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Metelski N, Gu Y, Quinn L, Friel KM, Gordon AM. Safety and efficacy of non-invasive brain stimulation for the upper extremities in children with cerebral palsy: A systematic review. Dev Med Child Neurol 2024; 66:573-597. [PMID: 37528530 DOI: 10.1111/dmcn.15720] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023]
Abstract
AIM To evaluate available evidence examining safety and efficacy of non-invasive brain stimulation (NIBS) on upper extremity outcomes in children with cerebral palsy (CP). METHOD We electronically searched 12 sources up to May 2023 using JBI and Cochrane guidelines. Two reviewers selected articles with predetermined eligibility criteria, conducted data extraction, and assessed risk of bias using the Cochrane Risk of Bias criteria. RESULTS Nineteen studies were included: eight using repetitive transcranial magnetic stimulation (rTMS) and 11 using transcranial direct current stimulation (tDCS). Moderate certainty evidence supports the safety of rTMS and tDCS for children with CP. Very low to moderate certainty evidence suggests that rTMS and tDCS result in little to no difference in upper extremity outcomes. INTERPRETATION Evidence indicates that NIBS is a safe and feasible intervention to target upper extremity outcomes in children with CP, although it also indicates little to no significant impact on upper extremity outcomes. These findings are discussed in relation to the heterogeneous participants' characteristics and stimulation parameters. Larger studies of high methodological quality are required to inform future research and protocols for NIBS.
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Affiliation(s)
- Nicole Metelski
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Yu Gu
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Kathleen M Friel
- Burke Neurological Institute, White Plains, New York, and Weill Cornell Medicine, New York, New York, USA
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
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2
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Ahmed I, Mustafaoglu R, Benkhalifa N, Yakhoub YH. Does noninvasive brain stimulation combined with other therapies improve upper extremity motor impairment, functional performance, and participation in activities of daily living after stroke? A systematic review and meta-analysis of randomized controlled trial. Top Stroke Rehabil 2023; 30:213-234. [PMID: 35112659 DOI: 10.1080/10749357.2022.2026278] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several studies have investigated the effect of noninvasive brain stimulation (NIBS) on upper limb motor function in stroke, but the evidence so far is conflicting. OBJECTIVE We aimed to determine the effect of NIBS on upper limb motor impairment, functional performance, and participation in activities of daily living after stroke. METHOD Literature search was conducted for randomized controlled trials (RCTs) assessing the effect of "tDCS" or "rTMS" combined with other therapies on upper extremity motor recovery after stroke. The outcome measures were Fugl-Meyer Assessment of Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), and Barthel Index (BI). The mean difference (MD) and 95%CI were estimated for motor outcomes. Cochrane risk of bias tool was used to assess the quality of evidence. RESULT Twenty-five RCTs involving 1102 participants were included in the review. Compared to sham stimulation, NIBS combined with other therapies has effectively improved FMA-UE (MD0.97 [95%CI, 0.09 to 1.86; p = .03]) and BI score (MD9.11 [95%CI, 2.27 to 15.95; p = .009]) in acute/sub-acute stroke (MD1.73 [95%CI, 0.61 to 2.85; p = .003]) but unable to modify FMA-UE score in chronic stroke (MD-0.31 [95%CI, -1.77 to 1.15; p = .68]). Only inhibitory (MD3.04 [95%CI, 1.76 to 4.31; I2 = 82%, p < .001] protocol is associated with improved FMA-UE score. Twenty minutes of stimulation/session for ≥20 sessions was found to be effective in improving FMA-UE score (Stimulation time: ES0.45; p ≤ .001; Sessions: ES0.33; p ≤ .001). The NIBS did not produce any significant improvement in WMFT as compared to sham NIBS (MD0.91 [95% CI, -0.89 to 2.70; p = .32]). CONCLUSION Moderate to high-quality evidence suggested that NIBS combined with other therapies is effective in improving upper extremity motor impairment and participation in activities of daily living after acute/sub-acute stroke.
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Affiliation(s)
- Ishtiaq Ahmed
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Rustem Mustafaoglu
- Department of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nesrine Benkhalifa
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Yakhoub Hassan Yakhoub
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
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3
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Jia J. Exploration on neurobiological mechanisms of the central–peripheral–central closed-loop rehabilitation. Front Cell Neurosci 2022; 16:982881. [PMID: 36119128 PMCID: PMC9479450 DOI: 10.3389/fncel.2022.982881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/12/2022] [Indexed: 11/13/2022] Open
Abstract
Central and peripheral interventions for brain injury rehabilitation have been widely employed. However, as patients’ requirements and expectations for stroke rehabilitation have gradually increased, the limitations of simple central intervention or peripheral intervention in the rehabilitation application of stroke patients’ function have gradually emerged. Studies have suggested that central intervention promotes the activation of functional brain regions and improves neural plasticity, whereas peripheral intervention enhances the positive feedback and input of sensory and motor control modes to the central nervous system, thereby promoting the remodeling of brain function. Based on the model of a central–peripheral–central (CPC) closed loop, the integration of center and peripheral interventions was effectively completed to form “closed-loop” information feedback, which could be applied to specific brain areas or function-related brain regions of patients. Notably, the closed loop can also be extended to central and peripheral immune systems as well as central and peripheral organs such as the brain–gut axis and lung–brain axis. In this review article, the model of CPC closed-loop rehabilitation and the potential neuroimmunological mechanisms of a closed-loop approach will be discussed. Further, we highlight critical questions about the neuroimmunological aspects of the closed-loop technique that merit future research attention.
