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Fernández-Pérez JJ, Serrano-Muñoz D, Beltran-Alacreu H, Avendaño-Coy J, Gómez-Soriano J. Trans-Spinal Direct Current Stimulation in Neurological Disorders: A systematic review. J Neurol Phys Ther 2024; 48:66-74. [PMID: 38015051 DOI: 10.1097/npt.0000000000000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND PURPOSE Trans-spinal direct current stimulation (tsDCS) is a noninvasive stimulation technique that applies direct current stimulation over spinal levels. However, the effectiveness and feasibility of this stimulation are still unclear. This systematic review summarizes the effectiveness of tsDCS in clinical and neurophysiological outcomes in neurological patients, as well as its feasibility and safety. METHODS The search was conducted using the following databases: PEDro, Scopus, Web of Science, CINAHL, SPORTDiscus, and PubMed. The inclusion criteria were: Participants : people with central nervous system diseases; Interventions : tsDCS alone or in combination with locomotion training; Comparators : sham tsDCS, transcranial direct current stimulation, or locomotion training; Outcomes : clinical and neurophysiological measures; and Studies : randomized clinical trials. RESULTS Eight studies with a total of 143 subjects were included. Anodal tsDCS led to a reduction in hypertonia, neuropathic pain intensity, and balance deficits in people with hereditary spastic paraplegia, multiple sclerosis, and primary orthostatic tremor, respectively. In contrast, cathodal tsDCS only had positive effects on balance and tremor in people with primary orthostatic tremor. No severe adverse effects were reported during and after anodal or cathodal tsDCS. DISCUSSION AND CONCLUSIONS Although certain studies have found an effect of anodal tsDCS on specific clinical outcomes in people with central nervous system diseases, its effectiveness cannot be established since these findings have not been replicated and the results were heterogeneous. This stimulation was feasible and safe to apply. Further studies are needed to replicate the obtained results of tsDCS when applied in populations with neurological diseases.
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Affiliation(s)
- Juan José Fernández-Pérez
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing of Toledo, Universidad de Castilla-La Mancha, Toledo, Spain
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Tajali S, Balbinot G, Pakosh M, Sayenko DG, Zariffa J, Masani K. Modulations in neural pathways excitability post transcutaneous spinal cord stimulation among individuals with spinal cord injury: a systematic review. Front Neurosci 2024; 18:1372222. [PMID: 38591069 PMCID: PMC11000807 DOI: 10.3389/fnins.2024.1372222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 03/06/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Transcutaneous spinal cord stimulation (TSCS), a non-invasive form of spinal cord stimulation, has been shown to improve motor function in individuals living with spinal cord injury (SCI). However, the effects of different types of TSCS currents including direct current (DC-TSCS), alternating current (AC-TSCS), and spinal paired stimulation on the excitability of neural pathways have not been systematically investigated. The objective of this systematic review was to determine the effects of TSCS on the excitability of neural pathways in adults with non-progressive SCI at any level. Methods The following databases were searched from their inception until June 2022: MEDLINE ALL, Embase, Web of Science, Cochrane Library, and clinical trials. A total of 4,431 abstracts were screened, and 23 articles were included. Results Nineteen studies used TSCS at the thoracolumbar enlargement for lower limb rehabilitation (gait & balance) and four studies used cervical TSCS for upper limb rehabilitation. Sixteen studies measured spinal excitability by reporting different outcomes including Hoffmann reflex (H-reflex), flexion reflex excitability, spinal motor evoked potentials (SMEPs), cervicomedullay evoked potentials (CMEPs), and cutaneous-input-evoked muscle response. Seven studies measured corticospinal excitability using motor evoked potentials (MEPs) induced by transcranial magnetic stimulation (TMS), and one study measured somatosensory evoked potentials (SSEPs) following TSCS. Our findings indicated a decrease in the amplitude of H-reflex and long latency flexion reflex following AC-TSCS, alongside an increase in the amplitudes of SMEPs and CMEPs. Moreover, the application of the TSCS-TMS paired associative technique resulted in spinal reflex inhibition, manifested by reduced amplitudes in both the H-reflex and flexion reflex arc. In terms of corticospinal excitability, findings from 5 studies demonstrated an increase in the amplitude of MEPs linked to lower limb muscles following DC-TSCS, in addition to paired associative stimulation involving repetitive TMS on the brain and DC-TSCS on the spine. There was an observed improvement in the latency of SSEPs in a single study. Notably, the overall quality of evidence, assessed by the modified Downs and Black Quality assessment, was deemed poor. Discussion This review unveils the systematic evidence supporting the potential of TSCS in reshaping both spinal and supraspinal neuronal circuitries post-SCI. Yet, it underscores the critical necessity for more rigorous, high-quality investigations.
