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Park AS, Thompson B. Non-invasive brain stimulation and vision rehabilitation: a clinical perspective. Clin Exp Optom 2024; 107:594-602. [PMID: 38772676 DOI: 10.1080/08164622.2024.2349565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/23/2024] Open
Abstract
Non-invasive brain stimulation techniques allow targeted modulation of brain regions and have emerged as a promising tool for vision rehabilitation. This review presents an overview of studies that have examined the use of non-invasive brain stimulation techniques for improving vision and visual functions. A description of the proposed neural mechanisms that underpin non-invasive brain stimulation effects is also provided. The clinical implications of non-invasive brain stimulation in vision rehabilitation are examined, including their safety, effectiveness, and potential applications in specific conditions such as amblyopia, post-stroke hemianopia, and central vision loss associated with age-related macular degeneration. Additionally, the future directions of research in this field are considered, including the need for larger and more rigorous clinical trials to validate the efficacy of these techniques. Overall, this review highlights the potential for brain stimulation techniques as a promising avenue for improving visual function in individuals with impaired vision and underscores the importance of continued research in this field.
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Affiliation(s)
- Adela Sy Park
- Centre for Eye & Vision Research, Hong Kong, Hong Kong
| | - Benjamin Thompson
- School of Optometry and Vision Science, University of Waterloo, Waterloo, Canada
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2
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Tol S, de Haan GA, Postuma EMJL, Jansen JL, Heutink J. Reading Difficulties in Individuals with Homonymous Visual Field Defects: A Systematic Review of Reported Interventions. Neuropsychol Rev 2024:10.1007/s11065-024-09636-4. [PMID: 38639880 DOI: 10.1007/s11065-024-09636-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/20/2024] [Indexed: 04/20/2024]
Abstract
Reading difficulties are amongst the most commonly reported problems in individuals with homonymous visual field defects (HVFDs). To be able to provide guidance for healthcare professionals considering offering reading training, researchers in this field and interested individuals with HVFDs, this systematic review aims to (1) provide an overview of the contextual and intervention characteristics of all published HVFD interventions and (2) generate insights into the different reading outcome measures that these studies adopted. A search on PsycINFO, MEDLINE and Web of Science was conducted up to February 2, 2023. All intervention studies for HVFD in which reading was measured were included. Data was collected about the intervention type, session duration, number of sessions, the intensity, duration, circumstance of the interventions, country in which the intervention was studied and reading measures. Sixty records are included, describing 70 interventions in total of which 21 are specifically reading interventions. Overall, adjusted saccadic behaviour interventions occur most in the literature. A wide range within all intervention characteristics was observed. Forty-nine records reported task-performance reading measures, and 33 records reported self-reported reading measures. The majority of task-performance measures are based on self-developed paragraph reading tasks with a time-based outcome measure (e.g. words per minute). Future research could benefit from making use of validated reading tests, approaching the measurement of reading mixed-methods and providing participants the possibility to supply outcomes relevant to them.
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Affiliation(s)
- S Tol
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - G A de Haan
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Amersfoortsestraatweg 180, 1272 RR, Huizen, The Netherlands
| | - E M J L Postuma
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - J L Jansen
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - J Heutink
- Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
- Royal Dutch Visio, Centre of Expertise for Blind and Partially Sighted People, Amersfoortsestraatweg 180, 1272 RR, Huizen, The Netherlands
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3
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Diana L, Casati C, Melzi L, Bianchi Marzoli S, Bolognini N. The effects of occipital and parietal tDCS on chronic visual field defects after brain injury. Front Neurol 2024; 15:1340365. [PMID: 38419713 PMCID: PMC10899507 DOI: 10.3389/fneur.2024.1340365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Homonymous visual field defects (HVFDs) following acquired brain lesions affect independent living by hampering several activities of everyday life. Available treatments are intensive and week- or month-long. Transcranial Direct current stimulation (tDCS), a plasticity-modulating non-invasive brain stimulation technique, could be combined with behavioral trainings to boost their efficacy or reduce treatment duration. Some promising attempts have been made pairing occipital tDCS with visual restitution training, however less is knows about which area/network should be best stimulated in association with compensatory approaches, aimed at improving exploratory abilities, such as multisensory trainings. Methods In a proof-of-principle, sham-controlled, single-blind study, 15 participants with chronic HVFDs underwent four one-shot sessions of active or sham anodal tDCS applied over the ipsilesional occipital cortex, the ipsilesional or contralesional posterior parietal cortex. tDCS was delivered during a compensatory multisensory (audiovisual) training. Before and immediately after each tDCS session, participants carried out a visual detection task, and two visual search tasks (EF and Triangles search tests). Accuracy (ACC) and response times (RTs) were analyzed with generalized mixed models. We investigated differences in baseline performance, clinical-demographic and lesion factors between tDCS responders and non-responders, based on post-tDCS behavioral improvements. Lastly, we conducted exploratory analyses to compare left and right brain-damaged participants. Results RTs improved after active ipsilesional occipital and parietal tDCS in the visual search tasks, while no changes in ACC were detected. Responders to ipsilesional occipital tDCS (Triangle task) had shorter disease duration and smaller lesions of the parietal cortex and the superior longitudinal fasciculus. On the other end, on the EF test, those participants with larger damage of the temporo-parietal cortex or the fronto-occipital white matter tracts showed a larger benefit from contralesional parietal tDCS. Overall, the visual search RTs improvements were larger in participants with right-sided hemispheric lesions. Conclusion The present result shows the facilitatory effects of occipital and parietal tDCS combined with compensatory multisensory training on visual field exploration in HVFDs, suggesting a potential for the development of new neuromodulation treatments to improve visual scanning behavior in brain-injured patients.
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Affiliation(s)
- Lorenzo Diana
- Laboratory of Neuropsychology, Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Carlotta Casati
- Laboratory of Neuropsychology, Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Lisa Melzi
- Neuro-Ophthalmology Center and Ocular Electrophysiology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefania Bianchi Marzoli
- Neuro-Ophthalmology Center and Ocular Electrophysiology Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Nadia Bolognini
- Laboratory of Neuropsychology, Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, University of Milano-Bicocca and NeuroMI, Milan, Italy
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Wu D, Wang Y, Liu N, Wang P, Sun K, Xiao W. High-definition transcranial direct current stimulation of the left middle temporal complex does not affect visual motion perception learning. Front Neurosci 2022; 16:988590. [PMID: 36117616 PMCID: PMC9474993 DOI: 10.3389/fnins.2022.988590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Visual perceptual learning (VPL) refers to the improvement in visual perceptual abilities through training and has potential implications for clinical populations. However, improvements in perceptual learning often require hundreds or thousands of trials over weeks to months to attain, limiting its practical application. Transcranial direct current stimulation (tDCS) could potentially facilitate perceptual learning, but the results are inconsistent thus far. Thus, this research investigated the effect of tDCS over the left human middle temporal complex (hMT+) on learning to discriminate visual motion direction. Twenty-seven participants were randomly assigned to the anodal, cathodal and sham tDCS groups. Before and after training, the thresholds of motion direction discrimination were assessed in one trained condition and three untrained conditions. Participants were trained over 5 consecutive days while receiving 4 × 1 ring high-definition tDCS (HD-tDCS) over the left hMT+. The results showed that the threshold of motion direction discrimination significantly decreased after training. However, no obvious differences in the indicators of perceptual learning, such as the magnitude of improvement, transfer indexes, and learning curves, were noted among the three groups. The current study did not provide evidence of a beneficial effect of tDCS on VPL. Further research should explore the impact of the learning task characteristics, number of training sessions and the sequence of stimulation.
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Affiliation(s)
- Di Wu
- Department of Medical Psychology, Air Force Medical University, Xi’an, China
| | - Yifan Wang
- Department of Medical Psychology, Air Force Medical University, Xi’an, China
| | - Na Liu
- Department of Nursing, Air Force Medical University, Xi’an, China
| | - Panhui Wang
- Department of Medical Psychology, Air Force Medical University, Xi’an, China
| | - Kewei Sun
- Department of Medical Psychology, Air Force Medical University, Xi’an, China
| | - Wei Xiao
- Department of Medical Psychology, Air Force Medical University, Xi’an, China
- *Correspondence: Wei Xiao,
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Battaglini L, Di Ponzio M, Ghiani A, Mena F, Santacesaria P, Casco C. Vision recovery with perceptual learning and non-invasive brain stimulation: Experimental set-ups and recent results, a review of the literature. Restor Neurol Neurosci 2022; 40:137-168. [PMID: 35964213 DOI: 10.3233/rnn-221261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vision is the sense which we rely on the most to interact with the environment and its integrity is fundamental for the quality of our life. However, around the globe, more than 1 billion people are affected by debilitating vision deficits. Therefore, finding a way to treat (or mitigate) them successfully is necessary. OBJECTIVE This narrative review aims to examine options for innovative treatment of visual disorders (retinitis pigmentosa, macular degeneration, optic neuropathy, refractory disorders, hemianopia, amblyopia), especially with Perceptual Learning (PL) and Electrical Stimulation (ES). METHODS ES and PL can enhance visual abilities in clinical populations, inducing plastic changes. We describe the experimental set-ups and discuss the results of studies using ES or PL or their combination in order to suggest, based on literature, which treatment is the best option for each clinical condition. RESULTS Positive results were obtained using ES and PL to enhance visual functions. For example, repetitive transorbital Alternating Current Stimulation (rtACS) appeared as the most effective treatment for pre-chiasmatic disorders such as optic neuropathy. A combination of transcranial Direct Current Stimulation (tDCS) and visual training seems helpful for people with hemianopia, while transcranial Random Noise Stimulation (tRNS) makes visual training more efficient in people with amblyopia and mild myopia. CONCLUSIONS This narrative review highlights the effect of different ES montages and PL in the treatment of visual disorders. Furthermore, new options for treatment are suggested. It is noteworthy to mention that, in some cases, unclear results emerged and others need to be more deeply investigated.