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Affiliation(s)
- Jie Jia
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
- National Regional Medical Center, Fujian, China
- The First Affiliated Hospital of Fujian Medical University, Fujian, China
- *Correspondence: Jie Jia,
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Tang Z, Han K, Wang R, Zhang Y, Zhang H. Excitatory Repetitive Transcranial Magnetic Stimulation Over the Ipsilesional Hemisphere for Upper Limb Motor Function After Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:918597. [PMID: 35795793 PMCID: PMC9251503 DOI: 10.3389/fneur.2022.918597] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is a promising therapy to promote recovery of the upper limb after stroke. According to the regulation of cortical excitability, rTMS can be divided into excitatory rTMS and inhibitory rTMS, and excitatory rTMS includes high-frequency rTMS (HF-rTMS) or intermittent theta-burst stimulation (iTBS). We aimed to evaluate the effects of excitatory rTMS over the ipsilesional hemisphere on upper limb motor recovery after stroke. Methods Databases of PubMed, Embase, ISI Web of Science, and the Cochrane Library were searched for randomized controlled trials published before 31 December 2021. RCTs on the effects of HF-rTMS or iTBS on upper limb function in patients diagnosed with stroke were included. Two researchers independently screened the literature, extracted the data, and assessed quality. The meta-analysis was performed by using Review Manager Version 5.4 software. Results Fifteen studies with 449 participants were included in this meta-analysis. This meta-analysis found that excitatory rTMS had significant efficacy on upper limb motor function (MD = 5.88, 95% CI, 3.32–8.43, P < 0.001), hand strength (SMD = 0.53, 95% CI, 0.04–1.01, P = 0.03), and hand dexterity (SMD = 0.76, 95% CI, 0.39–1.14, P < 0.001). Subgroup analyses based on different types of rTMS showed that both iTBS and HF-rTMS significantly promoted upper limb motor function (iTBS, P < 0.001; HF-rTMS, P < 0.001) and hand dexterity (iTBS, P = 0.01; HF-rTMS, P < 0.001) but not hand strength (iTBS, P = 0.07; HF-rTMS, P = 0.12). Further subgroup analysis based on the duration of illness demonstrated that applying excitatory rTMS during the first 3 months (<1 month, P = 0.01; 1–3 months, P = 0.001) after stroke brought significant improvement in upper limb motor function but not in the patients with a duration longer than 3 months (P = 0.06). We found that HF-rTMS significantly enhanced the motor evoked potential (MEP) amplitude of affected hemisphere (SMD = 0.82, 95% CI, 0.32–1.33, P = 0.001). Conclusion Our study demonstrated that excitatory rTMS over the ipsilesional hemisphere could significantly improve upper limb motor function, hand strength, and hand dexterity in patients diagnosed with stroke. Both iTBS and HF-rTMS which could significantly promote upper limb motor function and hand dexterity, and excitatory rTMS were beneficial to upper limb motor function recovery only when applied in the first 3 months after stroke. HF-rTMS could significantly enhance the MEP amplitude of the affected hemisphere. High-quality and large-scale randomized controlled trials in the future are required to confirm our conclusions. Clinical Trial Registration www.crd.york.ac.uk/prospero/, identifier: CRD42022312288.
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Affiliation(s)
- Zhiqing Tang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Kaiyue Han
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Rongrong Wang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Yue Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Hao Zhang
- School of Rehabilitation, Capital Medical University, Beijing, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- *Correspondence: Hao Zhang
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Cavendish BA, de Lima MFR, Perícoli L, Buratto LG. Effects of combining retrieval practice and tDCS over long-term memory: A randomized controlled trial. Brain Cogn 2021; 156:105807. [PMID: 34949566 DOI: 10.1016/j.bandc.2021.105807] [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: 04/02/2021] [Revised: 07/15/2021] [Accepted: 09/26/2021] [Indexed: 11/30/2022]
Abstract
The ability to retain new information is important in daily life. In particular, two techniques have shown promise for improving long-term retention: retrieval practice (RP), which consists of actively retrieving information from long-term memory to make it more accessible in the future; and transcranial direct current stimulation (tDCS), which consists of non-invasive brain stimulation that modulates cognitive processes by increasing and decreasing neuronal excitability. Previous studies have implicated the left dorsolateral prefrontal cortex (l-dlPFC) in memory encoding and memory organization. We examined whether RP associated with a single 20-min tDCS session over the l-dlPFC could improve long-term memory retention. Participants (N = 119) repeatedly studied a list of related words either via RP or via restudy, while undergoing either anodal or sham stimulation. Participants returned 2 days later for a free-recall test. Results showed that the RP group outperformed the restudy group in all measures, regardless of stimulation type. Also, recall organization was higher in the RP group than in the restudy group. The data support previous findings and indicate that RP may enhance performance by improving the organization of the to-be-remembered list items.
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Affiliation(s)
- Beatriz Araújo Cavendish
- Department of Basic Psychological Processes, Institute of Psychology, University of Brasília, Brasília 70.910-900, Brazil.
| | | | - Lara Perícoli
- Department of Basic Psychological Processes, Institute of Psychology, University of Brasília, Brasília 70.910-900, Brazil
| | - Luciano Grüdtner Buratto
- Department of Basic Psychological Processes, Institute of Psychology, University of Brasília, Brasília 70.910-900, Brazil
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Zhang XH, Gu T, Liu XW, Han P, Lv HL, Wang YL, Xiao P. The Effect of Transcranial Direct Current Stimulation and Functional Electrical Stimulation on the Lower Limb Function of Stroke Patients. Front Neurosci 2021; 15:685931. [PMID: 34621150 PMCID: PMC8490679 DOI: 10.3389/fnins.2021.685931] [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: 03/26/2021] [Accepted: 08/24/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aimed to research the effect of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on the lower limb function of post-convalescent stroke patients. Methods: A total of 122 patients in the stroke recovery stage who suffered from leg dysfunction were randomly divided into two groups: a tDCS group (n = 61) and a FES group (n = 61). All patients received same routine rehabilitation and equal treatment quality, the tDCS group was treated with tDCS, while the FES group received FES. The lower limb Fugl-Meyer assessment (FMA), modified Barthel index (MBI), functional ambulatory category (FAC), and somatosensory evoked potential (SEP) were used to assess the patients at three different stages: prior to treatment, 4 weeks after treatment, and 8 weeks after treatment. Results: The assessment scores for FMA, MBI, and FAC for the lower extremities after treatment (P > 0.05) were compared with those before treatment. The FMA, MBI, and FAC scores of the tDCS group were significantly higher than those of the FES group in all three stages (P < 0.05). The FMA, MBI, and FAC assessment scores of both groups were significantly higher after 4 weeks of treatment than that before treatment, and the scores after 8 weeks of treatment were significantly higher than those after 4 weeks after treatment (P < 0.05). The P40, N45 latencies decreased and the P40, N45 amplitudes increased, but there was no significant difference before treatment and after treatment (P >0.05), and there was no significant difference of the tDCS and FES groups before treatment and after treatment. Conclusion: In conclusion, FMA, MBI, and FAC indicate that both tDCS and FES can significantly promote the recovery of a patient’s leg motor function and tDCS is more effective than FES in the stroke recovery stage. The application value of SEP in stroke patients remains to be further studied.
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Affiliation(s)
- Xiao-Hua Zhang
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Tao Gu
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Xuan-Wei Liu
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Ping Han
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Hui-Lan Lv
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
| | - Yu-Long Wang
- Department of Rehabilitation, The First Affiliated Hospital, Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Peng Xiao
- Department of Rehabilitation, Shenzhen Dapeng New District Nanao People's Hospital, Shenzhen, China
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7
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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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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: 238] [Impact Index Per Article: 79.3] [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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9
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Discussion on the Rehabilitation of Stroke Hemiplegia Based on Interdisciplinary Combination of Medicine and Engineering. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6631835. [PMID: 33815554 PMCID: PMC7990546 DOI: 10.1155/2021/6631835] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 11/25/2022]
Abstract
Interdisciplinary combinations of medicine and engineering are part of the strategic plan of many universities aiming to be world-class institutions. One area in which these interactions have been prominent is rehabilitation of stroke hemiplegia. This article reviews advances in the last five years of stroke hemiplegia rehabilitation via interdisciplinary combination of medicine and engineering. Examples of these technologies include VR, RT, mHealth, BCI, tDCS, rTMS, and TCM rehabilitation. In this article, we will summarize the latest research in these areas and discuss the advantages and disadvantages of each to examine the frontiers of interdisciplinary medicine and engineering advances.
