonance imaging (fMRI) studies to compare spontaneous neural activity differences between stroke patients and healthy controls using measures including the amplitude of low frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo). The analysis included 10 cerebellar TMS studies and 18 fMRI studies. Cerebellar TMS treatment demonstrated significant improvements in the Berg Balance Scale score (p < 0.0001) and the Fugl-Meyer Assessment lower extremity score (p < 0.0001) compared to the control group in stroke patients. Additionally, spontaneous neural activity alterations were identified in motor-related regions after stroke, including the precentral gyrus, putamen, thalamus, and paracentral lobule. Cerebellar TMS shows promise as a therapeutic intervention to enhance balance and lower limb motor function in stroke patients. It is easy for clinical application and addresses the limitations of insufficient direct stimulation depth on the leg area of the cortex. However, further research combining neuroimaging outcomes with clinical measurements is necessary to validate these findings.
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Affiliation(s)
- Yuheng Zeng
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China.
| | - Zujuan Ye
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
| | - Wanxin Zheng
- Department of Genome Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, 156-8506, Japan
| | - Jue Wang
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, 610041, China
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Fan S, Yan L, Zhang J, Qian Y, Wang M, Yang L, Yu T. Effects of repetitive transcranial magnetic stimulation on lower extremity motor function and optimal parameters in stroke patients with different stages of stroke: a systematic evaluation and meta-analysis. Front Neurol 2024; 15:1372159. [PMID: 39131051 PMCID: PMC11310066 DOI: 10.3389/fneur.2024.1372159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS), as an emerging non-invasive neuromodulation technique, is now widely employed in rehabilitation therapy. The purpose of this paper is to comprehensively summarize existing evidence regarding rTMS intervention for lower limb motor function in patients at different stages of stroke. Methods A systematic search was conducted to identify randomized controlled trials (RCTs) assessing the efficacy of rTMS for treating lower limb motor dysfunction after stroke. Multiple databases, including China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Database, PubMed, Embase, Web of Science, and Cochrane Library, were searched. The search period extended from the inception of the libraries to June 2024. Literature information was extracted, and methodological quality was evaluated using the risk of bias assessment tool in the Cochrane Handbook. Meta-analysis was performed using Stata 17.0 software. Results Overall, 49 appropriate studies (including 3,558 stroke subjects) were found. Meta-analysis results demonstrated that rTMS effectively improved lower limb motor function across all stages of stroke. The intervention was particularly more effective in patients in the subacute stage than in the acute or chronic stages. Subgroup analysis revealed that, for acute-stage patients, low-frequency stimulation targeting the M1 or DLPFC brain regions on the unaffected side with 20-40 sessions significantly improved FMA-LE scores. In subacute-phase patients, low-frequency stimulation targeting the M1 brain regions on the unaffected side with 18 sessions significantly improved FMA-LE scores. The results demonstrated that HF-rTMS was more effective than LF-rTMS in improving walking speed, with the greatest efficacy observed at 20 sessions. While for enhancing gait balance in stroke patients, LF-rTMS with the best therapeutic effect was observed at a frequency of 20-40 treatments. Conclusion This study demonstrates the efficacy of rTMS in improving lower limb motor function, balance, and walking speed in stroke patients at various stages. The findings provide a valuable reference for the development of optimized rTMS treatment plans in clinical practice.Systematic review registration: PROSPERO: CRD42023466094.
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Affiliation(s)
- Shiyu Fan
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Long Yan
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Junfeng Zhang
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yulin Qian
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
| | - Meng Wang
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
| | - Lingqing Yang
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Tao Yu
- Comprehensive Rehabilitation Unit, The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine/National Clinical Research Center of Acupuncture and Moxibustion, Tianjin, China
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Wang L, Wang L, Wang Z, Gao F, Wu J, Tang H. Clinical Effect Analysis of Wearable Sensor Technology-Based Gait Function Analysis in Post-Transcranial Magnetic Stimulation Stroke Patients. SENSORS (BASEL, SWITZERLAND) 2024; 24:3051. [PMID: 38793907 PMCID: PMC11125090 DOI: 10.3390/s24103051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/26/2024]
Abstract
(1) Background: This study evaluates the effectiveness of low-frequency repetitive transcranial magnetic stimulation (LF-rTMS) in improving gait in post-stroke hemiplegic patients, using wearable sensor technology for objective gait analysis. (2) Methods: A total of 72 stroke patients were randomized into control, sham stimulation, and LF-rTMS groups, with all receiving standard medical treatment. The LF-rTMS group underwent stimulation on the unaffected hemisphere for 6 weeks. Key metrics including the Fugl-Meyer Assessment Lower Extremity (FMA-LE), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and gait parameters were measured before and after treatment. (3) Results: The LF-rTMS group showed significant improvements in the FMA-LE, BBS, MBI, and various gait parameters compared to the control and sham groups (p < 0.05). Specifically, the FMA-LE scores improved by an average of 5 points (from 15 ± 3 to 20 ± 2), the BBS scores increased by 8 points (from 35 ± 5 to 43 ± 4), the MBI scores rose by 10 points (from 50 ± 8 to 60 ± 7), and notable enhancements in gait parameters were observed: the gait cycle time was reduced from 2.05 ± 0.51 s to 1.02 ± 0.11 s, the stride length increased from 0.56 ± 0.04 m to 0.97 ± 0.08 m, and the walking speed improved from 35.95 ± 7.14 cm/s to 75.03 ± 11.36 cm/s (all p < 0.001). No adverse events were reported. The control and sham groups exhibited improvements but were not as significant. (4) Conclusions: LF-rTMS on the unaffected hemisphere significantly enhances lower-limb function, balance, and daily living activities in subacute stroke patients, with the gait parameters showing a notable improvement. Wearable sensor technology proves effective in providing detailed, objective gait analysis, offering valuable insights for clinical applications in stroke rehabilitation.