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Affiliation(s)
- Luca Battaglini
- Department of General Psychology, University of Padova, Italy.,Centro di Ateneo dei Servizi Clinici Universitari Psicologici (SCUP), University of Padova, Padova, Italy.,Neuro.Vis.U.S, University of Padova, Padova, Italy
| | - Michele Di Ponzio
- Department of General Psychology, University of Padova, Italy.,Istituto di Neuroscienze, Florence, Italy
| | - Andrea Ghiani
- Department of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Federica Mena
- Department of General Psychology, University of Padova, Italy
| | | | - Clara Casco
- Department of General Psychology, University of Padova, Italy.,Centro di Ateneo dei Servizi Clinici Universitari Psicologici (SCUP), University of Padova, Padova, Italy.,Neuro.Vis.U.S, University of Padova, Padova, Italy
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Park JG. Update on Stroke Rehabilitation for Non-Motor Impairment. BRAIN & NEUROREHABILITATION 2022; 15:e13. [PMID: 36743206 PMCID: PMC9833475 DOI: 10.12786/bn.2022.15.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022] Open
Abstract
Various interventions exist to treat non-motor impairments caused by stroke. Adjuvant treatments such as non-invasive brain stimulation, virtual reality, computer-assisted training, neurostimulation, and biofeedback are being investigated and applied in the areas of cognitive dysfunction, language problems, visual disorders, dysphagia, mood disorders, and post-stroke pain. Most of these treatments have shown efficacy and symptom improvement, but further investigation is required to fully clarify their effects.
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Affiliation(s)
- Jin Gee Park
- Department of Physical Medicine and Rehabilitation, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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He Q, Yang XY, Zhao D, Fang F. Enhancement of visual perception by combining transcranial electrical stimulation and visual perceptual training. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:271-284. [PMID: 37724187 PMCID: PMC10388778 DOI: 10.1515/mr-2022-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/16/2022] [Indexed: 09/20/2023]
Abstract
The visual system remains highly malleable even after its maturity or impairment. Our visual function can be enhanced through many ways, such as transcranial electrical stimulation (tES) and visual perceptual learning (VPL). TES can change visual function rapidly, but its modulation effect is short-lived and unstable. By contrast, VPL can lead to a substantial and long-lasting improvement in visual function, but extensive training is typically required. Theoretically, visual function could be further improved in a shorter time frame by combining tES and VPL than by solely using tES or VPL. Vision enhancement by combining these two methods concurrently is both theoretically and practically significant. In this review, we firstly introduced the basic concept and possible mechanisms of VPL and tES; then we reviewed the current research progress of visual enhancement using the combination of two methods in both general and clinical population; finally, we discussed the limitations and future directions in this field. Our review provides a guide for future research and application of vision enhancement and restoration by combining VPL and tES.
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Affiliation(s)
- Qing He
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
- Key Laboratory of Machine Perception, Ministry of Education, Peking University, Beijing, China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Xin-Yue Yang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
- Key Laboratory of Machine Perception, Ministry of Education, Peking University, Beijing, China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Daiqing Zhao
- Department of Psychology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Fang Fang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
- Key Laboratory of Machine Perception, Ministry of Education, Peking University, Beijing, China
- IDG/McGovern Institute for Brain Research, Peking University, Beijing, China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
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Motolese F, Capone F, Di Lazzaro V. New tools for shaping plasticity to enhance recovery after stroke. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:299-315. [PMID: 35034743 DOI: 10.1016/b978-0-12-819410-2.00016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stroke is the second most common cause of death worldwide and its prevalence is projected to increase in the coming years in parallel with the increase of life expectancy. Despite the great improvements in the management of the acute phase of stroke, some residual disability persists in most patients thus requiring rehabilitation. One third of patients do not reach the maximal recovery potential and different approaches have been explored with the aim to boost up recovery. In this regard, noninvasive brain stimulation techniques have been widely used to induce neuroplasticity phenomena. Different protocols of repetitive transcranial magnetic stimulation (rTMS) and transcranial electrical stimulation (tES) can induce short- and long-term changes of synaptic excitability and are promising tools for enhancing recovery in stroke patients. New options for neuromodulation are currently under investigation. They include: vagal nerve stimulation (VNS) that can be delivered invasively, with implanted stimulators and noninvasively with transcutaneous VNS (tVNS); and extremely low-frequency (1-300Hz) magnetic fields. This chapter will provide an overview on the new techniques that are used for neuroprotection and for enhancing recovery after stroke.
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Affiliation(s)
- Francesco Motolese
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Fioravante Capone
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.
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Saionz EL, Busza A, Huxlin KR. Rehabilitation of visual perception in cortical blindness. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:357-373. [PMID: 35034749 PMCID: PMC9682408 DOI: 10.1016/b978-0-12-819410-2.00030-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blindness is a common sequela after stroke affecting the primary visual cortex, presenting as a contralesional, homonymous, visual field cut. This can occur unilaterally or, less commonly, bilaterally. While it has been widely assumed that after a brief period of spontaneous improvement, vision loss becomes stable and permanent, accumulating data show that visual training can recover some of the vision loss, even long after the stroke. Here, we review the different approaches to rehabilitation employed in adult-onset cortical blindness (CB), focusing on visual restoration methods. Most of this work was conducted in chronic stroke patients, partially restoring visual discrimination and luminance detection. However, to achieve this, patients had to train for extended periods (usually many months), and the vision restored was not entirely normal. Several adjuvants to training such as noninvasive, transcranial brain stimulation, and pharmacology are starting to be investigated for their potential to increase the efficacy of training in CB patients. However, these approaches are still exploratory and require considerably more research before being adopted. Nonetheless, having established that the adult visual system retains the capacity for restorative plasticity, attention recently turned toward the subacute poststroke period. Drawing inspiration from sensorimotor stroke rehabilitation, visual training was recently attempted for the first time in subacute poststroke patients. It improved vision faster, over larger portions of the blind field, and for a larger number of visual discrimination abilities than identical training initiated more than 6 months poststroke (i.e., in the chronic period). In conclusion, evidence now suggests that visual neuroplasticity after occipital stroke can be reliably recruited by a range of visual training approaches. In addition, it appears that poststroke visual plasticity is dynamic, with a critical window of opportunity in the early postdamage period to attain more rapid, more extensive recovery of a larger set of visual perceptual abilities.
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Affiliation(s)
- Elizabeth L Saionz
- Medical Scientist Training Program, University of Rochester, Rochester, NY, United States
| | - Ania Busza
- Department of Neurology, University of Rochester, Rochester, NY, United States
| | - Krystel R Huxlin
- Flaum Eye Institute, University of Rochester, Rochester, NY, United States.
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10
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Sims JR, Chen AM, Sun Z, Deng W, Colwell NA, Colbert MK, Zhu J, Sainulabdeen A, Faiq MA, Bang JW, Chan KC. Role of Structural, Metabolic, and Functional MRI in Monitoring Visual System Impairment and Recovery. J Magn Reson Imaging 2021; 54:1706-1729. [PMID: 33009710 PMCID: PMC8099039 DOI: 10.1002/jmri.27367] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/24/2020] [Accepted: 08/27/2020] [Indexed: 12/13/2022] Open
Abstract
The visual system, consisting of the eyes and the visual pathways of the brain, receives and interprets light from the environment so that we can perceive the world around us. A wide variety of disorders can affect human vision, ranging from ocular to neurologic to systemic in nature. While other noninvasive imaging techniques such as optical coherence tomography and ultrasound can image particular sections of the visual system, magnetic resonance imaging (MRI) offers high resolution without depth limitations. MRI also gives superior soft-tissue contrast throughout the entire pathway compared to computed tomography. By leveraging different imaging sequences, MRI is uniquely capable of unveiling the intricate processes of ocular anatomy, tissue physiology, and neurological function in the human visual system from the microscopic to macroscopic levels. In this review we discuss how structural, metabolic, and functional MRI can be used in the clinical assessment of normal and pathologic states in the anatomic structures of the visual system, including the eyes, optic nerves, optic chiasm, optic tracts, visual brain nuclei, optic radiations, and visual cortical areas. We detail a selection of recent clinical applications of MRI at each position along the visual pathways, including the evaluation of pathology, plasticity, and the potential for restoration, as well as its limitations and key areas of ongoing exploration. Our discussion of the current and future developments in MR ocular and neuroimaging highlights its potential impact on our ability to understand visual function in new detail and to improve our protection and treatment of anatomic structures that are integral to this fundamental sensory system. LEVEL OF EVIDENCE 3: TECHNICAL EFFICACY STAGE 3: .