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10
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Chagas TDJ, Cravo ISDS, Bazan R, de Souza LAPS, Luvizutto GJ. Effects of transcranial direct current stimulation on balance after ischemic stroke (SANDE trial): Study protocol for a multicentric randomized controlled trial. Contemp Clin Trials 2021; 105:106396. [PMID: 33831502 DOI: 10.1016/j.cct.2021.106396] [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: 02/17/2021] [Revised: 03/25/2021] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Among the tools used for motor rehabilitation after stroke, transcranial direct current electrical stimulation (tDCS) aims to modify cortical excitability and improve motor function. Despite promising results, the effects of tDCS on balance after stroke have not yet been assessed using specific protocols. Therefore, this study will aim to evaluate the effects of tDCS and rehabilitation on balance after stroke. METHODS Eighty-two ischemic stroke patients across two inpatient rehabilitation sites in Brazil will be randomized into one of two treatment programs (anodic tDCS and sham tDCS), both associated with balance training, each 2 days/week, for six weeks and monitored for exertion, repetition and quality of movements. The primary outcome measure is the balance. Secondary outcomes will include clinical and functional measures. Outcome data will be assessed at two time points. DISCUSSION This trial will contribute to clarify if anodal tDCS is effective when associated with balance training to stroke recovery.
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Affiliation(s)
- Tatiane de Jesus Chagas
- Physical Therapy Department, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil
| | | | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School (UNESP), Botucatu, São Paulo, Brazil
| | | | - Gustavo José Luvizutto
- Physical Therapy Department, Federal University of Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.
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Lachowska M, Pastuszka A, Sokołowsk J, Szczudlik P, Niemczyk K. Cortical Deafness Due to Ischaemic Strokes in Both Temporal Lobes. J Audiol Otol 2020; 25:163-170. [PMID: 33327707 PMCID: PMC8311059 DOI: 10.7874/jao.2020.00269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/15/2020] [Indexed: 01/21/2023] Open
Abstract
Cortical deafness is a clinical rarity whereby a patient is unresponsive to all types of sounds despite the preserved integrity of the peripheral hearing organs. In this study, we present a patient who suddenly lost his hearing following ischaemic infarcts in both temporal lobes with no other neurological deficits. The CT confirmed damage to the primary auditory cortex (Heschl’s gyrus) of both hemispheres. Initially, the patient was unresponsive to all sounds, however, he regained some of the auditory abilities during 10 months follow up. Pure tone threshold improvement from complete deafness to the level of moderate hearing loss in the right ear and severe in the left was observed in pure tone audiometry. Otoacoustic emissions, auditory brainstem responses, and acoustic reflex findings showed normal results. The middle and late latency potential results confirmed objectively the improvement of the patient’s hearing, however, after 10 months still, they were somewhat compromised on both sides. In speech audiometry, there was no comprehension of spoken words neither at 3 nor at 10 months. The absent mismatch negativity confirmed above mentioned comprehension deficit. The extensive auditory electrophysiological testing presented in this study contributes to the understanding of the neural and functional changes in cortical deafness. It presents the evolution of changes after ischaemic cerebrovascular event expressed as auditory evoked potentials starting from short through middle and long latency and ending with event-related potentials and supported by neuroimaging.
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Affiliation(s)
- Magdalena Lachowska
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Pastuszka
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Sokołowsk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Szczudlik
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
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12
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Su F, Xu W. Enhancing Brain Plasticity to Promote Stroke Recovery. Front Neurol 2020; 11:554089. [PMID: 33192987 PMCID: PMC7661553 DOI: 10.3389/fneur.2020.554089] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 10/08/2020] [Indexed: 12/11/2022] Open
Abstract
Stroke disturbs both the structural and functional integrity of the brain. The understanding of stroke pathophysiology has improved greatly in the past several decades. However, effective therapy is still limited, especially for patients who are in the subacute or chronic phase. Multiple novel therapies have been developed to improve clinical outcomes by improving brain plasticity. These approaches either focus on improving brain remodeling and restoration or on constructing a neural bypass to avoid brain injury. This review describes emerging therapies, including modern rehabilitation, brain stimulation, cell therapy, brain-computer interfaces, and peripheral nervous transfer, and highlights treatment-induced plasticity. Key evidence from basic studies on the underlying mechanisms is also briefly discussed. These insights should lead to a deeper understanding of the overall neural circuit changes, the clinical relevance of these changes in stroke, and stroke treatment progress, which will assist in the development of future approaches to enhance brain function after stroke.
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Affiliation(s)
- Fan Su
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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13
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Gowan S, Hordacre B. Transcranial Direct Current Stimulation to Facilitate Lower Limb Recovery Following Stroke: Current Evidence and Future Directions. Brain Sci 2020; 10:brainsci10050310. [PMID: 32455671 PMCID: PMC7287858 DOI: 10.3390/brainsci10050310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022] Open
Abstract
Stroke remains a global leading cause of disability. Novel treatment approaches are required to alleviate impairment and promote greater functional recovery. One potential candidate is transcranial direct current stimulation (tDCS), which is thought to non-invasively promote neuroplasticity within the human cortex by transiently altering the resting membrane potential of cortical neurons. To date, much work involving tDCS has focused on upper limb recovery following stroke. However, lower limb rehabilitation is important for regaining mobility, balance, and independence and could equally benefit from tDCS. The purpose of this review is to discuss tDCS as a technique to modulate brain activity and promote recovery of lower limb function following stroke. Preliminary evidence from both healthy adults and stroke survivors indicates that tDCS is a promising intervention to support recovery of lower limb function. Studies provide some indication of both behavioral and physiological changes in brain activity following tDCS. However, much work still remains to be performed to demonstrate the clinical potential of this neuromodulatory intervention. Future studies should consider treatment targets based on individual lesion characteristics, stage of recovery (acute vs. chronic), and residual white matter integrity while accounting for known determinants and biomarkers of tDCS response.