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Affiliation(s)
- Shirin Tajali
- KITE Research Institute – University Health Network, Toronto, ON, Canada
| | - Gustavo Balbinot
- KITE Research Institute – University Health Network, Toronto, ON, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application – CRANIA, University Health Network, Toronto, ON, Canada
| | - Maureen Pakosh
- Library & Information Services, University Health Network, Toronto Rehabilitation Institute, ON, Canada
| | - Dimitry G. Sayenko
- Department of Neurosurgery, Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, United States
| | - Jose Zariffa
- KITE Research Institute – University Health Network, Toronto, ON, Canada
- Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Kei Masani
- KITE Research Institute – University Health Network, Toronto, ON, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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Hodaj H, Payen JF, Hodaj E, Sorel M, Dumolard A, Vercueil L, Delon-Martin C, Lefaucheur JP. Long-term analgesic effect of trans-spinal direct current stimulation compared to non-invasive motor cortex stimulation in complex regional pain syndrome. Brain Commun 2023; 5:fcad191. [PMID: 37545548 PMCID: PMC10400160 DOI: 10.1093/braincomms/fcad191] [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: 12/28/2022] [Revised: 05/26/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
The aim of the present study was to compare the analgesic effect of motor cortex stimulation using high-frequency repetitive transcranial magnetic stimulation or transcranial direct current stimulation and transcutaneous spinal direct current stimulation in patients with complex regional pain syndrome. Thirty-three patients with complex regional pain syndrome were randomized to one of the three treatment groups (repetitive transcranial magnetic stimulation, n = 11; transcranial direct current stimulation, n = 10; transcutaneous spinal direct current stimulation, n = 12) and received a series of 12 sessions of stimulation for 3 weeks (induction phase) and 11 sessions for 4 months (maintenance therapy). The primary end-point was the mean pain intensity assessed weekly with a visual numerical scale during the month prior to treatment (baseline), the 5-month stimulation period and 1 month after the treatment. The weekly visual numerical scale pain score was significantly reduced at all time points compared to baseline in the transcutaneous spinal direct current stimulation group, at the last two time points in the repetitive transcranial magnetic stimulation group (end of the 5-month stimulation period and 1 month later), but at no time point in the transcranial direct current stimulation group. A significant pain relief was observed at the end of induction phase using transcutaneous spinal direct current stimulation compared to repetitive transcranial magnetic stimulation (P = 0.008) and to transcranial direct current stimulation (P = 0.003). In this trial, transcutaneous spinal direct current stimulation was more efficient to relieve pain in patients with complex regional pain syndrome compared to motor cortex stimulation techniques (repetitive transcranial magnetic stimulation, transcranial direct current stimulation). This efficacy was found during the induction phase and was maintained thereafter. This study warrants further investigation to confirm the potentiality of transcutaneous spinal direct current stimulation as a therapeutic option in complex regional pain syndrome.
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Affiliation(s)
- Hasan Hodaj
- Correspondence to: Hasan Hodaj Pôle Anesthésie Réanimation CHU Grenoble Alpes, BP217, 38043 Grenoble, FranceE-mail:
| | - Jean-Francois Payen
- Centre de la Douleur, Pôle Anesthésie Réanimation, CHU Grenoble Alpes, 38000 Grenoble, France
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Enkelejda Hodaj
- Centre d'Investigation Clinique, CHU Grenoble Alpes, 38000, Grenoble, France
| | - Marc Sorel
- Centre d'Evaluation et de Traitement de la Douleur, Hôpital Sud-Seine-et-Marne, site Nemours, Nemours, France
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Faculté de Santé, Univ. Paris Est Créteil, Créteil, France
| | - Anne Dumolard
- Centre de la Douleur, Pôle Anesthésie Réanimation, CHU Grenoble Alpes, 38000 Grenoble, France
| | - Laurent Vercueil
- Service de Neurologie, CHU Grenoble Alpes, 38000, Grenoble, France
| | - Chantal Delon-Martin
- Univ. Grenoble Alpes, Inserm, U1216, Grenoble Institut Neurosciences, 38000 Grenoble, France
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Faculté de Santé, Univ. Paris Est Créteil, Créteil, France
- Unité de Neurophysiologie Clinique, Service de Physiologie—Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique—Hôpitaux de Paris, Créteil, France
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Marangolo P, Vasta S, Manfredini A, Caltagirone C. What Else Can Be Done by the Spinal Cord? A Review on the Effectiveness of Transpinal Direct Current Stimulation (tsDCS) in Stroke Recovery. Int J Mol Sci 2023; 24:10173. [PMID: 37373323 DOI: 10.3390/ijms241210173] [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: 05/10/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Since the spinal cord has traditionally been considered a bundle of long fibers connecting the brain to all parts of the body, the study of its role has long been limited to peripheral sensory and motor control. However, in recent years, new studies have challenged this view pointing to the spinal cord's involvement not only in the acquisition and maintenance of new motor skills but also in the modulation of motor and cognitive functions dependent on cortical motor regions. Indeed, several reports to date, which have combined neurophysiological techniques with transpinal direct current stimulation (tsDCS), have shown that tsDCS is effective in promoting local and cortical neuroplasticity changes in animals and humans through the activation of ascending corticospinal pathways that modulate the sensorimotor cortical networks. The aim of this paper is first to report the most prominent tsDCS studies on neuroplasticity and its influence at the cortical level. Then, a comprehensive review of tsDCS literature on motor improvement in animals and healthy subjects and on motor and cognitive recovery in post-stroke populations is presented. We believe that these findings might have an important impact in the future making tsDCS a potential suitable adjunctive approach for post-stroke recovery.