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Affiliation(s)
- Jeffrey R. Sims
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Anna M. Chen
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Zhe Sun
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Wenyu Deng
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Nicole A. Colwell
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Max K. Colbert
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Jingyuan Zhu
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Anoop Sainulabdeen
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Department of Surgery and Radiology, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Thrissur, India
| | - Muneeb A. Faiq
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Ji Won Bang
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
| | - Kevin C. Chan
- Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Sackler Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Neuroscience Institute, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York, USA
- Center for Neural Science, College of Arts and Science, New York University, New York, New York, USA
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11
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El Nahas N, Elbokl AM, Abd Eldayem EH, Roushdy TM, Amin RM, Helmy SM, Akl AZ, Ashour AA, Samy S, Amgad A, Emara TH, Nowara M, Kenawy FF. Navigated perilesional transcranial magnetic stimulation can improve post-stroke visual field defect: A double-blind sham-controlled study. Restor Neurol Neurosci 2021; 39:199-207. [PMID: 34024791 DOI: 10.3233/rnn-211181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Visual field defects (VFD) usually do not show improvement beyond 12 weeks from their onset. It has been shown that repetitive presentation of a stimulus to areas of residual vision in cases of visual field defect can improve vision. The counterpart of these areas in the brain are the partially damaged brain regions at the perilesional areas where plasticity can be enhanced. OBJECTIVE We aimed to study the effect of navigated repetitive transcranial magnetic stimulation (rTMS) applied to perilesional areas on the recovery of patients with cortical VFD. METHODS Thirty-two patients with cortical VFD secondary to stroke of more than 3 months duration received 16 sessions of either active or sham high frequency navigated perilesional rTMS. Automated perimetry and visual functioning questionnaire (VFQ-25) were performed at baseline and after completion of the sessions. RESULTS The active group showed significant improvement after intervention, compared to the sham group, in both mean deviation (MD), visual field index (VFI) and in the VFQ-25 scores. CONCLUSIONS Navigated rTMS is a new treatment option for post-stroke VFD as it can selectively stimulate areas of residual vision around the infarcted tissue, improving the threshold of visual stimulus detection which could be used alone or in combination with existing therapies.
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Affiliation(s)
- Nevine El Nahas
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed M Elbokl
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman Hamid Abd Eldayem
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer M Roushdy
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Randa M Amin
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shahinaz M Helmy
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Zaki Akl
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Aya Ahmed Ashour
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Samy
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alaa Amgad
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer H Emara
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Fatma Fathalla Kenawy
- Ain Shams Neuromodulation Research Lab, Neurology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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12
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Räty S, Borrmann C, Granata G, Cárdenas-Morales L, Schoenfeld A, Sailer M, Silvennoinen K, Holopainen J, De Rossi F, Antal A, Rossini PM, Tatlisumak T, Sabel BA. Non-invasive electrical brain stimulation for vision restoration after stroke: An exploratory randomized trial (REVIS). Restor Neurol Neurosci 2021; 39:221-235. [PMID: 34219679 PMCID: PMC8461672 DOI: 10.3233/rnn-211198] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Occipital strokes often cause permanent homonymous hemianopia leading to significant disability. In previous studies, non-invasive electrical brain stimulation (NIBS) has improved vision after optic nerve damage and in combination with training after stroke. Objective: We explored different NIBS modalities for rehabilitation of hemianopia after chronic stroke. Methods: In a randomized, double-blinded, sham-controlled, three-armed trial, altogether 56 patients with homonymous hemianopia were recruited. The three experiments were: i) repetitive transorbital alternating current stimulation (rtACS, n = 8) vs. rtACS with prior cathodal transcranial direct current stimulation over the intact visual cortex (tDCS/rtACS, n = 8) vs. sham (n = 8); ii) rtACS (n = 9) vs. sham (n = 9); and iii) tDCS of the visual cortex (n = 7) vs. sham (n = 7). Visual functions were evaluated before and after the intervention, and after eight weeks follow-up. The primary outcome was change in visual field assessed by high-resolution and standard perimetries. The individual modalities were compared within each experimental arm. Results: Primary outcomes in Experiments 1 and 2 were negative. Only significant between-group change was observed in Experiment 3, where tDCS increased visual field of the contralesional eye compared to sham. tDCS/rtACS improved dynamic vision, reading, and visual field of the contralesional eye, but was not superior to other groups. rtACS alone increased foveal sensitivity, but was otherwise ineffective. All trial-related procedures were tolerated well. Conclusions: This exploratory trial showed safety but no main effect of NIBS on vision restoration after stroke. However, tDCS and combined tDCS/rtACS induced improvements in visually guided performance that need to be confirmed in larger-sample trials. NCT01418820 (clinicaltrials.gov)
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Affiliation(s)
- Silja Räty
- HUS Neurocenter, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Carolin Borrmann
- Institute of Medical Psychology, Otto-v.-Guericke University of Magdeburg Medical Faculty, Magdeburg, Germany
| | - Giuseppe Granata
- Institute of Neurology, Policlinic A. Gemelli Foundation-IRCCS, Rome, Italy
| | - Lizbeth Cárdenas-Morales
- Institute of Medical Psychology, Otto-v.-Guericke University of Magdeburg Medical Faculty, Magdeburg, Germany.,Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Ariel Schoenfeld
- Clinic of Neurorehabilitation, Kliniken Schmieder, Heidelberg, Germany
| | - Michael Sailer
- MEDIAN Klinik NRZ Magdeburg, An-Institut für Neurorehabilitation, Otto-von-Guericke University, Magdeburg, Germany
| | - Katri Silvennoinen
- HUS Neurocenter, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London, UK
| | - Juha Holopainen
- Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland
| | - Francesca De Rossi
- National Centre of Services and Research for the Prevention of Blindness and Rehabilitation of Low Vision Patients - IAPB, Italian Branch, Rome, Italy
| | - Andrea Antal
- HUS Neurocenter, Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Clinic for Neurology, University Medical Center of Göttingen, Germany
| | - Paolo M Rossini
- Department Neuroscience & Neurorehabilitation, IRCCS San Raffaele-Pisana, Rome, Italy
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bernhard A Sabel
- Institute of Medical Psychology, Otto-v.-Guericke University of Magdeburg Medical Faculty, Magdeburg, Germany
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13
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Kim HJ, Chang SJ, Yang E, Jeong HN. Chronic disease interventions for people with visual impairment: A systematic review. Appl Nurs Res 2021; 60:151446. [PMID: 34247790 DOI: 10.1016/j.apnr.2021.151446] [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: 05/05/2021] [Accepted: 05/16/2021] [Indexed: 10/21/2022]
Abstract
AIM To identify the characteristics of chronic disease interventions for people with visual impairment (PVI) and provide suggestions for future interventions. BACKGROUND Chronic diseases are more common in PVI than people without visual impairment, and PVI have difficulty managing chronic diseases due to physical, social, and psychological problems associated with visual impairment. However, evidence regarding chronic disease intervention for PVI is limited. METHODS This review was guided by the PRISMA methodology. Data were extracted and checked, and each study was evaluated to ensure their methodological quality using appropriate tools based on the study design. Findings were described through a qualitative synthesis, and the above process was carried out by all four researchers. RESULTS 28 studies were selected. The intervention for mental disorders was the most common with about 39.3%, followed by stroke (25.0%), diabetes (17.8%), various chronic diseases (10.7%), chronic pain (3.6%), and scoliosis (3.6%). Most of the intervention was delivered individually, and the place of intervention often depends on the preference or convenience of PVI. A wide range of intervention materials was used, from large print, audio, or braille version reading materials to technology products. Based on the results, the main areas of the outcomes were daily living function, psychological conditions, and quality of life. CONCLUSIONS This review identified the components of interventions for PVI and provided intervention strategies. In particular, chronic disease interventions for PVI should be planned by considering how and where appropriate interventions are provided, various available materials, and the problems to be addressed.
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Affiliation(s)
- Hee Jung Kim
- College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
| | - Sun Ju Chang
- College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
| | - Eunjin Yang
- College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
| | - Ha Na Jeong
- College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, South Korea.
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14
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Abstract
PURPOSE OF REVIEW Homonymous visual field defects are a common sequela of stroke, and are assumed to be permanent within a few weeks of the event. Because consensus about the efficacy of rehabilitation is lacking, visual therapy is rarely prescribed. Here, we review current rehabilitation options and strategies in the translational pipeline that could change these perspectives. RECENT FINDINGS The mainstays of available therapy for homonymous visual defects are compensation training and substitution, which allow patients to better use their spared vision. However, early clinical studies suggest that vision can partially recover following intensive training inside the blind field. Research into the relative efficacy of different restorative approaches continues, providing insights into neurophysiologic substrates of recovery and its limitations. This, in turn, has led to new work examining the possible benefits of earlier intervention, advanced training procedures, noninvasive brain stimulation, and pharmacological adjuvants, all of which remain to be vetted through properly powered, randomized, clinical trials. SUMMARY Research has uncovered substantial visual plasticity after occipital strokes, suggesting that rehabilitative strategies for this condition should be more aggressive. For maximal benefit, poststroke vision-restorative interventions should begin early, and in parallel with strategies that optimize everyday use of an expanding field of view.
