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Edwards DJ, Liu CY, Dunning K, Fregni F, Laine J, Leiby BE, Rogers LM, Harvey RL. Electric Field Navigated 1-Hz rTMS for Poststroke Motor Recovery: The E-FIT Randomized Controlled Trial. Stroke 2023; 54:2254-2264. [PMID: 37577801 PMCID: PMC10453351 DOI: 10.1161/strokeaha.123.043164] [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: 03/09/2023] [Revised: 06/01/2023] [Accepted: 06/20/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND To determine if low-frequency repetitive transcranial magnetic stimulation targeting the primary motor cortex contralateral (M1CL) to the affected corticospinal tract in patients with hemiparetic stroke augments intensive training-related clinical improvement; an extension of the NICHE trial (Navigated Inhibitory rTMS to Contralesional Hemisphere Trial) using an alternative sham coil. METHODS The present E-FIT trial (Electric Field Navigated 1Hz rTMS for Post-stroke Motor Recovery Trial) included 5 of 12 NICHE trial outpatient US rehabilitation centers. The stimulation protocol remained identical (1 Hz repetitive transcranial magnetic stimulation, M1CL, preceding 60-minute therapy, 18 sessions/6 wks; parallel arm randomized clinical trial). The sham coil appearance mimicked the active coil but without the weak electric field in the NICHE trial sham coil. Outcomes measured 1 week, and 1, 3, and 6 months after the end of treatment included the following: upper extremity Fugl-Meyer (primary, 6 months after end of treatment), Action Research Arm Test, National Institutes of Health Stroke Scale, quality of life (EQ-5D), and safety. RESULTS Of 60 participants randomized, 58 completed treatment and were included for analysis. Bayesian analysis of combined data from the E-FIT and the NICHE trials indicated that active treatment was not superior to sham at the primary end point (posterior mean odds ratio of 1.94 [96% credible interval of 0.61-4.80]). For the E-FIT intent-to-treat population, upper extremity Fugl-Meyer improvement ≥5 pts occurred in 60% (18/30) active group and 50% (14/28) sham group. Participants enrolled 3 to 6 months following stroke had a 67% (31%-91% CI) response rate in the active group at the 6-month end point versus 50% in the sham group (21.5%-78.5% CI). There were significant improvements from baseline to 6 months for both active and sham groups in upper extremity Fugl-Meyer, Action Research Arm Test, and EQ-5D (P<0.05). Improvement in National Institutes of Health Stroke Scale was observed only in the active group (P=0.004). Ten serious unrelated adverse events occurred (4 active group, 6 sham group, P=0.72). CONCLUSIONS Intensive motor rehabilitation 3 to 12 months after stroke improved clinical impairment, function, and quality of life; however, 1 Hz-repetitive transcranial magnetic stimulation was not an effective treatment adjuvant in the present sample population with mixed lesion location and extent. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03010462.
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Affiliation(s)
- Dylan J. Edwards
- Moss Rehabilitation Research Institute, and Department of Rehabilitation Medicine Thomas Jefferson University, Philadelphia, PA (D.J.E.)
- Exercise Medicine Research Institute and School of Medical and Health Sciences, Edith Cowan University Australia (D.J.E.)
- Burke Neurological Institute, White Plains, NY (D.J.E.)
| | - Charles Y. Liu
- USC Neurorestoration Center, Rancho Los Amigos National Rehabilitation Center, Los Angeles, CA (C.Y.L.)
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, OH (K.D.)
| | - Felipe Fregni
- Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA (F.F.)
| | - Jarmo Laine
- Nexstim Corporation, Helsinki, Finland (J.L.)
| | | | - Lynn M. Rogers
- The Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL (L.M.R., R.L.H.)
| | - Richard L. Harvey
- The Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL (L.M.R., R.L.H.)