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Affiliation(s)
- Paola Marangolo
- Department of Humanities Studies, University Federico II, 80133 Naples, Italy
| | - Simona Vasta
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessio Manfredini
- Department of Humanities Studies, University Federico II, 80133 Naples, Italy
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Guidetti M, Giannoni-Luza S, Bocci T, Pacheco-Barrios K, Bianchi AM, Parazzini M, Ionta S, Ferrucci R, Maiorana NV, Verde F, Ticozzi N, Silani V, Priori A. Modeling Electric Fields in Transcutaneous Spinal Direct Current Stimulation: A Clinical Perspective. Biomedicines 2023; 11:biomedicines11051283. [PMID: 37238953 DOI: 10.3390/biomedicines11051283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023] Open
Abstract
Clinical findings suggest that transcutaneous spinal direct current stimulation (tsDCS) can modulate ascending sensitive, descending corticospinal, and segmental pathways in the spinal cord (SC). However, several aspects of the stimulation have not been completely understood, and realistic computational models based on MRI are the gold standard to predict the interaction between tsDCS-induced electric fields and anatomy. Here, we review the electric fields distribution in the SC during tsDCS as predicted by MRI-based realistic models, compare such knowledge with clinical findings, and define the role of computational knowledge in optimizing tsDCS protocols. tsDCS-induced electric fields are predicted to be safe and induce both transient and neuroplastic changes. This could support the possibility to explore new clinical applications, such as spinal cord injury. For the most applied protocol (2-3 mA for 20-30 min, active electrode over T10-T12 and the reference on the right shoulder), similar electric field intensities are generated in both ventral and dorsal horns of the SC at the same height. This was confirmed by human studies, in which both motor and sensitive effects were found. Lastly, electric fields are strongly dependent on anatomy and electrodes' placement. Regardless of the montage, inter-individual hotspots of higher values of electric fields were predicted, which could change when the subjects move from a position to another (e.g., from the supine to the lateral position). These characteristics underlines the need for individualized and patient-tailored MRI-based computational models to optimize the stimulation protocol. A detailed modeling approach of the electric field distribution might contribute to optimizing stimulation protocols, tailoring electrodes' configuration, intensities, and duration to the clinical outcome.
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Affiliation(s)
- Matteo Guidetti
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Stefano Giannoni-Luza
- Sensory-Motor Lab (SeMoLa), Department of Ophthalmology-University of Lausanne, Jules Gonin Eye Hospital/Fondation Asile des Aveugles, 1015 Lausanne, Switzerland
| | - Tommaso Bocci
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, MA 02129, USA
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Lima 15024, Peru
| | - Anna Maria Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Marta Parazzini
- Istituto di Elettronica e di Ingegneria Dell'Informazione e delle Telecomunicazioni (IEIIT), Consiglio Nazionale delle Ricerche (CNR), 10129 Milan, Italy
| | - Silvio Ionta
- Sensory-Motor Lab (SeMoLa), Department of Ophthalmology-University of Lausanne, Jules Gonin Eye Hospital/Fondation Asile des Aveugles, 1015 Lausanne, Switzerland
| | - Roberta Ferrucci
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
- Department of Oncology and Hematology, University of Milan, 20122 Milan, Italy
| | - Natale Vincenzo Maiorana
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
| | - Federico Verde
- Department of Neurology, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
- Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, 20122 Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
- Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, 20122 Milan, Italy
| | - Vincenzo Silani
- Department of Neurology, Istituto Auxologico Italiano IRCCS, 20149 Milan, Italy
- Department of Pathophysiology and Transplantation, 'Dino Ferrari' Center, Università degli Studi di Milano, 20122 Milan, Italy
| | - Alberto Priori
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy
- III Neurology Clinic, ASST-Santi Paolo e Carlo University Hospital, 20142 Milan, Italy
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Rahman MA, Tharu NS, Gustin SM, Zheng YP, Alam M. Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review. J Clin Med 2022; 11:jcm11061550. [PMID: 35329875 PMCID: PMC8954138 DOI: 10.3390/jcm11061550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) is one of the most debilitating injuries in the world. Complications after SCI, such as respiratory issues, bowel/bladder incontinency, pressure ulcers, autonomic dysreflexia, spasticity, pain, etc., lead to immense suffering, a remarkable reduction in life expectancy, and even premature death. Traditional rehabilitations for people with SCI are often insignificant or ineffective due to the severity and complexity of the injury. However, the recent development of noninvasive electrical neuromodulation treatments to the spinal cord have shed a ray of hope for these individuals to regain some of their lost functions, a reduction in secondary complications, and an improvement in their life quality. For this review, 250 articles were screened and about 150 were included to summarize the two most promising noninvasive spinal cord electrical stimulation methods of SCI rehabilitation treatment, namely, trans-spinal direct current stimulation (tsDCS) and trans-spinal pulsed current stimulation (tsPCS). Both treatments have demonstrated good success in not only improving the sensorimotor function, but also autonomic functions. Due to the noninvasive nature and lower costs of these treatments, in the coming years, we expect these treatments to be integrated into regular rehabilitation therapies worldwide.