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Affiliation(s)
| | - Steven E Feldon
- Flaum Eye Institute
- Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Krystel R Huxlin
- Flaum Eye Institute
- Center for Visual Science, University of Rochester, Rochester, NY, USA
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15
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Perin C, Viganò B, Piscitelli D, Matteo BM, Meroni R, Cerri CG. Non-invasive current stimulation in vision recovery: a review of the literature. Restor Neurol Neurosci 2020; 38:239-250. [PMID: 31884495 PMCID: PMC7504999 DOI: 10.3233/rnn-190948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background: Around 253 million people worldwide suffer from irreversible visual damage. Numerous studies have been carried out in order to unveil the effects of electrical stimulation (ES) as a useful tool for rehabilitation for different visual conditions and pathologies. Objective: This systematic review aimed to 1) examine the current evidence of ES efficacy for the treatment of visual pathologies and 2) define the corresponding degree of the recommendation of different ES techniques. Methods: A systematic review was conducted in MEDLINE and Cochrane Library database to collect documents published between 2000 and 2018. For each study, Level of Evidence of Effectiveness of ES as well as the Class of Quality for the treatment of different visual pathologies were determined. Results: Thirty-eight articles were included. Studies were grouped according to the pathology treated and the type of stimulation administered. The first group included studies treating pre-chiasmatic pathologies (age-related macular degeneration, macular dystrophy, retinal artery occlusion, retinitis pigmentosa, glaucoma, optic nerve damage, and optic neuropathy) using pre-chiasmatic stimulation; the second group included studies treating both pre-chiasmatic pathologies (amblyopia, myopia) and post-chiasmatic pathologies or brain conditions (hemianopsia, brain trauma) by means of post-chiasmatic stimulation. In the first group, repetitive transorbital alternating current stimulation (rtACS) reached level A recommendation, and transcorneal electrical stimulation (tcES) reached level B. In the second group, both high-frequency random noise stimulation (hf-RNS) and transcranial direct current stimulation (tDCS) reached level C recommendation. Conclusions: Study’s findings suggest conclusive evidence for rtACS treatment. For other protocols results are promising but not conclusive since the examined studies assessed different stimulation parameters and endpoints. A comparison of the effects of different combinations of these variables still lacks in the literature. Further studies are needed to optimize existing protocols and determine if different protocols are needed for different diseases.
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Affiliation(s)
- Cecilia Perin
- Dipartimento di Medicina e Chirurgia (School of Medicine and Surgery), University of Milan-Bicocca, Milan, Italy.,Milan Center for Neuroscience (NeuroMI), University of Milan-Bicocca, Milan, Italy
| | | | - Daniele Piscitelli
- Dipartimento di Medicina e Chirurgia (School of Medicine and Surgery), University of Milan-Bicocca, Milan, Italy.,School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Barbara Maria Matteo
- Dipartimento di Medicina e Chirurgia (School of Medicine and Surgery), University of Milan-Bicocca, Milan, Italy
| | - Roberto Meroni
- Dipartimento di Medicina e Chirurgia (School of Medicine and Surgery), University of Milan-Bicocca, Milan, Italy.,Milan Center for Neuroscience (NeuroMI), University of Milan-Bicocca, Milan, Italy.,Current Affilation: Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports. Differdange, Luxembourg
| | - Cesare Giuseppe Cerri
- Dipartimento di Medicina e Chirurgia (School of Medicine and Surgery), University of Milan-Bicocca, Milan, Italy.,Milan Center for Neuroscience (NeuroMI), University of Milan-Bicocca, Milan, Italy
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16
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Sabel BA, Thut G, Haueisen J, Henrich-Noack P, Herrmann CS, Hunold A, Kammer T, Matteo B, Sergeeva EG, Waleszczyk W, Antal A. Vision modulation, plasticity and restoration using non-invasive brain stimulation – An IFCN-sponsored review. Clin Neurophysiol 2020; 131:887-911. [DOI: 10.1016/j.clinph.2020.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
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17
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Raffin E, Salamanca-Giron RF, Hummel FC. Perspectives: Hemianopia-Toward Novel Treatment Options Based on Oscillatory Activity? Neurorehabil Neural Repair 2019; 34:13-25. [PMID: 31858874 DOI: 10.1177/1545968319893286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Stroke has become one of the main causes of visual impairment, with more than 15 million incidences of first-time strokes, per year, worldwide. One-third of stroke survivors exhibit visual impairment, and most of them will not fully recover. Some recovery is possible, but this usually happens in the first few weeks after a stroke. Most of the rehabilitation options that are offered to patients are compensatory, such as optical aids or eye training. However, these techniques do not seem to provide a sufficient amount of improvement transferable to everyday life. Based on the relatively recent idea that the visual system can actually recover from a chronic lesion, visual retraining protocols have emerged, sometimes even in combination with noninvasive brain stimulation (NIBS), to further boost plastic changes in the residual visual tracts and network. The present article reviews the underlying mechanisms supporting visual retraining and describes the first clinical trials that applied NIBS combined with visual retraining. As a further perspective, it gathers the scientific evidence demonstrating the relevance of interregional functional synchronization of brain networks for visual field recovery, especially the causal role of α and γ oscillations in parieto-occipital regions. Because transcranial alternating current stimulation (tACS) can induce frequency-specific entrainment and modulate spike timing-dependent plasticity, we present a new promising interventional approach, consisting of applying physiologically motivated tACS protocols based on multifocal cross-frequency brain stimulation of the visuoattentional network for visual field recovery.
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Affiliation(s)
- Estelle Raffin
- Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland.,Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland.,Clinique Romande de Réadaptation, Sion, Switzerland
| | | | - Friedhelm Christoph Hummel
- Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland.,Swiss Federal Institute of Technology (EPFL Valais), Sion, Switzerland.,Clinique Romande de Réadaptation, Sion, Switzerland.,University of Geneva Medical School, Geneva, Switzerland
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18
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Sabel BA, Hamid AIA, Borrmann C, Speck O, Antal A. Transorbital alternating current stimulation modifies BOLD activity in healthy subjects and in a stroke patient with hemianopia: A 7 Tesla fMRI feasibility study. Int J Psychophysiol 2019; 154:80-92. [PMID: 30978369 DOI: 10.1016/j.ijpsycho.2019.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Modifying brain activity using non-invasive, low intensity transcranial electrical brain stimulation (TES) has rapidly increased during the past 20 years. Alternating current stimulation (ACS), for example, has been shown to alter brain rhythm activities and modify neuronal functioning in the visual system. Daily application of transorbital ACS to patients with optic nerve damage induces functional connectivity reorganization, and partially restores vision. While ACS is thought to mainly modify neuronal mechanisms, e.g. changes in brain oscillations that can be detected by EEG, it is still an open question, whether and how it may alter BOLD activity. OBJECTIVE We evaluated whether transorbital ACS modulates BOLD activity in early visual cortex using high-resolution 7 Tesla functional magnetic resonance imaging (fMRI). METHODS In this feasibility study transorbital ACS in the alpha range and sham ACS was applied in a random block design in five healthy subjects for 20 min at 1 mA. Brain activation in the visual areas V1, V2 and V3 were measured using 7 Tesla fMRI-based retinotopic mapping at the time points before (baseline) and after stimulation. In addition, we collected data from one hemianopic stroke patient with visual cortex damage after ten daily sessions with 25-50 min stimulation duration. RESULTS In healthy subjects transorbital ACS increased the activated cortical surface area, decreased the fMRI response amplitude and increased coherence in the visual cortex, which was most prominent in the full field task. In the patient, stimulation improved contrast sensitivity in the central visual field. BOLD amplitudes and coherence values were increased in most early visual areas in both hemispheres, with the most pronounced activation detected during eccentricity testing in retinotopic mapping. CONCLUSIONS This feasibility study showed that transorbital ACS modifies BOLD activity to visual stimulation, which outlasts the duration of the AC stimulation. This is in line with earlier neurophysiological findings of increased power in EEG recordings and functional connectivity reorganization in patients with impaired vision. Accordingly, the larger BOLD response area after stimulation can be explained by more coherent activation and lower variability in the activation. Alternatively, increased neuronal activity can also be taken into account. Controlled trials are needed to systematically evaluate the potential of repetitive transorbital ACS to improve visual function after visual pathway stroke and to determine the cause-effect relationship between neural and BOLD activity changes.