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Affiliation(s)
- Samuel Gowan
- Interdisciplinary Neuroscience Program, Department of Biology, University of Wisconsin—La Crosse, La Crosse, WI 54601, USA
- Correspondence: ; Tel.: +61-8-83021286
| | - Brenton Hordacre
- IIMPACT in Health, University of South Australia, Adelaide, SA 5001, Australia;
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14
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Szelenberger R, Kostka J, Saluk-Bijak J, Miller E. Pharmacological Interventions and Rehabilitation Approach for Enhancing Brain Self-repair and Stroke Recovery. Curr Neuropharmacol 2020; 18:51-64. [PMID: 31362657 PMCID: PMC7327936 DOI: 10.2174/1570159x17666190726104139] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/25/2019] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
Neuroplasticity is a natural process occurring in the brain for the entire life. Stroke is the leading cause of long term disability and a huge medical and financial problem throughout the world. Research conducted over the past decade focused mainly on neuroprotection in the acute phase of stroke while very little studies target the chronic stage. Recovery after stroke depends on the ability of our brain to reestablish the structural and functional organization of neurovascular networks. Combining adjuvant therapies and drugs may enhance the repair processes and restore impaired brain functions. Currently, there are some drugs and rehabilitative strategies that can facilitate brain repair and improve clinical effect even years after stroke onset. Moreover, some of the compounds such as citicoline, fluoxetine, niacin, levodopa, etc. are already in clinical use or are being trialed in clinical issues. Many studies are also testing cell therapies; in our review, we focused on studies where cells have been implemented at the early stage of stroke. Next, we discuss pharmaceutical interventions. In this section, we selected methods of cognitive, behavioral, and physical rehabilitation as well as adjuvant interventions for neuroprotection including noninvasive brain stimulation and extremely low-frequency electromagnetic field. The modern rehabilitation represents a new model of physical interventions with the limited therapeutic window up to six months after stroke. However, previous studies suggest that the time window for stroke recovery is much longer than previously thought. This review attempts to present the progress in neuroprotective strategies, both pharmacological and non-pharmacological that can stimulate the endogenous neuroplasticity in post-stroke patients.
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Affiliation(s)
- Rafał Szelenberger
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Joanna Kostka
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection. University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Elżbieta Miller
- Department of Neurological Rehabilitation, Medical University of Lodz, Milionowa 14, 93-113 Lodz, Poland
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15
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Effectiveness of anodal transcranial direct current stimulation to improve muscle strength and motor functionality after incomplete spinal cord injury: a systematic review and meta-analysis. Spinal Cord 2020; 58:635-646. [DOI: 10.1038/s41393-020-0438-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 01/04/2023]
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16
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Evans C, Bachmann C, Lee JS, Gregoriou E, Ward N, Bestmann S. Dose-controlled tDCS reduces electric field intensity variability at a cortical target site. Brain Stimul 2020; 13:125-136. [DOI: 10.1016/j.brs.2019.10.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/26/2019] [Accepted: 10/03/2019] [Indexed: 01/30/2023] Open
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17
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Lee J, Jin Y, Yoon B. Bilateral Transcranial Direct Stimulation Over the Primary Motor Cortex Alters Motor Modularity of Multiple Muscles. J Mot Behav 2019; 52:474-488. [PMID: 31795875 DOI: 10.1080/00222895.2019.1646206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) has been demonstrated to modulate the motor performance of both healthy individuals and patients with neuromuscular disorders. However, the effect of tDCS on motor control of multiple muscles, which is a prerequisite to change in motor performance, is currently unknown. Using dimensionality reduction analysis, we investigated whether bilateral tDCS over M1 modulates the coordinated activity of 12 muscles. Fifteen healthy men participated in this randomized, double-blind crossover study. Each participant received a 20-min sham and 2-mA stimulation bilaterally over M1 (anode on the right M1 and cathode on the left M1), with a minimum washout period of 4 days. Muscle activation and end-point kinematics were evaluated during a task where participants reached out to a marked target with non-dominant hand as fast as possible, before and immediately after tDCS application. We found decreased similarity in motor modularity and significant changes in muscle activation in a specific motor module, particularly when reaching out to a target placed within arm's length and improved smoothness index of movement only following 2-mA stimulation. These findings indicate that clinicians and researchers need to consider the simultaneous effect of bilateral tDCS over M1 on multiple muscles when they establish tDCS protocol to change in motor performance of patients with neuromuscular deficits.
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Affiliation(s)
- JaeHyuk Lee
- Major in Rehabilitation Science, Graduate School, Korea University, Seoul, Korea
| | - Yan Jin
- Major in Rehabilitation Science, Graduate School, Korea University, Seoul, Korea
| | - BumChul Yoon
- Major in Rehabilitation Science, Graduate School, Korea University, Seoul, Korea.,Department of Physical Therapy, College of Health Science, Korea University, Seoul, Korea
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18
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Morya E, Monte-Silva K, Bikson M, Esmaeilpour Z, Biazoli CE, Fonseca A, Bocci T, Farzan F, Chatterjee R, Hausdorff JM, da Silva Machado DG, Brunoni AR, Mezger E, Moscaleski LA, Pegado R, Sato JR, Caetano MS, Sá KN, Tanaka C, Li LM, Baptista AF, Okano AH. Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes. J Neuroeng Rehabil 2019; 16:141. [PMID: 31730494 PMCID: PMC6858746 DOI: 10.1186/s12984-019-0581-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.
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Affiliation(s)
- Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Rio Grande do Norte Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Kátia Monte-Silva
- Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Claudinei Eduardo Biazoli
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Andre Fonseca
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Tommaso Bocci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Raaj Chatterjee
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Jeffrey M. Hausdorff
- Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Luciane Aparecida Moscaleski
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Science, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte Brazil
| | - João Ricardo Sato
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Marcelo Salvador Caetano
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Kátia Nunes Sá
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
| | - Clarice Tanaka
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Li Min Li
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Abrahão Fontes Baptista
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Alexandre Hideki Okano
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Graduate Program in Physical Education. State University of Londrina, Londrina, Paraná, Brazil
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19
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Fisicaro F, Lanza G, Grasso AA, Pennisi G, Bella R, Paulus W, Pennisi M. Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls. Ther Adv Neurol Disord 2019. [PMID: 31598137 DOI: 10.1177/1756286419878317.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.
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Affiliation(s)
- Francesco Fisicaro
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Via Santa Sofia, 78, Catania, 95125, Italy
| | - Alfio Antonio Grasso
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg August University, Göttingen, Germany
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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20
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Kang N, Lee RD, Lee JH, Hwang MH. Functional Balance and Postural Control Improvements in Patients With Stroke After Noninvasive Brain Stimulation: A Meta-analysis. Arch Phys Med Rehabil 2019; 101:141-153. [PMID: 31568760 DOI: 10.1016/j.apmr.2019.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/22/2019] [Accepted: 09/05/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The postural imbalance poststroke limits individuals' walking abilities as well as increase the risk of falling. We investigated the short-term treatment effects of noninvasive brain stimulation (NIBS) on functional balance and postural control in patients with stroke. DATA SOURCES We started the search via PubMed and the Institute for Scientific Information's Web of Science on March 1, 2019 and concluded the search on April 30, 2019. STUDY SELECTION The meta-analysis included studies that used either repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) for the recovery of functional balance and postural control poststroke. All included studies used either randomized controlled trial or crossover designs with a sham control group. DATA EXTRACTION Three researchers independently performed data extraction and assessing methodological quality and publication bias. We calculated overall and individual effect sizes using random effects meta-analysis models. DATA SYNTHESIS The random effects meta-analysis model on the 18 qualified studies identified the significant positive effects relating to NIBS in terms of functional balance and postural control poststroke. The moderator-variable analyses revealed that these treatment effects were only significant in rTMS across patients with acute, subacute, and chronic stroke whereas tDCS did not show any significant therapeutic effects. The meta-regression analysis showed that a higher number of rTMS sessions was significantly associated with more improvements in functional balance and postural control poststroke. CONCLUSIONS Our systematic review and meta-analysis confirmed that NIBS may be an effective option for restoring functional balance and postural control for patients with stroke.