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Affiliation(s)
- Litong Wang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, China;
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Likai Wang
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Zhan Wang
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Fei Gao
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Jingyi Wu
- Rehabilitation Medicine Department, The Second Hospital of Dalian Medical University, Dalian 116033, China (Z.W.); (F.G.); (J.W.)
| | - Hong Tang
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian 116024, China;
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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Arnal-Gómez A, Iosa M, Pérez-Alenda S, Cortés-Amador S. Validity of an android device for assessing mobility in people with chronic stroke and hemiparesis: a cross-sectional study. J Neuroeng Rehabil 2024; 21:54. [PMID: 38616288 PMCID: PMC11017601 DOI: 10.1186/s12984-024-01346-5] [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: 08/03/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Incorporating instrument measurements into clinical assessments can improve the accuracy of results when assessing mobility related to activities of daily living. This can assist clinicians in making evidence-based decisions. In this context, kinematic measures are considered essential for the assessment of sensorimotor recovery after stroke. The aim of this study was to assess the validity of using an Android device to evaluate kinematic data during the performance of a standardized mobility test in people with chronic stroke and hemiparesis. METHODS This is a cross-sectional study including 36 individuals with chronic stroke and hemiparesis and 33 age-matched healthy subjects. A simple smartphone attached to the lumbar spine with an elastic band was used to measure participants' kinematics during a standardized mobility test by using the inertial sensor embedded in it. This test includes postural control, walking, turning and sitting down, and standing up. Differences between stroke and non-stroke participants in the kinematic parameters obtained after data sensor processing were studied, as well as in the total execution and reaction times. Also, the relationship between the kinematic parameters and the community ambulation ability, degree of disability and functional mobility of individuals with stroke was studied. RESULTS Compared to controls, participants with chronic stroke showed a larger medial-lateral displacement (p = 0.022) in bipedal stance, a higher medial-lateral range (p < 0.001) and a lower cranio-caudal range (p = 0.024) when walking, and lower turn-to-sit power (p = 0.001), turn-to-sit jerk (p = 0.026) and sit-to-stand jerk (p = 0.001) when assessing turn-to-sit-to-stand. Medial-lateral range and total execution time significantly correlated with all the clinical tests (p < 0.005), and resulted significantly different between independent and limited community ambulation patients (p = 0.042 and p = 0.006, respectively) as well as stroke participants with significant disability or slight/moderate disability (p = 0.024 and p = 0.041, respectively). CONCLUSION This study reports a valid, single, quick and easy-to-use test for assessing kinematic parameters in chronic stroke survivors by using a standardized mobility test with a smartphone. This measurement could provide valid clinical information on reaction time and kinematic parameters of postural control and gait, which can help in planning better intervention approaches.
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Affiliation(s)
- M Luz Sánchez-Sánchez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Maria-Arantzazu Ruescas-Nicolau
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain.
| | - Anna Arnal-Gómez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Marco Iosa
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
- Smart Lab, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179, Rome, Italy
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
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Zhou L, Jin Y, Wu D, Cun Y, Zhang C, Peng Y, Chen N, Yang X, Zhang S, Ning R, Kuang P, Wang Z, Zhang P. Current evidence, clinical applications, and future directions of transcranial magnetic stimulation as a treatment for ischemic stroke. Front Neurosci 2023; 17:1177283. [PMID: 37534033 PMCID: PMC10390744 DOI: 10.3389/fnins.2023.1177283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/28/2023] [Indexed: 08/04/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) is a non-invasive brain neurostimulation technique that can be used as one of the adjunctive treatment techniques for neurological recovery after stroke. Animal studies have shown that TMS treatment of rats with middle cerebral artery occlusion (MCAO) model reduced cerebral infarct volume and improved neurological dysfunction in model rats. In addition, clinical case reports have also shown that TMS treatment has positive neuroprotective effects in stroke patients, improving a variety of post-stroke neurological deficits such as motor function, swallowing, cognitive function, speech function, central post-stroke pain, spasticity, and other post-stroke sequelae. However, even though numerous studies have shown a neuroprotective effect of TMS in stroke patients, its possible neuroprotective mechanism is not clear. Therefore, in this review, we describe the potential mechanisms of TMS to improve neurological function in terms of neurogenesis, angiogenesis, anti-inflammation, antioxidant, and anti-apoptosis, and provide insight into the current clinical application of TMS in multiple neurological dysfunctions in stroke. Finally, some of the current challenges faced by TMS are summarized and some suggestions for its future research directions are made.
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Affiliation(s)
- Li Zhou
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Yaju Jin
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Danli Wu
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Yongdan Cun
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Chengcai Zhang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Yicheng Peng
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Na Chen
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Xichen Yang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Simei Zhang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Rong Ning
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Peng Kuang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
| | - Zuhong Wang
- Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Pengyue Zhang
- Key Laboratory of Acupuncture and Massage for Treatment of Encephalopathy, College of Acupuncture, Tuina and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Kunming, China
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Rizvi A, Parveen S, Bazigha F, Noohu MM. Effect of transcranial direct current stimulation in combination with robotic therapy in upper limb impairments in people with stroke: a systematic review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00640-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Stroke is a devastating condition, which not only affects patients’ activity, but also is a primary reason for the psychosocial impact on them, their caregivers, and the healthcare system. Transcranial direct current stimulation (tDCS) modulates cortical activity, encouraging neuro-modulation and motor recovery in stroke rehabilitation. Robotic therapy (RT) provides repetitive, high-intensity, interactive, task-specific intervention and can measure changes while providing feedback to people with stroke.
Objectives
This study aimed to evaluate and summarize the scientific literature systematically to investigate the combined effect of tDCS and RT in patients with stroke.
Methods
Four databases (MEDLINE, Web of Science, ScienceDirect, & PEDro) were searched for clinical trials investigating the effect of RT and tDCS in stroke patients with upper limb impairment. PEDro scale was used for the quality assessment of included studies.
Results
The search yielded 208 articles. A total of 213 patients with stroke who had upper limb impairment were studied. In the majority of the trials, RT combined with tDCS lead to positive improvement in various measures of upper limb function and spasticity.