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Affiliation(s)
- Bernhard A Sabel
- Institute of Medical Psychology, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany.
| | - Aini Ismafairus Abd Hamid
- Department of Biomedical Magnetic Resonance, Institute for Experimental Physics, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany; Department of Neurosciences, School of Medical Sciences Health Campus, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Carolin Borrmann
- Institute of Medical Psychology, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany
| | - Oliver Speck
- Center for Behavioral Brain Sciences, Magdeburg, Germany; Department of Biomedical Magnetic Resonance, Institute for Experimental Physics, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany; Department of Neurosciences, School of Medical Sciences Health Campus, Jalan Hospital USM, 16150 Kubang Kerian, Kelantan, Malaysia; Leibniz Institute for Neurobiology, Magdeburg, Germany; German Center for Neurodegenerative Disease (DZNE), Germany
| | - Andrea Antal
- Institute of Medical Psychology, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany; Department of Clinical Neurophysiology, University Medical Center Göttingen, Göttingen, Germany
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19
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Larcombe SJ, Kulyomina Y, Antonova N, Ajina S, Stagg CJ, Clatworthy PL, Bridge H. Visual training in hemianopia alters neural activity in the absence of behavioural improvement: a pilot study. Ophthalmic Physiol Opt 2019; 38:538-549. [PMID: 30357899 PMCID: PMC6282990 DOI: 10.1111/opo.12584] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/08/2018] [Indexed: 01/01/2023]
Abstract
Background Damage to the primary visual cortex (V1) due to stroke often results in permanent loss of sight affecting one side of the visual field (homonymous hemianopia). Some rehabilitation approaches have shown improvement in visual performance in the blind region, but require a significant time investment. Methods Seven patients with cortical damage performed 400 trials of a motion direction discrimination task daily for 5 days. Three patients received anodal transcranial direct current stimulation (tDCS) during training, three received sham stimulation and one had no stimulation. Each patient had an assessment of visual performance and a functional magnetic resonance imaging (fMRI) scan before and after training to measure changes in visual performance and cortical activity. Results No patients showed improvement in visual function due to the training protocol, and application of tDCS had no effect on visual performance. However, following training, the neural response in motion area hMT+ to a moving stimulus was altered. When the stimulus was presented to the sighted hemifield, activity decreased in hMT+ of the damaged hemisphere. There was no change in hMT+ response when the stimulus was presented to the impaired hemifield. There was a decrease in activity in the inferior precuneus after training when the stimulus was presented to either the impaired or sighted hemifield. Preliminary analysis of tDCS data suggested that anodal tDCS interacted with the delivered training, modulating the neural response in hMT+ in the healthy side of the brain. Conclusion Training can affect the neural responses in hMT+ even in the absence of change in visual performance.
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Affiliation(s)
- Stephanie J Larcombe
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences (NDCN), University of Oxford, Oxford, UK
| | - Yuliya Kulyomina
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences (NDCN), University of Oxford, Oxford, UK
| | - Nikoleta Antonova
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, UK
| | - Sara Ajina
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences (NDCN), University of Oxford, Oxford, UK
| | - Charlotte J Stagg
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences (NDCN), University of Oxford, Oxford, UK.,Department of Psychiatry, Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Philip L Clatworthy
- Bristol Medical School: Translational Health Sciences, University of Bristol, Bristol, UK
| | - Holly Bridge
- Oxford Centre for Functional MRI of the Brain (FMRIB), Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences (NDCN), University of Oxford, Oxford, UK
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20
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Casco C, Barollo M, Contemori G, Battaglini L. Neural Restoration Training improves visual functions and expands visual field of patients with homonymous visual field defects. Restor Neurol Neurosci 2018. [PMID: 29526854 DOI: 10.3233/rnn-170752] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In recent years, the introduction of visual rehabilitation for patients with homonymous visual field defects has been met with both enthusiasm and caution. Despite the evidence that restitutive training results in expansion of the visual field, several concerns have been raised. OBJECTIVE We tested the effectiveness of a new rehabilitative protocol called "Neuro Restoration Training" (NRT) in reducing visual field defects and in restituting visual functions in the restored hemianopic area. METHODS Ten patients with homonymous visual field defects (lesion age >6 months) where trained in detecting low contrast Gabor patches randomly presented in the blind field, which refers to regions of 0 dB sensitivity, and along the hemianopic boundary between absolute (0 dB) and partial blindness (>0 dB). Training included static, drifting, and flickering Gabors in different blocks. Positions along the hemianopic boundary were systematically shifted toward the blind field according to the threshold reduction during the training. Before and after the training, we assessed visual field expansion and improvement in different high-level transfer tasks (i.e., letter identification and shape recognition) performed in the hemianopic boundary and in the blind field. RESULTS NRT led to significant visual field enlargement (≈5 deg), as indicated by the conventional Humphrey perimetry, and two custom made evaluations of visual field expansion with eye movement control (one static and one dynamic). The restored area acquired new visual functions such as small letter recognition and perception of moving shapes. Finally, for some patients, NRT also improved detection, either aware or not, of high contrast flickering grating and recognition of geometrical shapes entirely presented within the blind field. CONCLUSION These results suggest that NRT may lead to visual field enlargement and translate into untrained visual functions.
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Affiliation(s)
- Clara Casco
- Department of General Psychology, University of Padova, Padova, Italy.,Neuro.Vis.U.S. Laboratory, University of Padova, Padova, Italy
| | - Michele Barollo
- Department of General Psychology, University of Padova, Padova, Italy.,Neuro.Vis.U.S. Laboratory, University of Padova, Padova, Italy
| | - Giulio Contemori
- Department of General Psychology, University of Padova, Padova, Italy.,Neuro.Vis.U.S. Laboratory, University of Padova, Padova, Italy
| | - Luca Battaglini
- Department of General Psychology, University of Padova, Padova, Italy.,Neuro.Vis.U.S. Laboratory, University of Padova, Padova, Italy
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21
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22
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Matteo BM, Viganò B, Cerri CG, Meroni R, Cornaggia CM, Perin C. Transcranial direct current stimulation (tDCS) combined with blindsight rehabilitation for the treatment of homonymous hemianopia: a report of two-cases. J Phys Ther Sci 2017; 29:1700-1705. [PMID: 28932016 PMCID: PMC5599849 DOI: 10.1589/jpts.29.1700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 06/08/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Homonymous hemianopia is one of the most common symptoms following neurologic damage leading to impairments of functional abilities and activities of daily living. There are two main types of restorative rehabilitation in hemianopia: "border training" which involves exercising vision at the edge of the damaged visual field, and "blindsight training," which is based on exercising the unconscious perceptual functions deep inside the blind hemifield. Only border effects have been shown to be facilitated by transcranial direct current stimulation (tDCS). This pilot study represents the first attempt to associate the modulatory effects of tDCS over the parieto-occipital cortex to blindsight treatment in the rehabilitation of the homonymous hemianopia. [Subjects and Methods] Patients TA and MR both had chronic hemianopia. TA underwent blindsight treatment which was combined with tDCS followed by blindsight training alone. MR underwent the two training rounds in reverse order. [Results] The patients showed better scores in clinical-instrumental, functional, and ecological assessments after tDCS combined with blindsight rehabilitation rather than rehabilitation alone. [Conclusion] In this two-case report parietal-occipital tDCS modulate the effects induced by blindsight treatment on hemianopia.
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Affiliation(s)
- Barbara Maria Matteo
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Barbara Viganò
- School of Psychology, University of Milan-Bicocca,
Italy
| | - Cesare Giuseppe Cerri
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Roberto Meroni
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Cesare Maria Cornaggia
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
| | - Cecilia Perin
- School of Medicine and Surgery, University of
Milan-Bicocca: Piazza dell’Ateneo Nuovo, 1, 20126, Milan, Italy
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23
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Hadid V, Lepore F. From Cortical Blindness to Conscious Visual Perception: Theories on Neuronal Networks and Visual Training Strategies. Front Syst Neurosci 2017; 11:64. [PMID: 28912694 PMCID: PMC5583595 DOI: 10.3389/fnsys.2017.00064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 08/11/2017] [Indexed: 12/13/2022] Open
Abstract
Homonymous hemianopia (HH) is the most common cortical visual impairment leading to blindness in the contralateral hemifield. It is associated with many inconveniences and daily restrictions such as exploration and visual orientation difficulties. However, patients with HH can preserve the remarkable ability to unconsciously perceive visual stimuli presented in their blindfield, a phenomenon known as blindsight. Unfortunately, the nature of this captivating residual ability is still misunderstood and the rehabilitation strategies in terms of visual training have been insufficiently exploited. This article discusses type I and type II blindsight in a neuronal framework of altered global workspace, resulting from inefficient perception, attention and conscious networks. To enhance synchronization and create global availability for residual abilities to reach visual consciousness, rehabilitation tools need to stimulate subcortical extrastriate pathways through V5/MT. Multisensory bottom-up compensation combined with top-down restitution training could target pre-existing and new neuronal mechanisms to recreate a framework for potential functionality.
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Affiliation(s)
- Vanessa Hadid
- Département de Sciences Biomédicales, Université de MontréalMontréal, QC, Canada
| | - Franco Lepore
- Centre de Recherche en Neuropsychologie et Cognition (CERNEC), Département de Psychologie, Université de MontréalMontréal, QC, Canada
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24
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Behrens JR, Kraft A, Irlbacher K, Gerhardt H, Olma MC, Brandt SA. Long-Lasting Enhancement of Visual Perception with Repetitive Noninvasive Transcranial Direct Current Stimulation. Front Cell Neurosci 2017; 11:238. [PMID: 28860969 PMCID: PMC5559806 DOI: 10.3389/fncel.2017.00238] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/26/2017] [Indexed: 12/23/2022] Open
Abstract
Understanding processes performed by an intact visual cortex as the basis for developing methods that enhance or restore visual perception is of great interest to both researchers and medical practitioners. Here, we explore whether contrast sensitivity, a main function of the primary visual cortex (V1), can be improved in healthy subjects by repetitive, noninvasive anodal transcranial direct current stimulation (tDCS). Contrast perception was measured via threshold perimetry directly before and after intervention (tDCS or sham stimulation) on each day over 5 consecutive days (24 subjects, double-blind study). tDCS improved contrast sensitivity from the second day onwards, with significant effects lasting 24 h. After the last stimulation on day 5, the anodal group showed a significantly greater improvement in contrast perception than the sham group (23 vs. 5%). We found significant long-term effects in only the central 2–4° of the visual field 4 weeks after the last stimulation. We suspect a combination of two factors contributes to these lasting effects. First, the V1 area that represents the central retina was located closer to the polarization electrode, resulting in higher current density. Second, the central visual field is represented by a larger cortical area relative to the peripheral visual field (cortical magnification). This is the first study showing that tDCS over V1 enhances contrast perception in healthy subjects for several weeks. This study contributes to the investigation of the causal relationship between the external modulation of neuronal membrane potential and behavior (in our case, visual perception). Because the vast majority of human studies only show temporary effects after single tDCS sessions targeting the visual system, our study underpins the potential for lasting effects of repetitive tDCS-induced modulation of neuronal excitability.