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2
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Naro A, Calabrò RS. Improving Upper Limb and Gait Rehabilitation Outcomes in Post-Stroke Patients: A Scoping Review on the Additional Effects of Non-Invasive Brain Stimulation When Combined with Robot-Aided Rehabilitation. Brain Sci 2022; 12:1511. [PMID: 36358437 PMCID: PMC9688385 DOI: 10.3390/brainsci12111511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 07/03/2024] Open
Abstract
Robot-aided rehabilitation (RAR) and non-invasive brain stimulation (NIBS) are the two main interventions for post-stroke rehabilitation. The efficacy of both approaches in combination has not been well established yet. The importance of coupling these interventions, which both enhance brain plasticity to promote recovery, lies in augmenting the rehabilitation potential to constrain the limitation in daily living activities and the quality of life following stroke. This review aimed to evaluate the evidence of NIBS coupled with RAR in improving rehabilitation outcomes of upper limb and gait motor impairment in adult individuals with stroke. We included 18 clinical trials in this review. All studies were highly heterogeneous concerning the technical characteristics of robotic devices and NIBS protocols. However, the studies reported a global improvement in body structure and function and activity limitation for the upper limb, which were non-significant between the active and control groups. Concerning gait training protocols, the active group outperformed the control group in improving walking capacity and recovery. According to this review, NIBS and RAR in combination are promising but not yet largely recommendable as a systematic approach for stroke rehabilitation as there is not enough data about this. Therefore, more homogenous clinical trials are required, pointing out the best characteristics of the combined therapeutic protocols.
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Affiliation(s)
- Antonino Naro
- Stroke Unit, AOU Policlinico G. Martino, 98122 Messina, Italy
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3
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Chen S, Shu X, Jia J, Wang H, Ding L, He Z, Brauer S, Zhu X. Relation Between Sensorimotor Rhythm During Motor Attempt/Imagery and Upper-Limb Motor Impairment in Stroke. Clin EEG Neurosci 2022; 53:238-247. [PMID: 34028306 DOI: 10.1177/15500594211019917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Motor attempt (MA)/motor imagery (MI)-based brain-computer interface (BCI) is a newly developing rehabilitation technology for motor impairment. This study aims to explore the relationship between electroencephalography sensorimotor rhythm and motor impairment to provide reference for a BCI design. Twenty-eight stroke survivors with varying levels of motor dysfunction and spasticity status in the subacute or chronic stage were enrolled in the study to perform MA and MI tasks. Event-related desynchronization (ERD)/event-related synchronization (ERS) during and immediately after motor tasks were calculated. The Fugl-Meyer assessment scale (FMA) and the modified Ashworth scale (MAS) were applied to characterize upper-limb motor dysfunction and spasticity. There was a positive correlation between FMA total scores and ERS in the contralesional hemisphere in the MI task (P < .05) and negative correlations between FMA total scores and ERD in both hemispheres in the MA task (P < .05). Negative correlations were found between MAS scores of wrist flexors and ERD in the ipsilesional hemisphere (P < .05) in the MA task. It suggests that motor dysfunction may be more correlated to ERS in the MI task and to ERD in the MA task while spasticity may be more correlated to ERD in the MA task.