Conclusions
RT along with tDCS is an effective mode of rehabilitation, although no additional effects of tDCS plus RT in comparison with RT alone were reported. Large, robust studies are needed, so that health care providers and researchers can make better decisions about merging tDCS and RT in stroke rehabilitation settings in the future.
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Parikh V, Medley A, Chung YC, Goh HT. Optimal timing and neural loci: a scoping review on the effect of non-invasive brain stimulation on post-stroke gait and balance recovery. Top Stroke Rehabil 2023; 30:84-100. [PMID: 34859744 DOI: 10.1080/10749357.2021.1990467] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the optimal timing and neural loci for applying noninvasive brain stimulation (NIBS) to promote gait and balance recovery after stroke. OBJECTIVE To identify the optimal timing and neural loci of NIBS for gait and balance recovery after stroke. METHODS We performed a PubMed search using keywords of stroke, transcranial magnetic stimulation, transcranial direct current stimulation, NIBS, balance, and gait. Interventional trials with various designs published in English were selected. Both flowcharts and tables were used for the result presentation. RESULTS The majority of selected 31 studies included individuals with chronic stroke and primary motor cortex (M1) stimulation. Studies' quality ranged from 4 to 10 (max = 10) on the Pedro scale. NIBS led to improvements in gait and balance in individuals with chronic and subacute stroke, yet the evidence for the acute phase of stroke is limited. Further, stimulation over the ipsilesional M1 resulted in improvement in gait and balanced performance. Stimulation over non-motor regions such as the cerebellum has been limitedly explored. CONCLUSION Current evidence supports the use of NIBS to the M1 in conjunction with behavioral training to improve gait and balance performance in individuals with subacute and chronic stroke. Future research is recommended to evaluate the effect of NIBS during acute stroke and over neural loci other than M1, and to implement a more rigorous method.
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Affiliation(s)
- Vyoma Parikh
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
| | - Ann Medley
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
| | - Yu-Chen Chung
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Hui-Ting Goh
- School of Physical Therapy, Texas Woman's University, Dallas, Texas
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Xia Y, Tang X, Hu R, Liu J, Zhang Q, Tian S, Wang W, Li C, Zhu Y. Cerebellum-Cerebrum paired target magnetic stimulation on balance function and brain network of patients with stroke: A functional near-infrared spectroscopy pilot study. Front Neurol 2022; 13:1071328. [PMID: 36619935 PMCID: PMC9813387 DOI: 10.3389/fneur.2022.1071328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) modulation over the cerebellum, primary motor cortex, and supplementary motor cortex individually can improve the balance function of patients with stroke. However, whether their combination could have a better balance modulation effect is uncertain. Therefore, we hypothesized that performing TMS over a combination of these targets can regulate the balance function of patients with stroke. We compared the effects of one-session TMS on eye-open and eye-closed balance conditions in patients with stroke, using different target pairs of unilateral cerebellar (CB-single), cerebellar-primary motor cortex (CB-M1), and cerebellar-supplementary motor area (CB-SMA) targets. A total of 31 patients with stroke were enrolled and randomly divided into three groups to receive single sessions of intermittent theta burst stimulation each. Functional near-infrared spectrum data on resting and standing task states (eye-open and eye-closed) and center of pressure parameters (eye-open and eye-closed) were collected before and after the intervention. Compared with the results in the CB-single group, five intergroup differences in the changes in the center of pressure parameters in the CB-M1 group and two significant differences in the CB-SMA group were observed after one session of intermittent theta burst stimulation. In the CB-SMA group, 12 out of the 14 parameters improved significantly in the EC condition after the intervention. Meanwhile, the functional near-infrared spectrum results showed that the CB-SMA group exhibited a significant inhibitory pattern in the resting-state functional connectivity, which was not observed in the other two groups. In conclusion, we believe that paired targeting of the CB-SMA can reshape the brain network and improve the balance function of patients with stroke.
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Tomeh A, Yusof Khan AHK, Wan Sulaiman WA. Repetitive transcranial magnetic stimulation of the primary motor cortex in stroke survivors-more than motor rehabilitation: A mini-review. Front Aging Neurosci 2022; 14:897837. [PMID: 36225893 PMCID: PMC9549351 DOI: 10.3389/fnagi.2022.897837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
Stroke is a leading cause of morbidity and mortality among elderly populations worldwide. During the early phase of stroke, restoring blood circulation is of utmost importance to protect neurons from further injury. Once the initial condition is stabilized, various rehabilitation techniques can be applied to help stroke survivors gradually regain their affected functions. Among these techniques, transcranial magnetic stimulation (TMS) has emerged as a novel method to assess and modulate cortical excitability non-invasively and aid stroke survivors in the rehabilitation process. Different cortical regions have been targeted using TMS based on the underlying pathology and distorted function. Despite the lack of a standard operational procedure, repetitive TMS (rTMS) of the primary motor cortex (M1) is considered a promising intervention for post-stroke motor rehabilitation. However, apart from the motor response, mounting evidence suggests that M1 stimulation can be employed to treat other symptoms such as dysphagia, speech impairments, central post-stroke pain, depression, and cognitive dysfunction. In this mini-review, we summarize the therapeutic uses of rTMS stimulation over M1 in stroke survivors and discuss the potential mechanistic rationale behind it.