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Affiliation(s)
- Md. Akhlasur Rahman
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- Centre for the Rehabilitation of the Paralysed (CRP), Savar Union 1343, Bangladesh
| | - Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Sylvia M. Gustin
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
- Correspondence: ; Tel.: +852-6213-5054
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Therkildsen ER, Nielsen JB, Beck MM, Yamaguchi T, Lorentzen J. The effect of cathodal transspinal direct current stimulation on tibialis anterior stretch reflex components in humans. Exp Brain Res 2021; 240:159-171. [PMID: 34686909 DOI: 10.1007/s00221-021-06243-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/08/2021] [Indexed: 01/04/2023]
Abstract
Spinal DC stimulation (tsDCS) shows promise as a technique for the facilitation of functional recovery of motor function following central nervous system (CNS) lesion. However, the network mechanisms that are responsible for the effects of tsDCS are still uncertain. Here, in a series of experiments, we tested the hypothesis that tsDCS increases the excitability of the long-latency stretch reflex, leading to increased excitability of corticospinal neurons in the primary motor cortex. Experiments were performed in 33 adult human subjects (mean age 28 ± 7 years/14 females). Subjects were seated in a reclining armchair with the right leg attached to a footplate, which could be quickly plantarflexed (100 deg/s; 6 deg amplitude) to induce stretch reflexes in the tibialis anterior (TA) muscle at short (45 ms) and longer latencies (90-95 ms). This setup also enabled measuring motor evoked potentials (MEPs) and cervicomedullary evoked potentials (cMEPs) from TA evoked by transcranial magnetic stimulation (TMS) and electrical stimulation at the cervical junction, respectively. Cathodal tsDCS at 2.5 and 4 mA was found to increase the long-latency reflex without any significant effect on the short-latency reflex. Furthermore, TA MEPs, but not cMEPs, were increased following tsDCS. We conclude that cathodal tsDCS over lumbar segments may facilitate proprioceptive transcortical reflexes in the TA muscle, and we suggest that the most likely explanation of this facilitation is an effect on ascending fibers in the dorsal columns.
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Affiliation(s)
- Eva Rudjord Therkildsen
- Department of Neuroscience, Panum Institute 33.3, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark.
| | - Jens Bo Nielsen
- Department of Neuroscience, Panum Institute 33.3, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark.,Elsass Foundation, Holmegaardsvej 28, 2920, Charlottenlund, Denmark
| | - Mikkel Malling Beck
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Nørre Allé 51, 2200, Copenhagen, Denmark
| | - Tomofumi Yamaguchi
- Department of Neuroscience, Panum Institute 33.3, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark.,Department of Physical Therapy, Faculty of Health Science, Juntendo University, 2-1-1Bunkyo-ku, HongoTokyo, Japan
| | - Jakob Lorentzen
- Department of Neuroscience, Panum Institute 33.3, University of Copenhagen, Blegdamsvej 3, 2200, Copenhagen, Denmark
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Ciccone AB, Fry AC, Emerson DM, Gallagher PM, Herda TJ, Weir JP. Effects of Transspinal Direct Current Stimulation on Cycling Perception of Effort and Time to Exhaustion. J Strength Cond Res 2021; 35:347-352. [PMID: 33306592 DOI: 10.1519/jsc.0000000000003876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Ciccone, AB, Fry, AC, Emerson, DM, Gallagher, PM, Herda, TJ, and Weir, JP. Effects of transspinal direct current stimulation on cycling perception of effort and time to exhaustion. J Strength Cond Res 35(2): 347-352, 2021-In the past decade, researchers have investigated the efficacy of transspinal direct current stimulation (tsDCS) on the central nervous system and afferent neuron function in humans. Recently, data have suggested it may be possible for such tsDCS-induced changes in neuromuscular function to enhance performance. This study used noninvasive thoracic spine tsDCS to determine if cycling performance and perception of effort could be modulated by tsDCS. In 3 different stimulation conditions, anodal, cathodal, and sham, subjects cycled at 80% of their maximal aerobic capacity until exhaustion and reported their rating of perceived exertion (RPE) every minute. From this period, we compared the RPE responses over the first 3 minutes and time to exhaustion. There was no significant difference in time to exhaustion between anodal (408 ± 121 seconds), cathodal (413 ± 168 seconds), and sham (440 ± 189 seconds) conditions (p = 0.58). There was no significant difference in RPE from minutes 1-3 (collapsed across time) between anodal (12.9 ± 2.4 arbitrary units (AUs)), cathodal (13.3 ± 2.2 AUs), and sham (12.9 ± 2.1 AUs) conditions (p = 0.51). These data suggest tsDCS condition did not influence cycling performance or perception of effort during high-intensity cycling. Therefore, thoracic spine and lower abdominal montage delivering a current density of 0.071 mA·cm-2 for 20 minutes likely does not substantially improve high-intensity cycling work capacity. Therefore, more research is needed to investigate the efficacy of tsDCS and which stimulation methods may and may not enhance human performance.