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Affiliation(s)
- Shugeng Chen
- 159397Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaokang Shu
- 12474Shanghai Jiaotong University, Shanghai, China
| | - Jie Jia
- 159397Huashan Hospital, Fudan University, Shanghai, China
| | - Hewei Wang
- 159397Huashan Hospital, Fudan University, Shanghai, China
| | - Li Ding
- 159397Huashan Hospital, Fudan University, Shanghai, China
| | - Zhijie He
- 159397Huashan Hospital, Fudan University, Shanghai, China
| | - Sandra Brauer
- 1974The University of Queensland, Saint Lucia, Australia
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4
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Fanciullacci C, Panarese A, Spina V, Lassi M, Mazzoni A, Artoni F, Micera S, Chisari C. Connectivity Measures Differentiate Cortical and Subcortical Sub-Acute Ischemic Stroke Patients. Front Hum Neurosci 2021; 15:669915. [PMID: 34276326 PMCID: PMC8281978 DOI: 10.3389/fnhum.2021.669915] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/08/2021] [Indexed: 01/14/2023] Open
Abstract
Brain lesions caused by cerebral ischemia lead to network disturbances in both hemispheres, causing a subsequent reorganization of functional connectivity both locally and remotely with respect to the injury. Quantitative electroencephalography (qEEG) methods have long been used for exploring brain electrical activity and functional connectivity modifications after stroke. However, results obtained so far are not univocal. Here, we used basic and advanced EEG methods to characterize how brain activity and functional connectivity change after stroke. Thirty-three unilateral post stroke patients in the sub-acute phase and ten neurologically intact age-matched right-handed subjects were enrolled. Patients were subdivided into two groups based on lesion location: cortico-subcortical (CS, n = 18) and subcortical (S, n = 15), respectively. Stroke patients were evaluated in the period ranging from 45 days since the acute event (T0) up to 3 months after stroke (T1) with both neurophysiological (resting state EEG) and clinical assessment (Barthel Index, BI) measures, while healthy subjects were evaluated once. Brain power at T0 was similar between the two groups of patients in all frequency bands considered (δ, θ, α, and β). However, evolution of θ-band power over time was different, with a normalization only in the CS group. Instead, average connectivity and specific network measures (Integration, Segregation, and Small-worldness) in the β-band at T0 were significantly different between the two groups. The connectivity and network measures at T0 also appear to have a predictive role in functional recovery (BI T1-T0), again group-dependent. The results obtained in this study showed that connectivity measures and correlations between EEG features and recovery depend on lesion location. These data, if confirmed in further studies, on the one hand could explain the heterogeneity of results so far observed in previous studies, on the other hand they could be used by researchers as biomarkers predicting spontaneous recovery, to select homogenous groups of patients for the inclusion in clinical trials.
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Affiliation(s)
- Chiara Fanciullacci
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy
| | | | - Vincenzo Spina
- Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy
| | - Michael Lassi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Alberto Mazzoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Fiorenzo Artoni
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Translational Neural Engineering Laboratory, Center for Neuroprosthetics, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy.,Translational Neural Engineering Laboratory, Center for Neuroprosthetics, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Carmelo Chisari
- Unit of Neurorehabilitation, Department of Medical Specialties, University Hospital of Pisa, Pisa, Italy
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Mattos DJS, Rutlin J, Hong X, Zinn K, Shimony JS, Carter AR. White matter integrity of contralesional and transcallosal tracts may predict response to upper limb task-specific training in chronic stroke. NEUROIMAGE-CLINICAL 2021; 31:102710. [PMID: 34126348 PMCID: PMC8209270 DOI: 10.1016/j.nicl.2021.102710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 11/19/2022]
Abstract
Increase in upper limb function post task specific training in chronic stroke. Motor improvements were not accompanied by changes in white matter integrity. Integrity in contralesional fibers predicted larger motor recovery in Responders. Non-responders had more severe damage of transcallosal fibers than Responders.
Objective To investigate white matter (WM) plasticity induced by intensive upper limb (UL) task specific training (TST) in chronic stroke. Methods Diffusion tensor imaging data and UL function measured by the Action Research Arm Test (ARAT) were collected in 30 individuals with chronic stroke prior to and after intensive TST. ANOVAs tested the effects of training on the entire sample and on the Responders [ΔARAT ≥ 5.8, N = 13] and Non-Responders [ΔARAT < 5.8, N = 17] groups. Baseline fractional anisotropy (FA) values were correlated with ARATpost TST controlling for baseline ARAT and age to identify voxels predictive of response to TST. Results. While ARAT scores increased following training (p < 0.0001), FA changes within major WM tracts were not significant at p < 0.05. In the Responder group, larger baseline FA of both contralesional (CL) and transcallosal tracts predicted larger ARAT scores post-TST. Subcortical lesions and more severe damage to transcallosal tracts were more pronounced in the Non-Responder than in the Responder group. Conclusions The motor improvements post-TST in the Responder group may reflect the engagement of interhemispheric processes not available to the Non-Responder group. Future studies should clarify differences in the role of CL and transcallosal pathways as biomarkers of recovery in response to training for individuals with cortical and subcortical stroke. This knowledge may help to identify sources of heterogeneity in stroke recovery, which is necessary for the development of customized rehabilitation interventions.