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Affiliation(s)
- Nyeonju Kang
- From the Division of Sport Science & Sport Science Institute, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea.
| | - Ru Da Lee
- Department of Human Movement Science, Incheon National University, Incheon, South Korea
| | - Joon Ho Lee
- From the Division of Sport Science & Sport Science Institute, Incheon National University, Incheon, South Korea; Department of Human Movement Science, Incheon National University, Incheon, South Korea
| | - Moon Hyon Hwang
- Department of Human Movement Science, Incheon National University, Incheon, South Korea; Division of Health and Kinesiology, Incheon National University, Incheon, South Korea
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21
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Jin M, Zhang Z, Bai Z, Fong KNK. Timing-dependent interaction effects of tDCS with mirror therapy on upper extremity motor recovery in patients with chronic stroke: A randomized controlled pilot study. J Neurol Sci 2019; 405:116436. [PMID: 31493725 DOI: 10.1016/j.jns.2019.116436] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/02/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
This study was a randomized, controlled pilot trial to investigate the timing-dependent interaction effects of dual transcranial direct current stimulation (tDCS) in mirror therapy (MT) for hemiplegic upper extremity in patients with chronic stroke. Thirty patients with chronic stroke were randomly assigned to three groups: tDCS applied before MT (prior-tDCS group), tDCS applied during MT (concurrent-tDCS group), and sham tDCS applied randomly prior to or concurrent with MT (sham-tDCS group). Dual tDCS at 1 mA was applied bilaterally over the ipsilesional M1 (anodal electrode) and the contralesional M1 (cathodal electrode) for 30 min. The intervention was delivered five days per week for two weeks. Upper extremity motor performance was measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT), and the Box and Block Test (BBT). Assessments were administered at baseline, post-intervention, and two weeks follow-up. The results indicated that concurrent-tDCS group showed significant improvements in the ARAT in relation to the prior-tDCS group and sham-tDCS group at post-intervention. Besides, a trend toward greater improvement was also found in the FMA-UE for the concurrent-tDCS group. However, no statistically significant difference in the FMA-UE and BBT was identified among the three groups at either post-intervention or follow-up. The concurrent-tDCS seems to be more advantageous and time-efficient in the context of clinical trials combining with MT. The timing-dependent interaction factor of tDCS to facilitate motor recovery should be considered in future clinical application.
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Affiliation(s)
- Minxia Jin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR; Shanghai Sunshine Rehabilitation Centre, Shanghai, China
| | - Ziwei Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR; Shanghai Sunshine Rehabilitation Centre, Shanghai, China
| | - Zhongfei Bai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR; Shanghai Sunshine Rehabilitation Centre, Shanghai, China
| | - Kenneth N K Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.
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22
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de Moura MCDS, Hazime FA, Marotti Aparicio LV, Grecco LAC, Brunoni AR, Hasue RH. Effects of transcranial direct current stimulation (tDCS) on balance improvement: a systematic review and meta-analysis. Somatosens Mot Res 2019; 36:122-135. [PMID: 31181963 DOI: 10.1080/08990220.2019.1624517] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Transcranial direct current stimulation (tDCS) has emerged as a promising therapeutic tool to improve balance and optimize rehabilitation strategies. However, current literature shows the methodological heterogeneity of tDCS protocols and results, hindering any clear conclusions about the effects of tDCS on postural control. Objective: Evaluate the effectiveness of tDCS on postural control, and identify the most beneficial target brain areas and the effect on different populations. Methods: Two independent reviewers selected randomized tDCS clinical-trials studies from PubMed, Scopus, Web of Science, and reference lists of retrieved articles published between 1998 and 2017. Most frequently reported centre of pressure (COP) variables were selected for meta-analysis. Other postural control outcomes were discussed in the review. Results: Thirty studies were included in the systematic review, and 11 were submitted to a meta-analysis. A reduction of COP displacement area has been significantly achieved by tDCS, evidencing an improvement in balance control. Individuals with cerebral palsy (CP) and healthy young adults are mostly affected by stimulation. The analysis of the impact of tDCS over different brain areas revealed a significant effect after primary motor cortex (M1) stimulation, however, with no clear results after cerebellar stimulation due to divergent results among studies. Conclusions: tDCS appears to improve balance control, more evident in healthy and CP subjects. Effects are observed when primary MI is stimulated. Cerebellar stimulation should be better investigated.
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Affiliation(s)
- Maria Clara D Soares de Moura
- a Department of Physical Therapy, Communication Sciences and Disorders, and Occupational Therapy, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
| | - Fuad A Hazime
- b Department of Physical Therapy , Federal University of Piauí , Piauí , Brazil
| | - Luana V Marotti Aparicio
- c Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital of Clinics, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
| | | | - André R Brunoni
- c Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital of Clinics, Faculty of Medicine , University of São Paulo , São Paulo , Brazil.,e Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Renata Hydeé Hasue
- a Department of Physical Therapy, Communication Sciences and Disorders, and Occupational Therapy, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
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Malloggi C, Catino L, Rota V, Scarano S, Tesio L. Measuring voluntary activation of the Quadriceps femoris during isokinetic concentric contractions. ISOKINET EXERC SCI 2019. [DOI: 10.3233/ies-182224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Chiara Malloggi
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Milan, Italy
| | - Luigi Catino
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Viviana Rota
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Milan, Italy
| | - Luigi Tesio
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Behrangrad S, Zoghi M, Kidgell D, Jaberzadeh S. Does cerebellar non-invasive brain stimulation affect corticospinal excitability in healthy individuals? A systematic review of literature and meta-analysis. Neurosci Lett 2019; 706:128-139. [PMID: 31102706 DOI: 10.1016/j.neulet.2019.05.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/12/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
Numerous studies have indicated that non-invasive brain stimulation (NIBS) of the cerebellum could modulate corticospinal excitability (CSE) in young healthy individuals. However, there is no systematic review and meta-analysis that clarifies the effects of cerebellar NIBS on CSE. The aim of this study was to provide a meta-analytic summary of the effects of cerebellar NIBS on CSE. Seven search engines were used to identify any trial evaluating CSE before and after one session of cerebellar NIBS in healthy individuals up to June 2018. Twenty-six studies investigating the corticospinal responses following cerebellar NIBS were included. Meta-analysis was used to pool the findings from included studies. Effects were expressed as mean differences (MD) and the standard deviation (SD). Risk of bias was assessed with the Cochrane tool. Meta-analysis found that paired associative stimulation (PAS) with 2 ms interval, a combination of PAS with 21.5 ms interval and anodal transcranial direct current stimulation, and repetitive transcranial magnetic stimulation with a frequency of < 5 Hz increase CSE (P PAS2 < 0.00001, P PAS21.5 +a-tDCS = 0.02, P rTMS = 0.04). However, continuous theta burst stimulation, a combination of PAS with 25 ms interval and anodal transcranial direct current stimulation, and PAS with a 6 ms interval decreased CSE (P PAS6 < 0.00001, P cTBS < 0.00001, P PAS25 +a-tDCS = 0.003). The results of this review show that cerebellar NIBS techniques are a promising tool for increasing CSE.