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Affiliation(s)
- Abdulhameed Tomeh
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Abdul Hanif Khan Yusof Khan
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Malaysia
- *Correspondence: Wan Aliaa Wan Sulaiman,
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12
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Wu ZY, Wang YQ, Wen XP, Wang MY, Wang LN, Lu LM, Li KB. Does noninvasive cerebellar stimulation improve the balance and walking function of patients with stroke: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2022; 101:e30302. [PMID: 36086722 PMCID: PMC10980459 DOI: 10.1097/md.0000000000030302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 06/17/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Investigating the efficacy and safety of noninvasive cerebellar stimulation in improving the balance and walking function of patients with stroke. METHODS We searched 7 databases for randomized controlled trials (RCTs) related to noninvasive cerebellar stimulation in the treatment of stroke. The Berg Balance Scale (BBS), 6-minute walk test (6MWT), and Barthel Index (BI) were used as the outcome indexes to evaluate balance, walking and activities of daily living (ADL). The quality of the research was evaluated using the Cochrane Risk of Bias Tool. A meta-analysis was performed to evaluate the difference between the noninvasive cerebellar stimulation and control groups. Heterogeneity tests were performed to assess differences in treatment effects across noninvasive cerebellar stimulation modalities. A sensitivity analysis was performed to evaluate the robustness of the results. RESULTS Seven studies were included, and 5 articles (71.43%) were rated as having a low risk of bias. Among the primary outcome indicators, 4 of the 7 articles were combined into the fixed effect model (I2 = 38%, P = .18). Compared with the control group, noninvasive cerebellar stimulation improved the BBS score, and the difference was statistically significant (mean difference [MD]: 3.00, 95% confidence interval [CI]: 1.10-5.40, P = .03); the sensitivity analysis showed that the statistical model was still stable after sequentially eliminating each article. Compared with the control group, noninvasive cerebellar stimulation improved the 6MWT results of patients with stroke (MD: 25.29, 95% CI: 4.86-45.73, P = .02). However, noninvasive cerebellar stimulation did not improve the BI (MD: 15.61, 95% CI: -7.91 to 39.13, P = .19). No safety problems or adverse reactions to noninvasive cerebellar stimulation were observed. CONCLUSIONS Noninvasive cerebellar stimulation improves balance and walking function of patients with stroke, but its effect on ADL is uncertain. Due to the methodological weaknesses in the included trials, more RCTs are needed to confirm our conclusions.
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Affiliation(s)
- Zhi-Yuan Wu
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yi-Qiao Wang
- Evidence-based Medicine and Data Science Centre, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Peng Wen
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Mei-Ying Wang
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Li-Na Wang
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Li-Ming Lu
- Evidence-based Medicine and Data Science Centre, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Kun-Bin Li
- Department of Neurological Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, China
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13
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Corominas-Teruel X, Mozo RMSS, Simó MF, Colomina Fosch MT, Valero-Cabré A. Transcranial direct current stimulation for gait recovery following stroke: A systematic review of current literature and beyond. Front Neurol 2022; 13:953939. [PMID: 36158971 PMCID: PMC9490093 DOI: 10.3389/fneur.2022.953939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 08/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Over the last decade, transcranial direct current stimulation (tDCS) has set promise contributing to post-stroke gait rehabilitation. Even so, results are still inconsistent due to low sample size, heterogeneity of samples, and tDCS design differences preventing comparability. Nonetheless, updated knowledge in post-stroke neurophysiology and stimulation technologies opens up opportunities to massively improve treatments. Objective The current systematic review aims to summarize the current state-of-the-art on the effects of tDCS applied to stroke subjects for gait rehabilitation, discuss tDCS strategies factoring individual subject profiles, and highlight new promising strategies. Methods MEDLINE, SCOPUS, CENTRAL, and CINAHL were searched for stroke randomized clinical trials using tDCS for the recovery of gait before 7 February 2022. In order to provide statistical support to the current review, we analyzed the achieved effect sizes and performed statistical comparisons. Results A total of 24 records were finally included in our review, totaling n = 651 subjects. Detailed analyses revealed n = 4 (17%) studies with large effect sizes (≥0.8), n = 6 (25%) studies with medium ones (≥0.5), and n = 6 (25%) studies yielding low effects sizes (≤ 0.2). Statistically significant negative correlations (rho = −0.65, p = 0.04) and differences (p = 0.03) argued in favor of tDCS interventions in the sub-acute phase. Finally, significant differences (p = 0.03) were argued in favor of a bifocal stimulation montage (anodal M1 ipsilesional and cathodal M1 contralesional) with respect to anodal ipsilesional M1. Conclusion Our systematic review highlights the potential of tDCS to contribute to gait recovery following stroke, although also the urgent need to improve current stimulation strategies and subject-customized interventions considering stroke severity, type or time-course, and the use of network-based multifocal stimulation approaches guided by computational biophysical modeling. Systematic review registration PROSPERO: CRD42021256347.
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Affiliation(s)
- Xavier Corominas-Teruel
- Department of Psychology, Neurobehavior and Health Research Group (NEUROLAB), Universitat Rovira i Virgili, Tarragona, Spain
- Cerebral Dynamics, Plasticity and Rehabilitation Group, Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, Paris, France
| | | | - Montserrat Fibla Simó
- Rehabilitation and Physical Medicine Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Maria Teresa Colomina Fosch
- Department of Psychology, Neurobehavior and Health Research Group (NEUROLAB), Universitat Rovira i Virgili, Tarragona, Spain
- *Correspondence: Antoni Valero-Cabré
| | - Antoni Valero-Cabré
- Cerebral Dynamics, Plasticity and Rehabilitation Group, Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, Paris, France
- Cognitive Neuroscience and Information Tech. Research Program, Open University of Catalonia (UOC), Barcelona, Spain
- Department of Anatomy and Neurobiology, Laboratory of Cerebral Dynamics, Boston University School of Medicine, Boston, MA, United States
- Maria Teresa Colomina Fosch
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14
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Veldema J, Gharabaghi A. Non-invasive brain stimulation for improving gait, balance, and lower limbs motor function in stroke. J Neuroeng Rehabil 2022; 19:84. [PMID: 35922846 PMCID: PMC9351139 DOI: 10.1186/s12984-022-01062-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives This systematic review and meta-analysis aim to summarize and analyze the available evidence of non-invasive brain stimulation/spinal cord stimulation on gait, balance and/or lower limb motor recovery in stroke patients. Methods The PubMed database was searched from its inception through to 31/03/2021 for randomized controlled trials investigating repetitive transcranial magnetic stimulation or transcranial/trans-spinal direct current/alternating current stimulation for improving gait, balance and/or lower limb motor function in stroke patients. Results Overall, 25 appropriate studies (including 657 stroke subjects) were found. The data indicates that non-invasive brain stimulation/spinal cord stimulation is effective in supporting recovery. However, the effects are inhomogeneous across studies: (1) transcranial/trans-spinal direct current/alternating current stimulation induce greater effects than repetitive transcranial magnetic stimulation, and (2) bilateral application of non-invasive brain stimulation is superior to unilateral stimulation. Conclusions The current evidence encourages further research and suggests that more individualized approaches are necessary for increasing effect sizes in stroke patients.