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Affiliation(s)
- Daniela J S Mattos
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - Jerrel Rutlin
- Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - Xin Hong
- Department of Genetics, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - Kristina Zinn
- Department of Radiology, Washington University School of Medicine, Saint Louis, MO 63110, USA
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO 63110, USA.
| | - Alexandre R Carter
- Department of Neurology, Washington University School of Medicine, Saint Louis, MO 63110 USA.
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Hakiki B, Paperini A, Castagnoli C, Hochleitner I, Verdesca S, Grippo A, Scarpino M, Maiorelli A, Mosca IE, Gemignani P, Borsotti M, Gabrielli MA, Salvadori E, Poggesi A, Lucidi G, Falsini C, Gentilini M, Martini M, Luisi MLE, Biffi B, Mainardi P, Barretta T, Pancani S, Mannini A, Campagnini S, Bagnoli S, Ingannato A, Nacmias B, Macchi C, Carrozza MC, Cecchi F. Predictors of Function, Activity, and Participation of Stroke Patients Undergoing Intensive Rehabilitation: A Multicenter Prospective Observational Study Protocol. Front Neurol 2021; 12:632672. [PMID: 33897593 PMCID: PMC8060493 DOI: 10.3389/fneur.2021.632672] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/26/2021] [Indexed: 01/19/2023] Open
Abstract
Background: The complex nature of stroke sequelae, the heterogeneity in rehabilitation pathways, and the lack of validated prediction models of rehabilitation outcomes challenge stroke rehabilitation quality assessment and clinical research. An integrated care pathway (ICP), defining a reproducible rehabilitation assessment and process, may provide a structured frame within investigated outcomes and individual predictors of response to treatment, including neurophysiological and neurogenetic biomarkers. Predictors may differ for different interventions, suggesting clues to personalize and optimize rehabilitation. To date, a large representative Italian cohort study focusing on individual variability of response to an evidence-based ICP is lacking, and predictors of individual response to rehabilitation are largely unexplored. This paper describes a multicenter study protocol to prospectively investigate outcomes and predictors of response to an evidence-based ICP in a large Italian cohort of stroke survivors undergoing post-acute inpatient rehabilitation. Methods: All patients with diagnosis of ischemic or hemorrhagic stroke confirmed both by clinical and brain imaging evaluation, admitted to four intensive rehabilitation units (adopting the same stroke rehabilitation ICP) within 30 days from the acute event, aged 18+, and providing informed consent will be enrolled (expected sample: 270 patients). Measures will be taken at admission (T0), at discharge (T1), and at follow-up 6 months after a stroke (T2), including clinical data, nutritional, functional, neurological, and neuropsychological measures, electroencephalography and motor evoked potentials, and analysis of neurogenetic biomarkers. Statistics: In addition to classical multivariate logistic regression analysis, advanced machine learning algorithms will be cross-validated to achieve data-driven prognosis prediction models. Discussion: By identifying data-driven prognosis prediction models in stroke rehabilitation, this study might contribute to the development of patient-oriented therapy and to optimize rehabilitation outcomes. Clinical Trial Registration:ClinicalTrials.gov, NCT03968627. https://www.clinicaltrials.gov/ct2/show/NCT03968627?term=Cecchi&cond=Stroke&draw=2&rank=2.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | | | - Andrea Mannini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Campagnini
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Silvia Bagnoli
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Assunta Ingannato
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Benedetta Nacmias
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Chiara Carrozza
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Istituto di Biorobotica, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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7