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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, P.O. Box 527, Australia.
| | - Maryam Zoghi
- Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Dawson Kidgell
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, P.O. Box 527, Australia
| | - Shapour Jaberzadeh
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, P.O. Box 527, Australia
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Guggisberg AG, Koch PJ, Hummel FC, Buetefisch CM. Brain networks and their relevance for stroke rehabilitation. Clin Neurophysiol 2019; 130:1098-1124. [PMID: 31082786 DOI: 10.1016/j.clinph.2019.04.004] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 03/04/2019] [Accepted: 04/08/2019] [Indexed: 12/21/2022]
Abstract
Stroke has long been regarded as focal disease with circumscribed damage leading to neurological deficits. However, advances in methods for assessing the human brain and in statistics have enabled new tools for the examination of the consequences of stroke on brain structure and function. Thereby, it has become evident that stroke has impact on the entire brain and its network properties and can therefore be considered as a network disease. The present review first gives an overview of current methodological opportunities and pitfalls for assessing stroke-induced changes and reorganization in the human brain. We then summarize principles of plasticity after stroke that have emerged from the assessment of networks. Thereby, it is shown that neurological deficits do not only arise from focal tissue damage but also from local and remote changes in white-matter tracts and in neural interactions among wide-spread networks. Similarly, plasticity and clinical improvements are associated with specific compensatory structural and functional patterns of neural network interactions. Innovative treatment approaches have started to target such network patterns to enhance recovery. Network assessments to predict treatment response and to individualize rehabilitation is a promising way to enhance specific treatment effects and overall outcome after stroke.
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Affiliation(s)
- Adrian G Guggisberg
- Division of Neurorehabilitation, Department of Clinical Neurosciences, University Hospital Geneva, Switzerland.
| | - Philipp J Koch
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland
| | - Friedhelm C Hummel
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology (EPFL), 1202 Geneva, Switzerland; Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Swiss Federal Institute of Technology Valais (EPFL Valais), Clinique Romande de Réadaptation, 1951 Sion, Switzerland; Department of Clinical Neuroscience, University Hospital Geneva, 1202 Geneva, Switzerland
| | - Cathrin M Buetefisch
- Depts of Neurology, Rehabilitation Medicine, Radiology, Emory University, Atlanta, GA, USA
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Vaz PG, Salazar APDS, Stein C, Marchese RR, Lukrafka JL, Plentz RDM, Pagnussat AS. Noninvasive brain stimulation combined with other therapies improves gait speed after stroke: a systematic review and meta-analysis. Top Stroke Rehabil 2019; 26:201-213. [PMID: 30735104 DOI: 10.1080/10749357.2019.1565696] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) are noninvasive brain stimulation (NIBS) techniques able to modulate cortical excitability. OBJECTIVE To determine the effects of NIBS combined with other therapies on gait speed after stroke. METHODS Electronic databases searched were PUBMED, EMBASE, COCHRANE, SCOPUS, SCIELO and PEDro. Eligibility criteria were randomized controlled trials that reported the effects of tDCS and rTMS combined with other therapies for improving gait speed, walking cadence, functional ambulation category (FAC) and motricity index (MI-LE) after stroke. Risk of bias was assessed by Cochrane risk of bias assessment tool. Mean differences (MD) and 95% confidence intervals were calculated. Quality of evidence was assessed by Grades of Researches, Assessment, Development and Evaluation approach. RESULTS Ten studies (226 subjects) were included in the meta-analysis. NIBS combined with other therapies was effective for improving gait speed (MD 0.09 m/s [95% CI, 0.05 to 0.13; I2 0%, p < 0.0001]). Gait speed improved in both acute/subacute (MD 0.08 m/s [95% CI, 0.02 to 0.14]) and chronic phases (MD 0.08 m/s [95% CI, 0.03 to 0.13]). Furthermore, inhibitory (MD 0.09 m/s [95% CI, 0.04 to 0.14]) and excitatory (MD 0.07 m/s [95% CI, 0.02 to 0.12]) protocols were effective to improve gait speed. NIBS was also effective to improve walking cadence but was unable to modify other outcomes (FAC and MI-LE). CONCLUSIONS This systematic review with meta-analysis synthesizes moderate-quality evidence that NIBS combined with other therapies are effective to improve gait speed after stroke. Systematic Review registration number: PROSPERO registration number CDR42015024237.
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Affiliation(s)
- Patricia Graef Vaz
- a Health Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,b Department of Physiotherapy , Centro Universitário Ritter dos Reis (UniRitter) - Laureate International Universities , Porto Alegre , Brazil.,c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Ana Paula da Silva Salazar
- c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,d Rehabilitation Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Cinara Stein
- a Health Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Ritchele Redivo Marchese
- c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Janice Luisa Lukrafka
- c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,d Rehabilitation Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Rodrigo Della Méa Plentz
- a Health Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,d Rehabilitation Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
| | - Aline Souza Pagnussat
- a Health Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,c Movement Analysis and Neurological Rehabilitation Laboratory , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil.,d Rehabilitation Sciences Graduate Program , Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) , Porto Alegre , Brazil
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Fisicaro F, Lanza G, Grasso AA, Pennisi G, Bella R, Paulus W, Pennisi M. Repetitive transcranial magnetic stimulation in stroke rehabilitation: review of the current evidence and pitfalls. Ther Adv Neurol Disord 2019; 12:1756286419878317. [PMID: 31598137 PMCID: PMC6763938 DOI: 10.1177/1756286419878317] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 08/28/2019] [Indexed: 02/05/2023] Open
Abstract
Acute brain ischemia causes changes in several neural networks and related cortico-subcortical excitability, both in the affected area and in the apparently spared contralateral hemisphere. The modulation of these processes through modern techniques of noninvasive brain stimulation, namely repetitive transcranial magnetic stimulation (rTMS), has been proposed as a viable intervention that could promote post-stroke clinical recovery and functional independence. This review provides a comprehensive summary of the current evidence from the literature on the efficacy of rTMS applied to different clinical and rehabilitative aspects of stroke patients. A total of 32 meta-analyses published until July 2019 were selected, focusing on the effects on motor function, manual dexterity, walking and balance, spasticity, dysphagia, aphasia, unilateral neglect, depression, and cognitive function after a stroke. Only conventional rTMS protocols were considered in this review, and meta-analyses focusing on theta burst stimulation only were excluded. Overall, both HF-rTMS and LF-rTMS have been shown to be safe and well-tolerated. In addition, the current literature converges on the positive effect of rTMS in the rehabilitation of all clinical manifestations of stroke, except for spasticity and cognitive impairment, where definitive evidence of efficacy cannot be drawn. However, routine use of a specific paradigm of stimulation cannot be recommended yet due to a significant level of heterogeneity of the studies in terms of protocols to be set and outcome measures that have to be used. Future studies need to preliminarily evaluate the most promising protocols before going on to multicenter studies with large cohorts of patients in order to achieve a definitive translation into daily clinical practice.