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Affiliation(s)
- Jitka Veldema
- Department of Sport Science, Bielefeld University, 33 501, Bielefeld, Germany. .,Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tübingen, Tübingen, Germany.
| | - Alireza Gharabaghi
- Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tübingen, Tübingen, Germany
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Minelli C, Luvizutto GJ, Cacho RDO, Neves LDO, Magalhães SCSA, Pedatella MTA, de Mendonça LIZ, Ortiz KZ, Lange MC, Ribeiro PW, de Souza LAPS, Milani C, da Cruz DMC, da Costa RDM, Conforto AB, Carvalho FMM, Ciarlini BS, Frota NAF, Almeida KJ, Schochat E, Oliveira TDP, Miranda C, Piemonte MEP, Lopes LCG, Lopes CG, Tosin MHDS, Oliveira BC, de Oliveira BGRB, de Castro SS, de Andrade JBC, Silva GS, Pontes-Neto OM, de Carvalho JJF, Martins SCO, Bazan R. Brazilian practice guidelines for stroke rehabilitation: Part II. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:741-758. [PMID: 36254447 PMCID: PMC9685826 DOI: 10.1055/s-0042-1757692] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 05/18/2022] [Indexed: 10/14/2022]
Abstract
The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.
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Affiliation(s)
- Cesar Minelli
- Hospital Carlos Fernando Malzoni, Matão SP, Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
- Instituto Você sem AVC, Matão SP, Brazil
| | - Gustavo José Luvizutto
- Universidade Federal do Triângulo Mineiro, Departamento de Fisioterapia Aplicada, Uberaba MG, Brazil
| | - Roberta de Oliveira Cacho
- Universidade Federal do Rio Grande do Norte, Faculdade de Ciências da Saúde do Trairi, Santa Cruz RN, Brazil
| | | | | | - Marco Túlio Araújo Pedatella
- Hospital Israelita Albert Einstein, Unidade Goiânia, Goiânia GO, Brazil
- Hospital Santa Helena, Goiânia GO, Brazil
- Hospital Encore, Goiânia GO, Brazil
- Hospital Estadual Geral de Goiânia Dr. Alberto Rassi, Goiânia GO, Brazil
- Hospital de Urgência de Goiânia, Goiânia, GO, Brazil
| | - Lucia Iracema Zanotto de Mendonça
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Neurologia, São Paulo SP, Brazil
- Pontíficia Universidade Católica de São Paulo, Faculdade de Ciências Humanas e da Saúde, São Paulo SP, Brazil
| | - Karin Zazo Ortiz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Fala, Linguagem e Ciências Auditivas, São Paulo SP, Brazil
| | | | | | | | - Cristiano Milani
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Serviço de Neurologia Vascular e Emergências Neurológicas, Ribeirão Preto SP, Brazil
| | | | | | - Adriana Bastos Conforto
- Universidade de São Paulo, Hospital das Clínicas, Divisão de Neurologia Clínica, São Paulo SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo SP, Brazil
| | | | - Bruna Silva Ciarlini
- Universidade de Fortaleza, Programa de Pos-Graduação em Ciências Médicas, Fortaleza CE, Brazil
| | | | | | - Eliane Schochat
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Tatiana de Paula Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Camila Miranda
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Maria Elisa Pimentel Piemonte
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Laura Cardia Gomes Lopes
- Universidade Estadual de São Paulo, Faculdade de Medicina de Botucatu, Hospital das Clínicas, Departamento de Neurologia, Psicologia e Psiquiatria, São Paulo SP, Brazil
| | | | | | | | | | | | | | | | - Octávio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil
| | | | - Sheila C. Ouriques Martins
- Rede Brasil AVC, Porto Alegre RS, Brazil
- Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil
- Hospital de Clínicas de Porto Alegre, Departamento de Neurologia, Porto Alegre RS, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Botucatu SP, Brazil
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Noninvasive Human-Computer Interface Methods and Applications for Robotic Control: Past, Current, and Future. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:1635672. [PMID: 35720904 PMCID: PMC9200502 DOI: 10.1155/2022/1635672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/24/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022]
Abstract
The purpose of this study is to explore the noninvasive human-computer interaction methods that have been widely used in various fields, especially in the field of robot control. To have a deep understanding of the development of the methods, this paper employs “Mapping Knowledge Domains” (MKDs) to find research hotspots in the area to show the future potential development. Through the literature review, this paper found that there was a paradigm shift in the research of noninvasive BCI technologies for robotic control, which has occurred from early 2010 since the rapid development of machine learning, deep learning, and sensory technologies. This study further provides a trend analysis that the combination of data-driven methods with optimized algorithms and human-sensory-driven methods will be the key areas for the future noninvasive method development in robotic control. Based on the above findings, the paper provides a potential developing way of noninvasive HCI methods for related areas including health care, robotic system, and media.