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Affiliation(s)
- Janina R Behrens
- Charité Universitätsmedizin BerlinBerlin, Germany.,NeuroCare Clinical Research Center, Charité Universitätsmedizin BerlinBerlin, Germany
| | - Antje Kraft
- Department of Psychiatry, Psychiatric University Hospital St. Hedwig, Charité Universitätsmedizin BerlinBerlin, Germany
| | | | - Holger Gerhardt
- Center for Economics and Neuroscience, Rheinische Friedrich-Wilhelms-Universität BonnBonn, Germany
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Abstract
Homonymous hemianopia from stroke causes visual disability. Although some patients experience spontaneous improvement, others have limited to no change and may be left with a severe disability. Current rehabilitation strategies are compensatory and cannot restore function. Animal studies suggest that central nervous system plasticity could allow for redirection of lost visual function into undamaged areas of cortex. A commercial therapy system was developed, from which claims of visual field expansion were disputed by independent researchers. The treatment remains controversial with seemingly contradictory data being generated. Continued research is underway to demonstrate the (non-)efficacy of this treatment method.
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Affiliation(s)
- Alexander Frolov
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Jeanne Feuerstein
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Prem S Subramanian
- Department of Ophthalmology, University of Colorado School of Medicine, Mail Stop F731, 1675 Aurora Court, Aurora, CO 80045, USA.
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Guerrero Solano JL, Pacheco EM, Roldan GF, Prieto Montalvo JI, Gongora Rivera JF. Potential beneficial effects of high frequency rTMS to enhance visual function in bilateral visual cortex stroke: Case report. Brain Stimul 2017; 10:326-327. [DOI: 10.1016/j.brs.2016.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022] Open
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Alber R, Moser H, Gall C, Sabel BA. Combined Transcranial Direct Current Stimulation and Vision Restoration Training in Subacute Stroke Rehabilitation: A Pilot Study. PM R 2017; 9:787-794. [DOI: 10.1016/j.pmrj.2016.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 12/13/2016] [Accepted: 12/17/2016] [Indexed: 01/04/2023]
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Romei V, Thut G, Silvanto J. Information-Based Approaches of Noninvasive Transcranial Brain Stimulation. Trends Neurosci 2016; 39:782-795. [PMID: 27697295 DOI: 10.1016/j.tins.2016.09.001] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/01/2016] [Accepted: 09/06/2016] [Indexed: 11/16/2022]
Abstract
Progress in cognitive neuroscience relies on methodological developments to increase the specificity of knowledge obtained regarding brain function. For example, in functional neuroimaging the current trend is to study the type of information carried by brain regions rather than simply compare activation levels induced by task manipulations. In this context noninvasive transcranial brain stimulation (NTBS) in the study of cognitive functions may appear coarse and old fashioned in its conventional uses. However, in their multitude of parameters, and by coupling them with behavioral manipulations, NTBS protocols can reach the specificity of imaging techniques. Here we review the different paradigms that have aimed to accomplish this in both basic science and clinical settings and follow the general philosophy of information-based approaches.
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Affiliation(s)
- Vincenzo Romei
- Centre for Brain Science, Department of Psychology, University of Essex, Colchester, UK.
| | - Gregor Thut
- Centre for Cognitive Neuroimaging, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
| | - Juha Silvanto
- Department of Psychology, Faculty of Science and Technology, University of Westminster, London, UK.
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Cunningham DA, Varnerin N, Machado A, Bonnett C, Janini D, Roelle S, Potter-Baker K, Sankarasubramanian V, Wang X, Yue G, Plow EB. Stimulation targeting higher motor areas in stroke rehabilitation: A proof-of-concept, randomized, double-blinded placebo-controlled study of effectiveness and underlying mechanisms. Restor Neurol Neurosci 2016; 33:911-26. [PMID: 26484700 DOI: 10.3233/rnn-150574] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To demonstrate, in a proof-of-concept study, whether potentiating ipsilesional higher motor areas (premotor cortex and supplementary motor area) augments and accelerates recovery associated with constraint induced movement. METHODS In a randomized, double-blinded pilot clinical study, 12 patients with chronic stroke were assigned to receive anodal transcranial direct current stimulation (tDCS) (n = 6) or sham (n = 6) to the ipsilesional higher motor areas during constraint-induced movement therapy. We assessed functional and neurophysiologic outcomes before and after 5 weeks of therapy. RESULTS Only patients receiving tDCS demonstrated gains in function and dexterity. Gains were accompanied by an increase in excitability of the contralesional rather than the ipsilesional hemisphere. CONCLUSIONS Our proof-of-concept study provides early evidence that stimulating higher motor areas can help recruit the contralesional hemisphere in an adaptive role in cases of greater ipsilesional injury. Whether this early evidence of promise translates to remarkable gains in functional recovery compared to existing approaches of stimulation remains to be confirmed in large-scale clinical studies that can reasonably dissociate stimulation of higher motor areas from that of the traditional primary motor cortices.
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Affiliation(s)
- David A Cunningham
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.,School of Biomedical Sciences, Kent State University, Kent, OH, USA
| | - Nicole Varnerin
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Andre Machado
- Center for Neurological Restoration, Neurosurgery, Neurological Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Corin Bonnett
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Daniel Janini
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Roelle
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | - Kelsey Potter-Baker
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA
| | | | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA
| | - Guang Yue
- Human Performance & Engineering Laboratory, Kessler Foundation Research Center, West Orange, NJ, USA
| | - Ela B Plow
- Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA.,Center for Neurological Restoration, Neurosurgery, Neurological Inst., Cleveland Clinic, Cleveland, OH, USA.,Department of Physical Medicine & Rehab, Neurological Inst., Cleveland Clinic, Cleveland, OH, USA
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Rahmatnejad K, Ahmed OM, Waisbourd M, Katz LJ. Non-invasive electrical stimulation for vision restoration: dream or reality? EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1221761] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Transcranial direct current stimulation as a tool in the study of sensory-perceptual processing. Atten Percept Psychophys 2016; 77:1813-40. [PMID: 26139152 DOI: 10.3758/s13414-015-0932-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulatory technique with increasing popularity in the fields of basic research and rehabilitation. It is an affordable and safe procedure that is beginning to be used in the clinic, and is a tool with potential to contribute to the understanding of neural mechanisms in the fields of psychology, neuroscience, and medical research. This review presents examples of investigations in the fields of perception, basic sensory processes, and sensory rehabilitation that employed tDCS. We highlight some of the most relevant efforts in this area and discuss possible limitations and gaps in contemporary tDCS research. Topics include the five senses, pain, and multimodal integration. The present work aims to present the state of the art of this field of research and to inspire future investigations of perception using tDCS.
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Models to Tailor Brain Stimulation Therapies in Stroke. Neural Plast 2016; 2016:4071620. [PMID: 27006833 PMCID: PMC4781989 DOI: 10.1155/2016/4071620] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 12/30/2015] [Accepted: 01/04/2016] [Indexed: 11/18/2022] Open
Abstract
A great challenge facing stroke rehabilitation is the lack of information on how to derive targeted therapies. As such, techniques once considered promising, such as brain stimulation, have demonstrated mixed efficacy across heterogeneous samples in clinical studies. Here, we explain reasons, citing its one-type-suits-all approach as the primary cause of variable efficacy. We present evidence supporting the role of alternate substrates, which can be targeted instead in patients with greater damage and deficit. Building on this groundwork, this review will also discuss different frameworks on how to tailor brain stimulation therapies. To the best of our knowledge, our report is the first instance that enumerates and compares across theoretical models from upper limb recovery and conditions like aphasia and depression. Here, we explain how different models capture heterogeneity across patients and how they can be used to predict which patients would best respond to what treatments to develop targeted, individualized brain stimulation therapies. Our intent is to weigh pros and cons of testing each type of model so brain stimulation is successfully tailored to maximize upper limb recovery in stroke.
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Abstract
The incidence of cortically induced blindness is increasing as our population ages. The major cause of cortically induced blindness is stroke affecting the primary visual cortex. While the impact of this form of vision loss is devastating to quality of life, the development of principled, effective rehabilitation strategies for this condition lags far behind those used to treat motor stroke victims. Here we summarize recent developments in the still emerging field of visual restitution therapy, and compare the relative effectiveness of different approaches. We also draw insights into the properties of recovered vision, its limitations and likely neural substrates. We hope that these insights will guide future research and bring us closer to the goal of providing much-needed rehabilitation solutions for this patient population.