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Al-Hussain F, Nasim E, Iqbal M, Altwaijri N, Asim N, Yoo WK, Bashir S. The effect of transcranial direct current stimulation combined with functional task training on motor recovery in stroke patients. Medicine (Baltimore) 2021; 100:e24718. [PMID: 33578615 PMCID: PMC10545218 DOI: 10.1097/md.0000000000024718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 01/21/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Motor deficits are common after stroke and are a major contributor to stroke-related disability and the potential for long-lasting neurobiological consequences of stroke remains unresolved. There are only a few treatments available for the improvement of motor function in stroke patients. However, the mechanisms underlying stroke recovery remain poorly understood, and effective neurorehabilitation interventions remain insufficiently proven for widespread implementation. METHODS Herein, we propose to enhance the effects of brain plasticity using a powerful noninvasive technique for brain modulation consisting of navigated transcranial magnetic stimulation (TMS) priming with transcranial direct current stimulation (tDCS) in combination with motor-training-like constraint-induced movement therapy (CIMT). Our hypothesis is that navigated low-frequency rTMS stimulus priming with precise location provided by neuronavigation on the healthy side of the brain and with anodal tDCS on the affected side combined with CIMT will induce a greater motor function improvement than that obtained with sham tDCS combined with CIMT alone. We predict that the application of this technique will result in a large reduction in cortical excitability and dis-inhibition in the affected hemisphere and lead to improvements in behavioral measures of hand function in stroke patients. DISCUSSION The proposed study, therefore, is important for several reasons. The results could potentially lead to improved stroke therapeutics, and the approach makes use of 2 potential pathways to modulate brain function. TRIAL REGISTRATION This study protocol was registered in Clinical Trials Registry (https://clinicaltrials.gov/ct2/show/NCT04646577). ETHICS AND DISSEMINATION The study has been reviewed and approved by the Human Research Ethics Committee of the King Fahad Specialist Hospital Dammam. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media, print media, the internet and various community/stakeholder engagement activities.
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Affiliation(s)
- Fawaz Al-Hussain
- Department of Neurology, Faculty of Medicine, King Saud University, Riyadh
| | - Eman Nasim
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Muhammad Iqbal
- Department of Physiology, Faculty of Medicine, King Saud University, Riyadh
| | - Nouf Altwaijri
- Department of Neurology, Faculty of Medicine, King Saud University, Riyadh
| | - Niaz Asim
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital
- Hallym Institute for Translational Genomics & Bioinformatics, Hallym University College of Medicine
| | - Shahid Bashir
- Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
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8
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Reis SB, Bernardo WM, Oshiro CA, Krebs HI, Conforto AB. Effects of Robotic Therapy Associated With Noninvasive Brain Stimulation on Upper-Limb Rehabilitation After Stroke: Systematic Review and Meta-analysis of Randomized Clinical Trials. Neurorehabil Neural Repair 2021; 35:256-266. [PMID: 33522417 DOI: 10.1177/1545968321989353] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Robot-assisted therapy and noninvasive brain stimulation (NIBS) are promising strategies for stroke rehabilitation. OBJECTIVE This systematic review and meta-analysis aims to evaluate the evidence of NIBS as an add-on intervention to robotic therapy in order to improve outcomes of upper-limb motor impairment or activity in individuals with stroke. METHODS This study was performed according to the PRISMA Protocol and was previously registered on the PROSPERO Platform (CRD42017054563). Seven databases and gray literature were systematically searched by 2 reviewers, and 1176 registers were accessed. Eight randomized clinical trials with upper-limb body structure/function or activity limitation outcome measures were included. Subgroup analyses were performed according to phase poststroke, device characteristics (ie, arm support, joints involved, unimanual or bimanual training), NIBS paradigm, timing of stimulation, and number of sessions. The Grade-Pro Software was used to assess quality of the evidence. RESULTS A nonsignificant homogeneous summary effect size was found both for body structure function domain (mean difference [MD] = 0.15; 95% CI = -3.10 to 3.40; P = 0.93; I2 = 0%) and activity limitation domain (standard MD = 0.03; 95% CI = -0.28 to 0.33; P = 0.87; I2 = 0%). CONCLUSIONS According to this systematic review and meta-analysis, at the moment, there are not enough data about the benefits of NIBS as an add-on intervention to robot-assisted therapy on upper-limb motor function or activity in individuals with stroke.