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Affiliation(s)
- Francesco Fisicaro
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | | | - Alfio Antonio Grasso
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Catania, Italy
| | - Walter Paulus
- Department of Clinical Neurophysiology, University Medical Center, Georg August University, Göttingen, Germany
| | - Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Helekar SA, Convento S, Nguyen L, John BS, Patel A, Yau JM, Voss HU. The strength and spread of the electric field induced by transcranial rotating permanent magnet stimulation in comparison with conventional transcranial magnetic stimulation. J Neurosci Methods 2018; 309:153-160. [PMID: 30194040 DOI: 10.1016/j.jneumeth.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/16/2018] [Accepted: 09/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Weak or low intensity transcranial stimulation of the brain, such as low field magnetic stimulation and electrical stimulation, can produce significant functional and therapeutic neuromodulatory effects. NEW METHOD We have recently developed a portable wearable multifocal brain stimulator called transcranial rotating permanent magnet stimulator (TRPMS) that uses rapidly spinning high field strength permanent magnets attached to a cap. It produces oscillatory stimuli of different frequencies and patterns. Here we compared the strengths and spatial profiles of the changing magnetic fields of a figure-of-eight transcranial magnetic stimulator (TMS) coil, a TRPMS prototype, and a scaled-up version of TRPMS. We measured field strengths and directions of voltages induced in a magnetic field sensor oriented along all three orthogonal axes. RESULTS AND COMPARISON WITH EXISTING METHODS The spatial spread of the TRPMS-induced electric field is more restricted, and its shape and strength vary less with the orientation of the inductance than TMS. The maximum voltage induced by the current prototype is ∼7% of the maximal TMS output at depths corresponding to the human cerebral cortex from the scalp surface. This field strength can be scaled up by a factor ∼8 with a larger diametrically magnetized magnet. These comparative data allow us to estimate that intracortical effects of TRPMS could be stronger than other low intensity stimulation methods. CONCLUSIONS TRPMS might enable greater uniformity, consistency and focality in stimulation of targeted cortical areas subject to significant anatomical variability. Multiple TRPMS microstimulators can also be combined to produce patterned multifocal spatiotemporal stimulation.
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Affiliation(s)
- S A Helekar
- Speech and Language Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Houston, TX, 77030, USA.
| | - S Convento
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, 77030, USA
| | - L Nguyen
- Speech and Language Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - B S John
- Speech and Language Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - A Patel
- Speech and Language Center, Stanley H. Appel Department of Neurology, Houston Methodist Research Institute, Houston, TX, 77030, USA
| | - J M Yau
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, 77030, USA
| | - H U Voss
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10021, USA
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CREB controls cortical circuit plasticity and functional recovery after stroke. Nat Commun 2018; 9:2250. [PMID: 29884780 PMCID: PMC5993731 DOI: 10.1038/s41467-018-04445-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/27/2018] [Indexed: 11/25/2022] Open
Abstract
Treatments that stimulate neuronal excitability enhance motor performance after stroke. cAMP-response-element binding protein (CREB) is a transcription factor that plays a key role in neuronal excitability. Increasing the levels of CREB with a viral vector in a small pool of motor neurons enhances motor recovery after stroke, while blocking CREB signaling prevents stroke recovery. Silencing CREB-transfected neurons in the peri-infarct region with the hM4Di-DREADD blocks motor recovery. Reversing this inhibition allows recovery to continue, demonstrating that by manipulating the activity of CREB-transfected neurons it is possible to turn off and on stroke recovery. CREB transfection enhances remapping of injured somatosensory and motor circuits, and induces the formation of new connections within these circuits. CREB is a central molecular node in the circuit responses after stroke that lead to recovery from motor deficits. Increasing excitability in the peri-infarct area enhances motor recovery after stroke. Here the authors show that expressing CREB, a transcription factor known for its role in synaptic plasticity, or increasing activity of CREB-expressing cells near the stroke site improves recovery in an effect that is strong enough that it can be used to turn on and off motor recovery after stroke.
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Priming With 1-Hz Repetitive Transcranial Magnetic Stimulation Over Contralesional Leg Motor Cortex Does Not Increase the Rate of Regaining Ambulation Within 3 Months of Stroke. Am J Phys Med Rehabil 2018; 97:339-345. [DOI: 10.1097/phm.0000000000000850] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Comparison of Neuroplastic Responses to Cathodal Transcranial Direct Current Stimulation and Continuous Theta Burst Stimulation in Subacute Stroke. Arch Phys Med Rehabil 2018; 99:862-872.e1. [DOI: 10.1016/j.apmr.2017.10.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 10/20/2017] [Accepted: 10/28/2017] [Indexed: 11/22/2022]
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32
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An H, Shin HC. Development of Electrical Neural Stimulator Generating Periodic and Non-periodic Signals and Supporting Closed-loop Experimental System. Exp Neurobiol 2018. [PMID: 29535570 PMCID: PMC5840462 DOI: 10.5607/en.2018.27.1.57] [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] [Indexed: 11/19/2022] Open
Abstract
It is essential to build a system to generate proper neural stimulus signals with adjusting parameters. We developed a stimulator with up to four channels for separate settings in periodic and non-periodic modes. The device can support a closed-loop experimental system which utilizes neural information in real time as a feedback for controlling stimuli. To confirm whether stimulating signals are properly produced and delivered inside the brain, two experiments with rats were conducted. We observed that the change of firing rates and the cross-power spectral density increased after stimulation which meant that electric signals were transferred well and that they affected the neurons' activities. Thus, it is expected that the stimulator can be utilized to produce appropriate stimulation signals in accordance with various objectives.
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Affiliation(s)
- Hyejin An
- Department of Electronic Engineering, Soongsil University, Seoul 06978, Korea
| | - Hyun-Chool Shin
- Department of Electronic Engineering, Soongsil University, Seoul 06978, Korea
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Salazar APS, Vaz PG, Marchese RR, Stein C, Pinto C, Pagnussat AS. Noninvasive Brain Stimulation Improves Hemispatial Neglect After Stroke: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2018; 99:355-366.e1. [DOI: 10.1016/j.apmr.2017.07.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 07/13/2017] [Accepted: 07/16/2017] [Indexed: 10/19/2022]
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van Lieshout ECC, Visser-Meily JMA, Neggers SFW, van der Worp HB, Dijkhuizen RM. Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients. BMJ Open 2017; 7:e016566. [PMID: 28851789 PMCID: PMC5629737 DOI: 10.1136/bmjopen-2017-016566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Many patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking. METHODS AND ANALYSIS In a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7-14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion. ETHICS AND DISSEMINATION The study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences. TRIAL REGISTRATION NUMBER NTR6133.