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Affiliation(s)
- Michael D Melnick
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY, USA
| | - Duje Tadin
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY, USA The Flaum Eye Institute, University of Rochester, Rochester, NY, USA The Center for Visual Science, University of Rochester, Rochester, NY, USA
| | - Krystel R Huxlin
- Department of Brain & Cognitive Sciences, University of Rochester, Rochester, NY, USA The Flaum Eye Institute, University of Rochester, Rochester, NY, USA The Center for Visual Science, University of Rochester, Rochester, NY, USA
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Siong KH, Woo GC, Chan DYL, Chung KYK, Li LSW, Cheung HKY, Lai CKY, Cheong AMY. Prevalence of visual problems among stroke survivors in Hong Kong Chinese. Clin Exp Optom 2015; 97:433-41. [PMID: 25138748 DOI: 10.1111/cxo.12166] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 03/23/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Stroke, a common cerebrovascular accident, usually results in various extents of functional disability. Extensive studies have shown that ocular and visual problems are common in patients with stroke. Unfortunately, current stroke rehabilitation programs rarely address stroke-related ocular and visual problems in Hong Kong. METHODS To examine how visual impairment (for example, deterioration in visual acuity and restriction in visual field) affects the stroke population in Hong Kong, vision screening was conducted for post-stroke patients attending in-patient and out-patient stroke clinics at two hospitals. RESULTS One hundred and thirteen stroke patients were recruited. The percentage of various aspects of visual problems in Hong Kong post-stroke patients was generally lower than that reported in Western countries; however, a high percentage of patients had deficits in oculomotor (53.1 per cent) and vergence functions (11.5 per cent), restrictions in binocular visual field (11.5 per cent) and impairment in visual acuity (worse than 0.30 logMAR, 29.8 per cent). Conversely, only a small proportion of patients noticed problems with their vision (for example, diplopia and blurry vision) through subjective reports. This revealed that many post-stroke patients had undetected or undiagnosed ocular and visual problems. Appropriate referral was given to patients with visual problems for further evaluation and treatment. CONCLUSION Neglecting visual problems may impose deteriorating effect on patients' stroke rehabilitation and functional independence and lead to increased incidents of injury. To address this potential hindrance in rehabilitation, formal screening for visual problems in stroke patients in a rehabilitation setting is essential.
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Affiliation(s)
- Kar Ho Siong
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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36
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Contrasting effects of transcranial direct current stimulation on central and peripheral visual fields. Exp Brain Res 2015; 233:1391-7. [PMID: 25650104 DOI: 10.1007/s00221-015-4213-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
Abstract
Recent research suggested that transcranial direct current stimulation (tDCS) can affect visual processing and that it can be useful in visual rehabilitation. Nevertheless, there are still few investigations on the subject. tDCS selectivity and the extent of its outcomes on visual perception are still to be assessed. Here, we investigate whether central and peripheral visual fields are equally affected by tDCS. We also tried to reproduce a previous work that has evaluated tDCS effects on the central visual field only (Kraft et al. 207:283-290, 2010). Fifteen healthy subjects participated in this randomized repeated-measure design study and received 1.5-mA anodal, cathodal and sham stimulation in different sessions, while performing 10-2 and 60-4 protocols in an automated perimeter. Anodal tDCS significantly decreased thresholds, but was limited to the most eccentric regions of the visual field measured (60°). This suggests that tDCS might be used for rehabilitation of peripheral visual field losses. We did not replicate the excitatory tDCS effect in the central visual field as previously reported by another group. Instead, we observed a trend toward an inhibitory (yet not statistically significant) effect of anodal tDCS on the central field. This might be explained by methodological differences. These results highlight that although tDCS is a technique with a low focality in the spatial domain, its effects might be highly focal in a functional domain. When taken together with previous findings, this also suggests that tDCS may have a differential effect on different retinotopic areas in the brain.
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Urbanski M, Coubard OA, Bourlon C. Visualizing the blind brain: brain imaging of visual field defects from early recovery to rehabilitation techniques. Front Integr Neurosci 2014; 8:74. [PMID: 25324739 PMCID: PMC4179723 DOI: 10.3389/fnint.2014.00074] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/03/2014] [Indexed: 01/04/2023] Open
Abstract
Visual field defects (VFDs) are one of the most common consequences observed after brain injury, especially after a stroke in the posterior cerebral artery territory. Less frequently, tumors, traumatic brain injury, brain surgery or demyelination can also determine various visual disabilities, from a decrease in visual acuity to cerebral blindness. Visual field defects is a factor of bad functional prognosis as it compromises many daily life activities (e.g., obstacle avoidance, driving, and reading) and therefore the patient's quality of life. Spontaneous recovery seems to be limited and restricted to the first 6 months, with the best chance of improvement at 1 month. The possible mechanisms at work could be partly due to cortical reorganization in the visual areas (plasticity) and/or partly to the use of intact alternative visual routes, first identified in animal studies and possibly underlying the phenomenon of blindsight. Despite processes of early recovery, which is rarely complete, and learning of compensatory strategies, the patient's autonomy may still be compromised at more chronic stages. Therefore, various rehabilitation therapies based on neuroanatomical knowledge have been developed to improve VFDs. These use eye-movement training techniques (e.g., visual search, saccadic eye movements), reading training, visual field restitution (the Vision Restoration Therapy, VRT), or perceptual learning. In this review, we will focus on studies of human adults with acquired VFDs, which have used different imaging techniques (Positron Emission Tomography, PET; Diffusion Tensor Imaging, DTI; functional Magnetic Resonance Imaging, fMRI; Magneto Encephalography, MEG) or neurostimulation techniques (Transcranial Magnetic Stimulation, TMS; transcranial Direct Current Stimulation, tDCS) to show brain activations in the course of spontaneous recovery or after specific rehabilitation techniques.
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Affiliation(s)
- Marika Urbanski
- Service de Médecine et de Réadaptation Gériatrique et Neurologique, Hôpitaux de Saint-Maurice Saint-Maurice, France ; Inserm, U 1127, ICM FrontLab Paris, France ; CNRS, UMR 7225, ICM FrontLab Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, UMRS 1127 Paris, France ; Institut du Cerveau et de la Moelle Épinière, ICM FrontLab Paris, France
| | - Olivier A Coubard
- The Neuropsychological Laboratory, CNS-Fed Paris, France ; Laboratoire Psychologie de la Perception, UMR 8242 CNRS-Université Paris Descartes Paris, France
| | - Clémence Bourlon
- Service de Médecine et de Réadaptation, Clinique Les Trois Soleils Boissise-le-Roi, France
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Guarienti F, Caumo W, Shiozawa P, Cordeiro Q, Boggio PS, Benseñor IM, Lotufo PA, Bikson M, Brunoni AR. Reducing transcranial direct current stimulation-induced erythema with skin pretreatment: considerations for sham-controlled clinical trials. Neuromodulation 2014; 18:261-5. [PMID: 25209456 DOI: 10.1111/ner.12230] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/21/2014] [Accepted: 06/10/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Transcranial direct current stimulation (tDCS)-induced erythema (skin reddening) has been described as an adverse effect that can harm blinding integrity in sham-controlled designs. To tackle this issue, we investigated whether the use of topical pretreatments could decrease erythema and other adverse effects associated with tDCS. MATERIALS AND METHODS Thirty healthy volunteers were recruited, and four interventions were applied 30 min prior to tDCS in a Latin square design: placebo, ketoprofen 2%, hydroxyzine 1%, and lidocaine 5%. TDCS was applied for 30 min (2 mA, anode and cathode over F3 and F4, respectively) in two active sessions with a minimum 1-week interval. The Draize erythema scoring system scale was used to assess erythema intensity; a tDCS questionnaire was used to assess other adverse effects (e.g., tingling, itching, burning sensation, and pain). RESULTS We found that ketoprofen (but not hydroxyzine or lidocaine) significantly attenuated tDCS-induced erythema regarding intensity and duration, with a medium effect compared with placebo. Erythema was overall mild, short-lived (lasting 18-24 min after tDCS ending), and more intense under the anode. Subjects with darker skin color also tended to present less intense tDCS-induced erythema. The prevalence of other adverse effects was low and did not differ between dermatological groups. CONCLUSIONS Ketoprofen 2% topical pretreatment might be an interesting strategy to reduce tDCS-induced erythema and might be useful for blinding improvement in further sham-controlled tDCS trials.
