Fox-Hesling J, Wisseman D, Kantak S. Noninvasive cerebellar stimulation and behavioral interventions: A crucial synergy for post-stroke motor rehabilitation.
NeuroRehabilitation 2024;
54:521-542. [PMID:
38943401 DOI:
10.3233/nre-230371]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
BACKGROUND
Improvement of functional movements after supratentorial stroke occurs through spontaneous biological recovery and training-induced reorganization of remnant neural networks. The cerebellum, through its connectivity with the cortex, brainstem and spinal cord, is actively engaged in both recovery and reorganization processes within the cognitive and sensorimotor systems. Noninvasive cerebellar stimulation (NiCBS) offers a safe, clinically feasible and potentially effective way to modulate the excitability of spared neural networks and promote movement recovery after supratentorial stroke. NiCBS modulates cerebellar connectivity to the cerebral cortex and brainstem, as well as influences the sensorimotor and frontoparietal networks.
OBJECTIVE
Our objective was twofold: (a) to conduct a scoping review of studies that employed NiCBS to influence motor recovery and learning in individuals with stroke, and (b) to present a theory-driven framework to inform the use of NiCBS to target distinct stroke-related deficits.
METHODS
A scoping review of current research up to August 2023 was conducted to determine the effect size of NiCBS effect on movement recovery of upper extremity function, balance, walking and motor learning in humans with stroke.
RESULTS
Calculated effect sizes were moderate to high, offering promise for improving upper extremity, balance and walking outcomes after stroke. We present a conceptual framework that capitalizes on cognitive-motor specialization of the cerebellum to formulate a synergy between NiCBS and behavioral interventions to target specific movement deficits.
CONCLUSION
NiCBS enhances recovery of upper extremity impairments, balance and walking after stroke. Physiologically-informed synergies between NiCBS and behavioral interventions have the potential to enhance recovery. Finally, we propose future directions in neurophysiological, behavioral, and clinical research to move NiCBS through the translational pipeline and augment motor recovery after stroke.
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