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Affiliation(s)
- Anthony B Ciccone
- Department of Exercise Science and Outdoor Recreation, Utah Valley University, Orem, Utah; and
| | - Andrew C Fry
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Dawn M Emerson
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Philip M Gallagher
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Trent J Herda
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
| | - Joseph P Weir
- Osness Human Performance Laboratories, Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas
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Transcutaneous spinal direct current stimulation shows no effect on paired stimulation suppression of the somatosensory cortex. Sci Rep 2020; 10:22010. [PMID: 33319846 PMCID: PMC7738485 DOI: 10.1038/s41598-020-79131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 12/03/2020] [Indexed: 11/08/2022] Open
Abstract
Transcutaneous spinal direct current stimulation (tsDCS) is a safe and convenient method of neuromodulation. It has been proven to alter sensory processing at cervicomedullary level by amplitude changes of the P30 response of tibial nerve somatosensory evoked potentials (TN SEPs). With knowledge that tsDCS affects cortical circuits, we hypothesized that tsDCS may also affect intracortical excitability of the somatosensory cortex assessed by paired stimulation suppression (PSS). Fourteen healthy men were included in this prospective, single-blinded, placebo-controlled crossover study. Single (SS) and paired stimulation (PS) TN SEPs were recorded over the scalp before, immediately as well as 30 and 60 min after applying 15 min of tsDCS over the twelfth thoracic vertebra. Each volunteer underwent three independent and randomized sessions of either cathodal, anodal or sham stimulation. tsDCS showed no effect on peak-to-peak amplitudes or latencies of cortical P40-N50 response after SS. Furthermore, tsDCS failed to induce significant changes on amplitude ratios of PSS, thus showing no impact on intracortical excitability of the somatosensory cortex in healthy subjects. Further research is required to reveal the different mechanisms and to strengthen clinical use of this promising technique.
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Pisano F, Caltagirone C, Incoccia C, Marangolo P. Spinal or cortical direct current stimulation: Which is the best? Evidence from apraxia of speech in post-stroke aphasia. Behav Brain Res 2020; 399:113019. [PMID: 33207242 DOI: 10.1016/j.bbr.2020.113019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 09/04/2020] [Accepted: 11/11/2020] [Indexed: 10/23/2022]
Abstract
To date, new advances in technology have already shown the effectiveness of non-invasive brain stimulation and, in particular, of transcranial direct current stimulation (tDCS), in enhancing language recovery in post-stroke aphasia. More recently, it has been suggested that the stimulation over the spinal cord improves the production of words associated to sensorimotor schemata, such as action verbs. Here, for the first time, we present evidence that transpinal direct current stimulation (tsDCS) combined with a language training is efficacious for the recovery from speech apraxia, a motor speech disorder which might co-occur with aphasia. In a randomized-double blind experiment, ten aphasics underwent five days of tsDCS with concomitant treatment for their articulatory deficits in two different conditions: anodal and sham. In all patients, language measures were collected before (T0), at the end (T5) and one week after the end of treatment (F/U). Results showed that only after anodal tsDCS patients exhibited a better accuracy in repeating the treated items. Moreover, these effects persisted at F/U and generalized to other oral language tasks (i.e. picture description, noun and verb naming, word repetition and reading). A further analysis, which compared the tsDCS results with those collected in a matched group of patients who underwent the same language treatment but combined with tDCS, revealed no differences between the two groups. Given the persistency and severity of articulatory deficits in aphasia and the ease of use of tsDCS, we believe that spinal stimulation might result a new innovative approach for language rehabilitation.
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Affiliation(s)
- Francesca Pisano
- Department of Humanities studies - University Federico II, Naples, Italy
| | | | | | - Paola Marangolo
- Department of Humanities studies - University Federico II, Naples, Italy; IRCCS Santa Lucia Foundation, Rome, Italy.
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Pisano F, Caltagirone C, Satriano F, Perri R, Fadda L, Marangolo P. Can Alzheimer's Disease Be Prevented? First Evidence from Spinal Stimulation Efficacy on Executive Functions. J Alzheimers Dis 2020; 77:1755-1764. [PMID: 32925066 DOI: 10.3233/jad-200695] [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 Recently, a growing body of evidence has shown that, from the early stage of impairment, Alzheimer's patients (AD) present difficulties on a variety of tasks mostly relying on executive functions. These strongly impact their daily life activities causing a severe loss of independency and autonomy. OBJECTIVE To evaluate the efficacy of transpinal direct current stimulation (tsDCS) combined with cognitive trainings for improving attentional and executive function abilities in a group of AD patients. METHODS In a randomized-double blind design, sixteen AD patients underwent different cognitive trainings combined with tsDCS. During the treatment, each subject received tsDCS (20 min, 2 mA) over the thoracic vertebrae (IX-X vertebrae) in two different conditions: 1) anodal, and 2) sham while performing three computerized tasks: alertness, selective attention, and executive functions. Each experimental condition was run in ten consecutive daily sessions over two weeks. RESULTS After anodal tsDCS, a greater improvement in executive functions compared to sham condition was found. More importantly, the follow-up testing revealed that these effects lasted over 1 month after the intervention and generalized to the different neuropsychological tests administered before, after the treatment and at one month after the end of the intervention. This generalization was present also in the attentional domain. CONCLUSION This evidence emphasizes, for the first time, that tsDCS combined with cognitive training results efficacious for AD patients. We hypothesize that enhancing activity into the spinal sensorimotor pathways through stimulation improved cognitive abilities which rely on premotor activity, such as attention and executive functions.