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Berenguer-Rocha M, Baltar A, Rocha S, Shirahige L, Brito R, Monte-Silva K. Interhemispheric asymmetry of the motor cortex excitability in stroke: relationship with sensory-motor impairment and injury chronicity. Neurol Sci 2020; 41:2591-2598. [PMID: 32253636 DOI: 10.1007/s10072-020-04350-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 03/16/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To compare the interhemispheric asymmetry of the motor cortex excitability of chronic stroke patients with healthy and to observe if the magnitude of this asymmetry is associated to sensory-motor impairment and stroke chronicity. METHODS This cross-sectional study was performed with chronic stroke and aged and sex-matched healthy individuals. The interhemispheric asymmetry index was calculated by the difference of rest motor threshold (rMT) of the brain hemispheres. The rMT was assessed by transcranial magnetic stimulation over the cortical representation of the first dorsal interosseous muscle. To investigate the relationship of the asymmetry with sensory-motor impairment and injury chronicity, the stroke patients were grouped according to the level of sensory-motor impairment (mild/moderate, moderate/severe, and severe) and different chronicity stages (> 3-12, 13-24, 25-60, and > 60 months since stroke). RESULTS Fifty-six chronic stroke and twenty-six healthy were included. We found higher interhemispheric asymmetry in stroke patients (mean, 27.1 ± 20.9) compared to healthy (mean, 4.9 ± 4.7). The asymmetry was higher in patients with moderate/severe (mean, 35.4 ± 20.4) and severe (mean, 32.9 ± 22.7) impairment. No difference was found between patients with mild/moderate impairment (mean, 15.5 ± 12.5) and healthy. There were no differences of the interhemispheric asymmetry between patients with different times since stroke (> 3-12, mean, 32 ± 18.1; > 13-24, mean, 20.7 ± 16.2; > 25-60, mean, 29.6 ± 18.1; > 60 months, mean, 25.9 ± 17.5). CONCLUSION Stroke patients showed higher interhemispheric asymmetry of the motor cortex excitability when compared to healthy, and the magnitude of this asymmetry seems to be correlated with the severity of sensory-motor impairment, but not with stroke chronicity. SIGNIFICANCE Higher interhemispheric asymmetry was found in stroke patients with greatest sensory-motor impairment.
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Affiliation(s)
- Marina Berenguer-Rocha
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Adriana Baltar
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Sérgio Rocha
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Lívia Shirahige
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Rodrigo Brito
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Kátia Monte-Silva
- Applied Neuroscience Laboratory, Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
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10
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Edwards DJ, Cortes M, Rykman-Peltz A, Chang J, Elder J, Thickbroom G, Mariman JJ, Gerber LM, Oromendia C, Krebs HI, Fregni F, Volpe BT, Pascual-Leone A. Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS. Restor Neurol Neurosci 2019; 37:167-180. [DOI: 10.3233/rnn-180869] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
- Burke Neurological Institute, White Plains, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
- Edith Cowan University, School of Medical and Health Sciences, Joondalup, Australia
| | - Mar Cortes
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Avrielle Rykman-Peltz
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Johanna Chang
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Jessica Elder
- Boehringer Ingelheim Pharmaceuticals Inc, Ridgefield, CT, USA
| | - Gary Thickbroom
- Burke Neurological Institute, White Plains, NY, USA
- Department of PM&R, Weill Cornell Medicine, New York, NY, USA
| | - Juan J. Mariman
- Metropolitan University of Educational Sciences, Santiago, Chile
- University of Chile, Neurosystems Laboratory, Santiago, Chile
| | - Linda M. Gerber
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Clara Oromendia
- Department of Healthcare Policy and Research, Weill Cornell Medicine, Division of Biostatistics and Epidemiology, New York, NY, USA
| | - Hermano I Krebs
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Boston, MA, USA
| | - Felipe Fregni
- Department of PM&R, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA
| | - Bruce T. Volpe
- Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Alvaro Pascual-Leone