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Affiliation(s)
- Eline C C van Lieshout
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Department of Rehabilitation, Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center, Utrecht, The Netherlands
| | - Sebastiaan F W Neggers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands
| | - Rick M Dijkhuizen
- Biomedical MR Imaging and Spectroscopy Group, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
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Aşkın A, Tosun A, Demirdal ÜS. Effects of low-frequency repetitive transcranial magnetic stimulation on upper extremity motor recovery and functional outcomes in chronic stroke patients: A randomized controlled trial. Somatosens Mot Res 2017; 34:102-107. [PMID: 28427299 DOI: 10.1080/08990220.2017.1316254] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) was suggested as a preconditioning method that would increase brain plasticity and that it would be optimal to combine rTMS with intensive rehabilitation. OBJECTIVE To assess the efficacy of inhibitory rTMS on upper extremity motor recovery and functional outcomes in chronic ischemic stroke patients. METHODS In this randomized controlled trial, experimental group received low-frequency (LF) rTMS to the primary motor cortex of the unaffected side + physical therapy (PT), and control group received PT. RESULTS No statistically significant difference was found in baseline demographical and clinical characteristics of the subjects including stroke severity or severity of paralysis prior to intervention. There were statistically significant improvements in all clinical outcome measures except for the Brunnstrom Recovery Stages. Fugl-Meyer Assessment, Box and Block test, motor and total scores of Functional Independence Measurement (FIM), and Functional Ambulation Scale (FAS) scores were significantly increased in both groups, however, these changes were significantly greater in the rTMS group except for FAS score. FIM cognitive scores and standardized mini-mental test scores were significantly increased and distal and hand Modified Ashworth Scale scores were significantly decreased only in the rTMS group (p < .05). CONCLUSIONS LF-rTMS can safely facilitate upper extremity motor recovery in patients with chronic ischemic stroke. TMS seems to be a promising treatment for motor, functional, and cognitive deficits in chronic stroke. Further studies with a larger number of patients with longer follow-up periods are needed to establish its effectiveness in stroke rehabilitation.
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Affiliation(s)
- Ayhan Aşkın
- a Department of Physical Medicine and Rehabilitation , Katip Celebi University , Izmir , Turkey
| | - Aliye Tosun
- a Department of Physical Medicine and Rehabilitation , Katip Celebi University , Izmir , Turkey
| | - Ümit Seçil Demirdal
- a Department of Physical Medicine and Rehabilitation , Katip Celebi University , Izmir , Turkey
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Increased functional connectivity one week after motor learning and tDCS in stroke patients. Neuroscience 2016; 340:424-435. [PMID: 27826107 DOI: 10.1016/j.neuroscience.2016.10.066] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 10/25/2016] [Accepted: 10/29/2016] [Indexed: 01/10/2023]
Abstract
Recent studies using resting-state functional magnetic resonance imaging (rs-fMRI) demonstrated that changes in functional connectivity (FC) after stroke correlate with recovery. The aim of this study was to explore whether combining motor learning to dual transcranial direct current stimulation (dual-tDCS, applied over both primary motor cortices (M1)) modulated FC in stroke patients. Twenty-two chronic hemiparetic stroke patients participated in a baseline rs-fMRI session. One week later, dual-tDCS/sham was applied during motor skill learning (intervention session); one week later, the retention session started with the acquisition of a run of rs-fMRI imaging. The intervention+retention sessions were performed once with dual-tDCS and once with sham in a randomized, cross-over, placebo-controlled, double-blind design. A whole-brain independent component analysis based analysis of variance (ANOVA) demonstrated no changes between baseline and sham sessions in the somatomotor network, whereas a FC increase was observed one week after dual-tDCS compared to baseline (qFDR <0.05, t63=4.15). A seed-based analysis confirmed specific stimulation-driven changes within a network of motor and premotor regions in both hemispheres. At baseline and one week after sham, the strongest FC was observed between the M1 and dorsal premotor cortex (PMd) of the undamaged hemisphere. In contrast, one week after dual-tDCS, the strongest FC was found between the M1 and PMd of the damaged hemisphere. Thus, a single session of dual-tDCS combined with motor skill learning increases FC in the somatomotor network of chronic stroke patients for one week.
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Corticospinal Excitability in Children with Congenital Hemiparesis. Brain Sci 2016; 6:brainsci6040049. [PMID: 27775599 PMCID: PMC5187563 DOI: 10.3390/brainsci6040049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/20/2016] [Accepted: 10/14/2016] [Indexed: 02/06/2023] Open
Abstract
Transcranial magnetic stimulation (TMS) can be used as an assessment or intervention to evaluate or influence brain activity in children with hemiparetic cerebral palsy (CP) commonly caused by perinatal stroke. This communication report analyzed data from two clinical trials using TMS to assess corticospinal excitability in children and young adults with hemiparetic CP. The results of this communication revealed a higher probability of finding a motor evoked potential (MEP) on the non-lesioned hemisphere compared to the lesioned hemisphere (p = 0.005). The resting motor threshold (RMT) was lower on the non-lesioned hemisphere than the lesioned hemisphere (p = 0.013). There was a significantly negative correlation between age and RMT (rs = −0.65, p = 0.003). This communication provides information regarding MEP responses, motor thresholds (MTs) and the association with age during TMS assessment in children with hemiparetic CP. Such findings contribute to the development of future pediatric studies in neuroplasticity and neuromodulation to influence motor function and recovery after perinatal stroke.
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Sanchez-Mendoza EH, Hermann DM. Correlates of Post-Stroke Brain Plasticity, Relationship to Pathophysiological Settings and Implications for Human Proof-of-Concept Studies. Front Cell Neurosci 2016; 10:196. [PMID: 27547178 PMCID: PMC4974253 DOI: 10.3389/fncel.2016.00196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/26/2016] [Indexed: 01/01/2023] Open
Abstract
The promotion of neurological recovery by enhancing neuroplasticity has recently obtained strong attention in the stroke field. Experimental studies support the hypothesis that stroke recovery can be improved by therapeutic interventions that augment neuronal sprouting. However plasticity responses of neurons are highly complex, involving the growth and differentiation of axons, dendrites, dendritic spines and synapses, which depend on the pathophysiological setting and are tightly controlled by extracellular and intracellular signals. Thorough mechanistic insights are needed into how neuronal plasticity is influenced by plasticity-promoting therapies in order not to risk the success of future clinical proof-of-concept studies.
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