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Affiliation(s)
- Francesca Pisano
- Department of Humanities studies - University Federico II, Naples, Italy
| | | | | | | | | | - Paola Marangolo
- Department of Humanities studies - University Federico II, Naples, Italy.,IRCCS Santa Lucia Foundation, Rome, Italy
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12
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Effect of transspinal direct current stimulation on afferent pain signalling in humans. J Clin Neurosci 2020; 77:163-167. [DOI: 10.1016/j.jocn.2020.04.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 02/03/2023]
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13
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Awosika OO, Matthews S, Staggs EJ, Boyne P, Song X, Rizik BA, Sucharew HJ, Zhang C, Mungcal G, Moudgal R, Bhattacharya A, Dunning K, Woo D, Kissela BM. Backward locomotor treadmill training combined with transcutaneous spinal direct current stimulation in stroke: a randomized pilot feasibility and safety study. Brain Commun 2020; 2:fcaa045. [PMID: 32954299 PMCID: PMC7425394 DOI: 10.1093/braincomms/fcaa045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 11/17/2022] Open
Abstract
Walking impairment impacts nearly 66% of stroke survivors and is a rising cause of morbidity worldwide. Despite conventional post-stroke rehabilitative care, the majority of stroke survivors experience continued limitations in their walking speed, temporospatial dynamics and walking capacity. Hence, novel and comprehensive approaches are needed to improve the trajectory of walking recovery in stroke survivors. Herein, we test the safety, feasibility and preliminary efficacy of two approaches for post-stroke walking recovery: backward locomotor treadmill training and transcutaneous spinal direct current stimulation. In this double-blinded study, 30 chronic stroke survivors (>6 months post-stroke) with mild-severe residual walking impairment underwent six 30-min sessions (three sessions/week) of backward locomotor treadmill training, with concurrent anodal (N = 19) or sham transcutaneous spinal direct current stimulation (N = 11) over the thoracolumbar spine, in a 2:1 stratified randomized fashion. The primary outcomes were: per cent participant completion, safety and tolerability of these two approaches. In addition, we collected data on training-related changes in overground walking speed, cadence, stride length (baseline, daily, 24-h post-intervention, 2 weeks post-intervention) and walking capacity (baseline, 24-h post-intervention, 2 weeks post-intervention), as secondary exploratory aims testing the preliminary efficacy of these interventions. Eighty-seven per cent (N = 26) of randomized participants completed the study protocol. The majority of the study attrition involved participants with severe baseline walking impairment. There were no serious adverse events in either the backward locomotor treadmill training or transcutaneous spinal direct current stimulation approaches. Also, both groups experienced a clinically meaningful improvement in walking speed immediately post-intervention that persisted at the 2-week follow-up. However, in contrast to our working hypothesis, anodal-transcutaneous spinal direct current stimulation did not enhance the degree of improvement in walking speed and capacity, relative to backward locomotor treadmill training + sham, in our sample. Backward locomotor treadmill training and transcutaneous spinal direct current stimulation are safe and feasible approaches for walking recovery in chronic stroke survivors. Definitive efficacy studies are needed to validate our findings on backward locomotor treadmill training-related changes in walking performance. The results raise interesting questions about mechanisms of locomotor learning in stroke, and well-powered transcutaneous spinal direct current stimulation dosing studies are needed to understand better its potential role as a neuromodulatory adjunct for walking rehabilitation.
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Affiliation(s)
- Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Saira Matthews
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Emily J Staggs
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Pierce Boyne
- College of Allied Health and Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Xiao Song
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Bridget A Rizik
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Heidi J Sucharew
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Christina Zhang
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Gabrielle Mungcal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Rohitha Moudgal
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Amit Bhattacharya
- Biomechanics-Ergonomics Research Laboratories, Department of Environmental Health, University of Cincinnati Medical College, USA
| | - Kari Dunning
- College of Allied Health and Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Brett M Kissela
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
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14
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Stairways to the brain: Transcutaneous spinal direct current stimulation (tsDCS) modulates a cerebellar-cortical network enhancing verb recovery. Brain Res 2020; 1727:146564. [DOI: 10.1016/j.brainres.2019.146564] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/01/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
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15
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Caetano A, Pereira P, Pereira M, de Carvalho M. Modulation of sensory nerve fiber excitability by transcutaneous cathodal direct current stimulation. Neurophysiol Clin 2019; 49:385-390. [PMID: 31735493 DOI: 10.1016/j.neucli.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the lasting effects on sensory nerve membrane excitability of transcutaneous peripheral nerve stimulation with cathodal direct currents (pDCS). METHODS We performed pDCS in 10 healthy subjects with the active electrode placed over the distal right forearm and the reference electrode on the back of the right hand. We used 5×5cm rubber electrodes and the current applied was 2.5mA during 15min. Three pDCS sessions were performed on the same day: first, a baseline stimulation was performed, followed by a sham stimulation and lastly a cathodal stimulation. Median sensory nerve excitability measurements were performed at baseline and immediately after each pDCS session using the TRONDNF nerve excitability protocol of the QTRAC program (measurement on the second finger). RESULTS The protocol was completed and well tolerated in all subjects. RRP (relative refractory period) and refractoriness at 2.5ms were significantly different across the three study conditions, with a significant increase of RRP immediately following cathodal stimulation compared with baseline assessment (mean 4.2 versus 5.3, P=0.002). Other measurements were not modulated by the intervention. Sham-stimulation did not change axonal excitability. CONCLUSIONS Cathodal pDCS stimulation increased RRP of sensory fibers, but no other consistent long-lasting effect was observed. This finding might suggest a reduction of sensory fiber excitability induced by cathodal pDCS.