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Sabel BA, Zhou W, Huber F, Schmidt F, Sabel K, Gonschorek A, Bilc M. Non-invasive brain microcurrent stimulation therapy of long-COVID-19 reduces vascular dysregulation and improves visual and cognitive impairment. Restor Neurol Neurosci 2021; 39:393-408. [PMID: 34924406 PMCID: PMC8764598 DOI: 10.3233/rnn-211249] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND An effective treatment is needed for long-COVID patients which suffer from symptoms of vision and/or cognition impairment such as impaired attention, memory, language comprehension, or fatigue. OBJECTIVE Because COVID-19infection causes reduced blood flow which may cause neuronal inactivation, we explored if neuromodulation with non-invasive brain stimulation using microcurrent (NIBS), known to enhance blood flow and neuronal synchronization, can reduce these symptoms. METHODS Two female long-COVID patients were treated for 10-13 days with alternating current stimulation of the eyes and brain. While one patient (age 40) was infected with the SARS CoV-2 virus, the other (age 72) developed symptoms following AstraZeneca vaccination. Before and after therapy, cognition was assessed subjectively by interview and visual fields quantified using perimetry. One patient was also tested with a cognitive test battery and with a retinal dynamic vascular analyser (DVA), a surrogate marker of vascular dysregulation in the brain. RESULTS In both patients NIBS markedly improved cognition and partially reversed visual field loss within 3-4 days. Cognitive tests in one patient confirmed recovery of up to 40-60% in cognitive subfunctions with perimetry results showing stable and visual field recovery even during follow-up. DVA showed that NIBS reduced vascular dysregulation by normalizing vessel dynamics (dilation/constriction), with particularly noticeable changes in the peripheral veins and arteries. CONCLUSIONS NIBS was effective in improving visual and cognitive deficits in two confirmed SARS-COV-2 patients. Because recovery of function was associated with restoration of vascular autoregulation, we propose that (i) hypometabolic, "silent" neurons are the likely biological cause of long-COVID associated visual and cognitive deficits, and (ii) reoxygenation of these "silent" neurons provides the basis for neural reactivation and neurological recovery. Controlled trials are now needed to confirm these observations.
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Affiliation(s)
- Bernhard A Sabel
- Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Wanshu Zhou
- Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Frank Huber
- Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | - Florentina Schmidt
- Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
| | | | | | - Mirela Bilc
- Institute of Medical Psychology, Medical Faculty, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany
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Behrangrad S, Zoghi M, Kidgell D, Jaberzadeh S. The Effect of a Single Session of Non-Invasive Brain Stimulation on Balance in Healthy Individuals: A Systematic Review and Best Evidence Synthesis. Brain Connect 2021; 11:695-716. [PMID: 33798002 DOI: 10.1089/brain.2020.0872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Aim: To evaluate the effects of a single session of non-invasive brain stimulation (NIBS) on postural balance. Introduction: The NIBS has been used widely in improving balance. However, the effect of a single session of NIBS on balance in healthy individuals has not been systemically reviewed. Methods: A systematic literature review and best evidence synthesis were conducted, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, to determine the effects of different NIBS techniques on balance function in healthy individuals. The methodological quality of included articles was assessed by the risk of bias, and the Downs and Black tool. Data were analyzed by using the best evidence synthesis. Thirty-five articles were included that used the following NIBS techniques: anodal transcranial direct current stimulation (a-tDCS), cathodal transcranial direct current stimulation (c-tDCS), continuous theta burst stimulation (cTBS), and repetitive transcranial magnetic stimulation (rTMS) on primary motor cortex (M1), supplementary motor area (SMA), dorsolateral prefrontal cortex (DLPFC), and cerebellum on balance. Results: Strong evidence showed that a-tDCS of M1, SMA improve balance in healthy participants, and the a-tDCS of DLPFC induces improvement only in dual task balance indices. Also, the findings indicate that cerebellar a-tDCS might significantly improve balance, if at least 10 min cerebellar a-tDCS with an intensity of ≥1 mA, over or maximum 1.5 cm below the inion, is used. Strong evidence showed that c-tDCS, cTBS, and rTMS are not effective on the balance. Conclusion: According to the results, the a-tDCS may be a useful technique to improve balance in healthy adults.
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Affiliation(s)
- Shabnam Behrangrad
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Australia
| | - Dawson Kidgell
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Transcranial direct current stimulation for improving ambulation after stroke: a systematic review and meta-analysis. Int J Rehabil Res 2021; 43:299-309. [PMID: 32675686 PMCID: PMC7643800 DOI: 10.1097/mrr.0000000000000427] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Achieving a sufficient level of functional ambulation remains to be a challenge to most stroke survivors. Different modes of transcranial direct current stimulation (tDCS) have been applied for improving various aspects of walking and mobility following stroke. However, systematic reviews before 2017 provided only general effects of tDCS on limited walking outcomes. Therefore, the aims of this study were to update the evidence of tDCS for improving walking and mobility after stroke with emphasis on individual outcomes and to delineate the effects of different modes of tDCS in subgroup analysis. The systematic search of PubMed, Medline, PEDro, Scopus, and Cochrane databases for studies published up to January 2019 identified 14 eligible reports. The PEDro scale indicated a good methodological quality of the included studies (score 6.8). The meta-analysis of primary outcomes revealed that active tDCS had no better effect than sham on walking speed [n = 7, standardized mean difference (SMD) = 0.189, P = 0.252] and 6-minute walking distance (n = 3, SMD = 0.209, P = 0.453). Among the secondary outcomes, significant positive effects were found on functional ambulation category (FAC) (n = 5, SMD = 0.542, P = 0.008), Rivermead Mobility Index (n = 3, SMD = 0.699, P = 0.008), and timed up and go test (TUG) (n = 5, SMD = 0.676, P = 0.001), whereas non-significant positive effects were found on Tinetti test (n = 3, SMD = 0.441, P = 0.062) and Berg Balance Scale (n = 2, SMD = 0.408, P = 0.177). In subgroup analyses, anodal tDCS had significant positive effects on FAC (n = 4, SMD = 0.611, P = 0.005) and dual-hemispheric tDCS on TUG (n = 2, SMD = 1.090, P = 0.000). The results provide up-to-date evidence of variable effects of tDCS on walking and functional mobility after stroke.