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Affiliation(s)
- Fabiana Guarienti
- Service of Interdisciplinary Neuromodulation & Interdisciplinary Center for Applied Neuromodulation, Department and Institute of Psychiatry, University Hospital, University of São Paulo, São Paulo, Brazil.,Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Wolnei Caumo
- Laboratory of Pain and Neuromodulation, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro Shiozawa
- Service of Interdisciplinary Neuromodulation & Interdisciplinary Center for Applied Neuromodulation, Department and Institute of Psychiatry, University Hospital, University of São Paulo, São Paulo, Brazil.,Laboratory of Clinical Neuromodulation, Santa Casa Medical School, São Paulo, Brazil
| | - Quirino Cordeiro
- Laboratory of Clinical Neuromodulation, Santa Casa Medical School, São Paulo, Brazil
| | - Paulo S Boggio
- Laboratory of Cognitive and Social Neurosciences, Mackenzie Presbyterian University, São Paulo, Brazil
| | - Isabela M Benseñor
- Service of Interdisciplinary Neuromodulation & Interdisciplinary Center for Applied Neuromodulation, Department and Institute of Psychiatry, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Paulo A Lotufo
- Service of Interdisciplinary Neuromodulation & Interdisciplinary Center for Applied Neuromodulation, Department and Institute of Psychiatry, University Hospital, University of São Paulo, São Paulo, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, City University of New York, New York, NY, USA
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation & Interdisciplinary Center for Applied Neuromodulation, Department and Institute of Psychiatry, University Hospital, University of São Paulo, São Paulo, Brazil
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Effectiveness and neural mechanisms associated with tDCS delivered to premotor cortex in stroke rehabilitation: study protocol for a randomized controlled trial. Trials 2013; 14:331. [PMID: 24119615 PMCID: PMC3852558 DOI: 10.1186/1745-6215-14-331] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/02/2013] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND More than 60% of stroke survivors experience residual deficits of the paretic upper limb/hand. Standard rehabilitation generates modest gains. Stimulation delivered to the surviving Primary Motor Cortex in the stroke-affected hemisphere has been considered a promising adjunct. However, recent trials challenge its advantage. We discuss our pilot clinical trial that aims to address factors implicated in divergent success of the approach. We assess safety, feasibility and efficacy of targeting an alternate locus during rehabilitation- the premotor cortex. In anticipating variance across patients, we measure neural markers differentiating response from non-response. METHODS/DESIGN In a randomized, sham-controlled, double-blinded pilot clinical study, patients with chronic stroke (n = 20) are assigned to receive transcranial direct current stimulation delivered to the premotor cortex or sham during rehabilitation of the paretic arm/hand. Patients receive the designated intervention for 30 min, twice a day for 3 days a week for 5 weeks. We assess hand function and patients' reports of use of paretic hand. A general linear mixed methods model will analyze changes from pre- to post-intervention. Responders and non-responders will be compared upon baseline level of function, and neural substrates, including function and integrity of output tracts, bi-hemispheric balance, and lesion profile. Incidence of adverse events will be compared using Fisher's Exact test, while rigor of blinding will be assessed with Chi-square analysis to ascertain feasibility. DISCUSSION Variable success of cortical stimulation in rehabilitation can be related to gaps in theoretical basis and clinical investigation. Given that most patients with severe deficits have damage to the primary motor cortex or its output pathways, it would be futile to target stimulation to this site. We suggest targeting premotor cortex because it contributes substantially to descending output, a role that is amplified with greater damage to the motor cortex. With regards to clinical investigation, paired cortical stimulation in rehabilitation has been compared to rehabilitation alone in unblinded trials or to unconvincing sham conditions. Transcranial direct current stimulation, a noninvasive technique of brain stimulation, which offers a more effective placebo and has a favorable safety-feasibility profile, may improve scientific rigor. Neural markers of response would help inform patient selection for future clinical trials so we can address limitations of recent negative studies. TRIAL REGISTRATION NCT01539096.
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Olma MC, Dargie RA, Behrens JR, Kraft A, Irlbacher K, Fahle M, Brandt SA. Long-Term Effects of Serial Anodal tDCS on Motion Perception in Subjects with Occipital Stroke Measured in the Unaffected Visual Hemifield. Front Hum Neurosci 2013; 7:314. [PMID: 23805097 PMCID: PMC3690540 DOI: 10.3389/fnhum.2013.00314] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/10/2013] [Indexed: 11/24/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a novel neuromodulatory tool that has seen early transition to clinical trials, although the high variability of these findings necessitates further studies in clinically relevant populations. The majority of evidence into effects of repeated tDCS is based on research in the human motor system, but it is unclear whether the long-term effects of serial tDCS are motor-specific or transferable to other brain areas. This study aimed to examine whether serial anodal tDCS over the visual cortex can exogenously induce long-term neuroplastic changes in the visual cortex. However, when the visual cortex is affected by a cortical lesion, up-regulated endogenous neuroplastic adaptation processes may alter the susceptibility to tDCS. To this end, motion perception was investigated in the unaffected hemifield of subjects with unilateral visual cortex lesions. Twelve subjects with occipital ischemic lesions participated in a within-subject, sham-controlled, double-blind study. MRI-registered sham or anodal tDCS (1.5 mA, 20 min) was applied on five consecutive days over the visual cortex. Motion perception was tested before and after stimulation sessions and at 14- and 28-day follow-up. After a 16-day interval an identical study block with the other stimulation condition (anodal or sham tDCS) followed. Serial anodal tDCS over the visual cortex resulted in an improvement in motion perception, a function attributed to MT/V5. This effect was still measurable at 14- and 28-day follow-up measurements. Thus, this may represent evidence for long-term tDCS-induced plasticity and has implications for the design of studies examining the time course of tDCS effects in both the visual and motor systems.
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Affiliation(s)
- M C Olma
- Department of Neurology, Charité University Hospital , Berlin , Germany
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Abstract
There are currently two techniques to manipulate brain function non-invasively: transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). These brain stimulation techniques work to cause long-term change within the brain. We have been combining noninvasive brain stimulation with functional magnetic resonance imaging (fMRI) to investigate the plasticity of brain networks. When fMRI is used as an outcome measure, it is possible to identify the specificity of tDCS-modulated plasticity in a visual rehabilitation protocol. Alternatively, fMRI can be used as a guide for stimulation. Brain stimulation with TMS affects neural networks, and fMRI guidance combined with an understanding of network effects of TMS may improve TMS therapy.
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The second face of blindness: processing speed deficits in the intact visual field after pre- and post-chiasmatic lesions. PLoS One 2013; 8:e63700. [PMID: 23667657 PMCID: PMC3648511 DOI: 10.1371/journal.pone.0063700] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 04/09/2013] [Indexed: 01/25/2023] Open
Abstract
Purpose Damage along the visual pathway results in a visual field defect (scotoma), which retinotopically corresponds to the damaged neural tissue. Other parts of the visual field, processed by the uninjured tissue, are considered to be intact. However, perceptual deficits have been observed in the “intact” visual field, but these functional impairments are poorly understood. We now studied temporal processing deficits in the intact visual field of patients with either pre- or post-chiasmatic lesions to better understand the functional consequences of partial blindness. Methods Patients with pre- (n = 53) or post- chiasmatic lesions (n = 98) were tested with high resolution perimetry – a method used to map visual fields with supra-threshold light stimuli. Reaction time of detections in the intact visual field was then analyzed as an indicator of processing speed and correlated with features of the visual field defect. Results Patients from both groups exhibited processing speed deficits in their presumably “intact” field as indicated by comparison to a normative sample. Further, in both groups processing speed was found to be a function of two factors. Firstly, a spatially restricted (retinotopic) influence of the scotoma was seen in longer reaction times when stimuli were presented in intact field sectors close to the defect. Secondly, patients with larger scotomata had on average longer reaction times in their intact field indicating a more general (non-retinotopic) influence of the scotoma. Conclusions Processing speed deficits in the “intact” visual field of patients with visual system damage demonstrate that visual system lesions have more widespread consequences on perception than previously thought. Because dysfunctions of the seeing field are expected to contribute to subjective vision, including visual tests of the presumed “intact” field may help to better understand vision loss and to improve methods of vision restoration and rehabilitation.
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Non-invasive electrical brain stimulation induces vision restoration in patients with visual pathway damage. Graefes Arch Clin Exp Ophthalmol 2012; 251:1041-3. [PMID: 22733164 DOI: 10.1007/s00417-012-2084-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 04/18/2012] [Accepted: 05/31/2012] [Indexed: 12/27/2022] Open
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Plow EB, Obretenova SN, Jackson ML, Merabet LB. Temporal profile of functional visual rehabilitative outcomes modulated by transcranial direct current stimulation. Neuromodulation 2012; 15:367-73. [PMID: 22376226 DOI: 10.1111/j.1525-1403.2012.00440.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We have previously reported that transcranial direct current stimulation (tDCS) delivered to the occipital cortex enhances visual functional recovery when combined with three months of computer-based rehabilitative training in patients with hemianopia. The principal objective of this study was to evaluate the temporal sequence of effects of tDCS on visual recovery as they appear over the course of training and across different indicators of visual function. METHODS Primary objective outcome measures were 1) shifts in visual field border and 2) stimulus detection accuracy within the affected hemifield. These were compared between patients randomized to either vision restoration therapy (VRT) combined with active tDCS or VRT paired with sham tDCS. Training comprised two half-hour sessions, three times a week for three months. Primary outcome measures were collected at baseline (pretest), monthly interim intervals, and at posttest (three months). As secondary outcome measures, contrast sensitivity and reading performance were collected at pretest and posttest time points only. RESULTS Active tDCS combined with VRT accelerated the recovery of stimulus detection as between-group differences appeared within the first month of training. In contrast, a shift in the visual field border was only evident at posttest (after three months of training). tDCS did not affect contrast sensitivity or reading performance. CONCLUSIONS These results suggest that tDCS may differentially affect the magnitude and sequence of visual recovery in a manner that is task specific to the type of visual rehabilitative training strategy employed.
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Affiliation(s)
- Ela B Plow
- The Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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