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Affiliation(s)
- André Caetano
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
| | - Pedro Pereira
- Department of Neurology, Hospital Garcia de Orta, Almada, Portugal
| | - Mariana Pereira
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mamede de Carvalho
- Instituto de Fisiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences, Hospital de Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
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16
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Morya E, Monte-Silva K, Bikson M, Esmaeilpour Z, Biazoli CE, Fonseca A, Bocci T, Farzan F, Chatterjee R, Hausdorff JM, da Silva Machado DG, Brunoni AR, Mezger E, Moscaleski LA, Pegado R, Sato JR, Caetano MS, Sá KN, Tanaka C, Li LM, Baptista AF, Okano AH. Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes. J Neuroeng Rehabil 2019; 16:141. [PMID: 31730494 PMCID: PMC6858746 DOI: 10.1186/s12984-019-0581-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.
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Affiliation(s)
- Edgard Morya
- Edmond and Lily Safra International Institute of Neuroscience, Santos Dumont Institute, Macaíba, Rio Grande do Norte Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Kátia Monte-Silva
- Universidade Federal de Pernambuco, Recife, Pernambuco Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY USA
| | - Claudinei Eduardo Biazoli
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Andre Fonseca
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Tommaso Bocci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
| | - Faranak Farzan
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Raaj Chatterjee
- School of Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia Canada
| | - Jeffrey M. Hausdorff
- Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eva Mezger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Luciane Aparecida Moscaleski
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Rodrigo Pegado
- Graduate Program in Rehabilitation Science, Universidade Federal do Rio Grande do Norte, Santa Cruz, Rio Grande do Norte Brazil
| | - João Ricardo Sato
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Marcelo Salvador Caetano
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
| | - Kátia Nunes Sá
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
| | - Clarice Tanaka
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Li Min Li
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
| | - Abrahão Fontes Baptista
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Bahia Brazil
- Laboratório de Investigações Médicas-54, Universidade de São Paulo, São Paulo, São Paulo Brazil
| | - Alexandre Hideki Okano
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN/CEPID-FAPESP), University of Campinas, Campinas, São Paulo, Brazil
- Núcleo de Assistência e Pesquisa em Neuromodulação (NAPeN), Universidade Federal do ABC (UFABC)/Universidade de São Paulo (USP)/Universidade Cidade de São Paulo (UNICID)/Universidade Federal de Pernambuco (UFPE), Escola Bahiana de Medicina e Saúde Pública (EBMSP), Santo André, Brazil
- Center of Mathematics, Computing and Cognition (CMCC), Universidade Federal do ABC (UFABC), Alameda da Universidade, 3 - Anchieta, Bloco Delta – Sala 257, São Bernardo do Campo, SP CEP 09606-070 Brazil
- Graduate Program in Physical Education. State University of Londrina, Londrina, Paraná, Brazil
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Awosika OO, Sandrini M, Volochayev R, Thompson RM, Fishman N, Wu T, Floeter MK, Hallett M, Cohen LG. Transcutaneous spinal direct current stimulation improves locomotor learning in healthy humans. Brain Stimul 2019; 12:628-634. [PMID: 30733143 PMCID: PMC7326485 DOI: 10.1016/j.brs.2019.01.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/08/2018] [Accepted: 01/24/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Ambulation is an essential aspect of daily living and is often impaired after brain and spinal cord injuries. Despite the implementation of standard neurorehabilitative care, locomotor recovery is often incomplete. OBJECTIVE In this randomized, sham-controlled, double-blind, parallel design study, we aimed to determine if anodal transcutaneous spinal direct current stimulation (anodal tsDCS) could improve training effects on locomotion compared to sham (sham tsDCS) in healthy subjects. METHODS 43 participants underwent a single backwards locomotion training (BLT) session on a reverse treadmill with concurrent anodal (n = 22) or sham (n = 21) tsDCS. The primary outcome measure was speed gain measured 24 h post-training. We hypothesized that anodal tsDCS + BLT would improve training effects on backward locomotor speed compared to sham tsDCS + BLT. A subset of participants (n = 31) returned for two additional training days of either anodal (n = 16) or sham (n = 15) tsDCS and underwent (n = 29) H-reflex testing immediately before, immediately after, and 30 min post-training over three consecutive days. RESULTS A single session of anodal tsDCS + BLT elicited greater speed gain at 24 h relative to sham tsDCS + BLT (p = 0.008, two-sample t-test, adjusted for one interim analysis after the initial 12 subjects). Anodal tsDCS + BLT resulted in higher retention of the acquired skill at day 30 relative to sham tsDCS + BLT (p = 0.002) in the absence of significant group differences in online or offline learning over the three training days (p = 0.467 and p = 0.131). BLT resulted in transient down-regulation of H-reflex amplitude (Hmax/Mmax) in both test groups (p < 0.0001). However, the concurrent application of anodal-tsDCS with BLT elicited a longer lasting effect than sham-tsDCS + BLT (p = 0.050). CONCLUSION tsDCS improved locomotor skill acquisition and retention in healthy subjects and prolonged the physiological exercise-mediated downregulation of excitability of the alpha motoneuron pool. These results suggest that this strategy is worth exploring in neurorehabilitation of locomotor function.