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Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, Brunelin J, Nakamura-Palacios EM, Marangolo P, Venkatasubramanian G, San-Juan D, Caumo W, Bikson M, Brunoni AR. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol 2021; 24:256-313. [PMID: 32710772 PMCID: PMC8059493 DOI: 10.1093/ijnp/pyaa051] [Citation(s) in RCA: 251] [Impact Index Per Article: 83.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. OBJECTIVE We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson's disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. METHODS Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. RESULTS Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson's disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). CONCLUSION All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
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Affiliation(s)
- Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Mirret M El-Hagrassy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Sandra Carvalho
- Neurotherapeutics and experimental Psychopathology Group (NEP), Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal
| | - Marcel Simis
- Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sao Paulo, Brazil
| | - Jerome Brunelin
- CH Le Vinatier, PSYR2 team, Lyon Neuroscience Research Center, UCB Lyon 1, Bron, France
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Federal University of Espírito Santo, Espírito Santo, Brasil (Dr Nakamura-Palacios)
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) Surgery Department, School of Medicine, UFRGS; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA) Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, New York
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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21
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Navarro-López V, Molina-Rueda F, Jiménez-Jiménez S, Alguacil-Diego IM, Carratalá-Tejada M. Effects of Transcranial Direct Current Stimulation Combined with Physiotherapy on Gait Pattern, Balance, and Functionality in Stroke Patients. A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11040656. [PMID: 33916442 PMCID: PMC8066876 DOI: 10.3390/diagnostics11040656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 01/24/2023] Open
Abstract
Background: The effectiveness of transcranial direct current stimulation (tDCS) together with conventional physiotherapy in motor rehabilitation after stroke has been widely studied. Despite this, few studies have focused on its application in gait and balance rehabilitation. This review aimed to determine the efficacy of transcranial direct current stimulation combined with conventional physiotherapy on gait, balance, and the functionality of the lower limb after stroke. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases were systematically searched for relevant articles. Randomized clinical trials in English or Spanish that evaluated the use of the transcranial direct current stimulation, combined with physiotherapy, to improve gait, balance, and lower limb functionality after stroke were included. Main results: 10 articles were included, with a total of 222 subjects. Data about population, assessment tools, protocols, sessions, and results were extracted. The methodological quality of the included studies ranged between 3 and 5. Conclusion: The use of transcranial direct current stimulation combined with physiotherapy improves gait parameters, static and dynamic balance, and lower limb functionality in stroke patients. Long-term effects have not yet been demonstrated.
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Affiliation(s)
- Víctor Navarro-López
- International Doctoral School, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Francisco Molina-Rueda
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (M.C.-T.)
| | | | - Isabel M Alguacil-Diego
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (M.C.-T.)
- Correspondence:
| | - María Carratalá-Tejada
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (M.C.-T.)
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22
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Solanki D, Rezaee Z, Dutta A, Lahiri U. Investigating the feasibility of cerebellar transcranial direct current stimulation to facilitate post-stroke overground gait performance in chronic stroke: a partial least-squares regression approach. J Neuroeng Rehabil 2021; 18:18. [PMID: 33509192 PMCID: PMC7842063 DOI: 10.1186/s12984-021-00817-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
Background Investigation of lobule-specific electric field effects of cerebellar transcranial direct current stimulation (ctDCS) on overground gait performance has not been performed, so this study aimed to investigate the feasibility of two lobule-specific bilateral ctDCS montages to facilitate overground walking in chronic stroke. Methods Ten chronic post-stroke male subjects participated in this repeated-measure single-blind crossover study, where we evaluated the single-session effects of two bilateral ctDCS montages that applied 2 mA via 3.14 cm2 disc electrodes for 15 min targeting (a) dentate nuclei (also, anterior and posterior lobes), and (b) lower-limb representations (lobules VIIb-IX). A two-sided Wilcoxon rank-sum test was performed at a 5% significance level on the percent normalized change measures in the overground gait performance. Partial least squares regression (PLSR) analysis was performed on the quantitative gait parameters as response variables to the mean lobular electric field strength as the predictors. Clinical assessments were performed with the Ten-Meter walk test (TMWT), Timed Up & Go (TUG), and the Berg Balance Scale based on minimal clinically important differences (MCID). Results The ctDCS montage specific effect was found significant using a two-sided Wilcoxon rank-sum test at a 5% significance level for 'Step Time Affected Leg' (p = 0.0257) and '%Stance Time Unaffected Leg' (p = 0.0376). The changes in the quantitative gait parameters were found to be correlated to the mean electric field strength in the lobules based on PLSR analysis (R2 statistic = 0.6574). Here, the mean electric field strength at the cerebellar lobules, Vermis VIIIb, Ipsi-lesional IX, Vermis IX, Ipsi-lesional X, had the most loading and were positively related to the 'Step Time Affected Leg' and '%Stance Time Unaffected Leg,' and negatively related to the '%Swing Time Unaffected Leg,' '%Single Support Time Affected Leg.' Clinical assessments found similar improvement in the TMWT (MCID: 0.10 m/s), TUG (MCID: 8 s), and BBS score (MCID: 12.5 points) for both the ctDCS montages. Conclusion Our feasibility study found an association between the lobular mean electric field strength and the changes in the quantitative gait parameters following a single ctDCS session in chronic stroke. Both the ctDCS montages improved the clinical outcome measures that should be investigated with a larger sample size for clinical validation. Trial registration: Being retrospectively registered.