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Affiliation(s)
- Oluwole O Awosika
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA; Department of Neurology and Rehabilitation Medicine, University of Cincinnati, USA.
| | - Marco Sandrini
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA; Department of Psychology, University of Roehampton, London, UK
| | - Rita Volochayev
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA
| | - Ryan M Thompson
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA
| | - Nathan Fishman
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA
| | | | | | | | - Leonardo G Cohen
- Human Cortical Physiology and Neurorehabilitation Section, NINDS, USA
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18
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Differential modulation of pressure pain threshold in response to transcutaneous spinal direct current stimulation with physical activity level. Neurosci Lett 2019; 698:154-159. [PMID: 30654000 DOI: 10.1016/j.neulet.2019.01.025] [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: 12/14/2018] [Revised: 01/04/2019] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
Abstract
This study investigated the interaction between physical activity level and responses to transcutaneous spinal direct current stimulation (tsDCS) as reflected in changes in pressure pain threshold (PPT) in the lower extremity. Participants (n = 35, 15 males) consisted of physically active young adults. PPTs were determined at three sites (thigh, leg and foot) on the dominant leg before and after 20-min of anodal tsDCS applied at mid-thoracic level. Based on a questionnaire, participants were assigned to either a low-moderately active (n = 21) or highly active group (n = 14). At baseline, participants in the two activity groups exhibited comparable PPTs. After the intervention, PPTs were significantly elevated at all sites at 5-min and 30-min post-tsDCS. An interaction was found between activity groups and tsDCS-induced changes at the thigh site owing to a larger elevation in PPTs in the highly active group. These results corroborate previous findings regarding antalgic effects of tsDCS and point to the role of physical activity level as a potential factor susceptible to modulate responses to tsDCS interventions.
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Powell ES, Carrico C, Salyers E, Westgate PM, Sawaki L. The effect of transcutaneous spinal direct current stimulation on corticospinal excitability in chronic incomplete spinal cord injury. NeuroRehabilitation 2018; 43:125-134. [PMID: 30040753 PMCID: PMC6130412 DOI: 10.3233/nre-172369] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study investigated the feasibility of modulating bilateral corticospinal excitability with different polarities of transcutaneous spinal direct current stimulation (tsDCS) in chronic, incomplete spinal cord injury (SCI). METHODS Six subjects with chronic incomplete SCI (>12 months post injury) participated in this crossover study. Intervention consisted of 3 sessions, separated by at least 1 week, in which each subject received the conditions cathodal, anodal, and sham tsDCS. Stimulation was delivered at 2.5 mA for 20 minutes with the active electrode positioned over the spinous processes of T10-T11 and the reference electrode over left deltoid. To measure the effects of tsDCS on corticospinal excitability, motor evoked potentials (MEPs) from transcranial magnetic stimulation were measured bilaterally from soleus before and after tsDCS. RESULTS Five subjects completed all 3 sessions. One subject withdrew after 2 sessions due to complications unrelated to the study. MEPs were measurable in 5 subjects. No significant differences in change of MEP amplitudes were found between the 3 conditions. However, there were trends that indicated laterality of response, particularly with cathodal tsDCS increasing corticospinal excitability contralateral to the reference electrode and decreasing corticospinal excitability ipsilateral to the reference electrode. CONCLUSION Corticospinal excitability may be modulated with laterality by tsDCS in individuals with chronic, incomplete SCI. Further research is needed to 1) determine whether different placement of the reference electrode can lead to uniform modulation bilaterally, and 2) reveal whether these alterations in corticospinal excitability can lead to improved movement function in individuals with chronic, incomplete SCI.
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Affiliation(s)
- Elizabeth Salmon Powell
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA
| | - Cheryl Carrico
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA
| | - Emily Salyers
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA
| | - Philip M. Westgate
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Lumy Sawaki
- Department of Physical Medicine and Rehabilitation, University of Kentucky, Lexington, KY, USA
- HealthSouth Cardinal Hill Hospital, Lexington, KY, USA
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