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Affiliation(s)
- Dhaval Solanki
- Electrical Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India.
| | - Zeynab Rezaee
- Biomedical Engineering, University at Buffalo SUNY, New York, USA
| | - Anirban Dutta
- Biomedical Engineering, University at Buffalo SUNY, New York, USA.
| | - Uttama Lahiri
- Electrical Engineering, Indian Institute of Technology Gandhinagar, Gujarat, India
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23
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Breaking the ice to improve motor outcomes in patients with chronic stroke: a retrospective clinical study on neuromodulation plus robotics. Neurol Sci 2020; 42:2785-2793. [PMID: 33159273 DOI: 10.1007/s10072-020-04875-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stroke is one of the main causes of impairment affecting daily activities and quality of life. There is a growing effort to potentiate the recovery of functional gait and to enable stroke patients to walk independently. AIM To estimate the effects of dual-site transcranial direct current stimulation (dstDCS) on gait recovery in chronic stroke patients provided with robot-aided gait training (RAGT). METHODS Thirty-seven patients were included in this retrospective clinical study. Nine patients were provided with dstDCS during the first 10 min of RAGT by using Lokomat®Pro (on-RAGT), 15 patients immediately after RAGT (post-RAGT), and 13 patients immediately before RAGT (pre-RAGT). RESULTS Each group improved over time concerning disability burden and lower limb strength. on-RAGT and post-RAGT experienced better improvement in balance (p < 0.001) and, moderately, gait endurance (p = 0.04) as compared to pre-RAGT. Furthermore, all treatments decreased the facilitation of the unaffected hemisphere (p < 0.001) and the inhibition of the affected hemisphere (p < 0.001). The duration of such aftereffects was found to be greater for post-RAGT. DISCUSSION AND CONCLUSION This is the first trial with dstDCS coupled with RAGT in chronic stroke patients with gait impairment. When timely coupled with RAGT, dstDCS may be considered an effective tool for the recovery of lower limb function in patients with first unilateral stroke in the chronic phase. Moreover, our data suggest the ductility of dstDCS concerning RAGT timing, thus making this intervention suitable in a neurorehabilitation setting and well adaptable to patients' needs.
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24
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Katagiri N, Kawakami S, Okuyama S, Koseki T, Kudo D, Namba S, Tanabe S, Yamaguchi T. Single-Session Cerebellar Transcranial Direct Current Stimulation Affects Postural Control Learning and Cerebellar Brain Inhibition in Healthy Individuals. THE CEREBELLUM 2020; 20:203-211. [PMID: 33108574 DOI: 10.1007/s12311-020-01208-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
Cerebellar transcranial direct current stimulation (ctDCS) modulates cerebellar activity and postural control. However, the effects of ctDCS on postural control learning and the mechanisms associated with these effects remain unclear. To examine the effects of single-session ctDCS on postural control learning and cerebellar brain inhibition (CBI) of the primary motor cortex in healthy individuals. In this triple-blind, sham-controlled study, 36 participants were allocated randomly to one of three groups: (1) anodal ctDCS group, (2) cathodal ctDCS group, and (3) sham ctDCS group. ctDCS (2 mA) was applied to the cerebellar brain for 20 min prior to six blocks of standing postural control training (each block consisted of five trials of a 30-s tracking task). CBI and corticospinal excitability of the tibialis anterior muscle were assessed at baseline, immediately after, 1 day after, and 7 days after training. Skill acquisition following training was significantly reduced in both the anodal and cathodal ctDCS groups compared with the sham ctDCS group. Changes in performance measured 1 day after and 7 days after training did not differ among the groups. In the anodal ctDCS group, CBI significantly increased after training, whereas corticospinal excitability decreased. Anodal ctDCS-induced CBI changes were correlated with the learning formation of postural control (r = 0.55, P = 0.04). Single-session anodal and cathodal ctDCS could suppress the skill acquisition of postural control in healthy individuals. The CBI changes induced by anodal ctDCS may affect the learning process of postural control.
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Affiliation(s)
- Natsuki Katagiri
- Department of Physical Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata-shi, Yamagata, 990-2212, Japan
| | - Saki Kawakami
- Department of Physical Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata-shi, Yamagata, 990-2212, Japan
| | - Sayuri Okuyama
- Department of Physical Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata-shi, Yamagata, 990-2212, Japan
| | - Tadaki Koseki
- Department of Physical Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata-shi, Yamagata, 990-2212, Japan
| | - Daisuke Kudo
- Department of Physical Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata-shi, Yamagata, 990-2212, Japan
| | - Shigehiro Namba
- Department of Physical Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata-shi, Yamagata, 990-2212, Japan
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake-shi, Aichi, 470-1192, Japan
| | - Tomofumi Yamaguchi
- Department of Physical Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata-shi, Yamagata, 990-2212, Japan. .,Department of Physical Therapy, Faculty of Health Science, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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25
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Xu AH, Sun YX. Research hotspots and effectiveness of repetitive transcranial magnetic stimulation in stroke rehabilitation. Neural Regen Res 2020; 15:2089-2097. [PMID: 32394967 PMCID: PMC7716019 DOI: 10.4103/1673-5374.282269] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Repetitive transcranial magnetic stimulation, as a relatively new type of rehabilitation treatment, is a painless and non-invasive method for altering brain excitability. Repetitive transcranial magnetic stimulation has been widely used in the neurorehabilitation of stroke patients. Here, we used CiteSpace software to visually analyze 315 studies concerning repetitive transcranial magnetic stimulation for stroke rehabilitation from 1999 to 2019, indexed by Web of Science, to clarify the research hotspots in different periods and characterize the gradual process of discovery in this field. We found that four main points were generally accepted: (1) repetitive transcranial magnetic stimulation has a positive effect on motor function recovery in patients with subcortical stroke; (2) it may be more advantageous for stroke patients to receive low-frequency repetitive transcranial magnetic stimulation in the unaffected hemispheres than to receive high-frequency repetitive transcranial magnetic stimulation in affected hemisphere; (3) low-frequency repetitive transcranial magnetic stimulation has become a potential therapeutic tool for patients with non-fluent aphasia after chronic stroke for neurological rehabilitation and language recovery; and (4) there are some limitations to these classic clinical studies, such as small sample size and low test efficiency. Our assessment indicates that prospective, multi-center, large-sample, randomized controlled clinical trials are still needed to further verify the effectiveness of various repetitive transcranial magnetic stimulation programs for the rehabilitation of stroke patients.
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Affiliation(s)
- Ai-Hua Xu
- Department of Rehabilitation Medicine, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Yong-Xin Sun
- Department of Rehabilitation Medicine, the First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
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