- Department of Neurology, Beth Israel Deaconess Medical Center, Berenson-Allen Center for Noninvasive Brain Stimulation, and Harvard Medical School, Boston, MA, USA
- Institut de Neurorehabilitacio Guttmann, Universitat Autonoma Barcelona, Barcelona, Spain
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11
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Bertolucci F, Chisari C, Fregni F. The potential dual role of transcallosal inhibition in post-stroke motor recovery. Restor Neurol Neurosci 2018; 36:83-97. [PMID: 29439366 DOI: 10.3233/rnn-170778] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Up to now, the mechanism of motor impairment and recovery after stroke has been thought to be based on the interhemispheric competition model. According to this model, which assumes that suppressing the excitability of contralesional hemisphere will enhance recovery by reducing transcallosal inhibition (TCI) of the stroke hemisphere, many clinical trials used non-invasive brain stimulation to improve motor function. Despite some positive findings, meta-analysis shows an important source of variability in the results, questioning whether the interhemispheric competition model would be exhaustive enough to explain the positive results or whether other mechanisms could explain the motor effects of inhibitory stimulation in the contralesional hemisphere. The goal of this study was to review the relationship between increased TCI and motor impairment after stroke.A systematic review of clinical studies investigating TCI through transcranial magnetic stimulation (TMS) in stroke patients and the relationship of this metric with motor recovery was then performed. After a literary search in PubMed eleven articles were included. The potential role of several covariates was examined and discussed.Overall, the importance of TCI as a putative mechanism for stimulation of the contralesional hemisphere seems to depend on the baseline motor function. In other words, from evidence coming mostly from chronic patients, modulation of abnormal TCI seems to be useful for patients with good motor function and less important in patients with poor motor function. TCI seems to be negatively correlated with mirror movements of the paretic hand. It can be inferred that suppressing the activity of the contralesional hemisphere could be beneficial for patients with good residual motor function and strong TCI, but not for those with poor motor function and weak TCI. Baseline motor function and measure of TCI should be taken into account for stratification of patients in clinical trials and for the design of customized treatment.
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Affiliation(s)
- Federica Bertolucci
- Department of Neuroscience, Unit of Neurorehabilitation, University Hospital of Pisa, Italy.,Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
| | - Carmelo Chisari
- Department of Neuroscience, Unit of Neurorehabilitation, University Hospital of Pisa, Italy
| | - Felipe Fregni
- Neuromodulation Center, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, USA
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12
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Van Kaam R, van Putten M, Vermeer S, Hofmeijer J. Contralesional Brain Activity in Acute Ischemic Stroke. Cerebrovasc Dis 2018; 45:85-92. [DOI: 10.1159/000486535] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 12/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background: The noninjured, contralateral hemisphere is increasingly acknowledged in the process of recovery from acute ischemic stroke. We estimated the value of conventional electroencephalography (EEG) recordings for identifying contralateral hemisphere involvement in relation to functional recovery. Methods: We analyzed 2-min epochs from 21 electrode EEG registrations of 18 patients with acute hemispheric ischemic stroke and compared with 18 age-matched controls. Outcome was dichotomized as good (modified Rankin Scale [mRS] 0–2) or poor (mRS 3–5 or death) at 3 months. Effects of the infarct on the ipsi-and contralateral hemispheres were analyzed by the delta/alpha ratio (DAR) and 2 measures of functional connectivity (magnitude squared coherence [MSC] and weighted phase lag index [WPLI]). Results: DAR was higher in patients than in controls, both in the ipsilateral and in the contralateral hemisphere (median 4.5 ± 6.7 ipsilateral and 2.4 ± 2.0 contralateral vs. 0.5 ± 0.5 in the control group, p < 0.001), indicating robust EEG changes in both lesioned and non-lesioned hemisphere. MSC and WPLI in the alpha and beta frequency bands were lower in patients than in controls in both hemispheres, indicating clear disturbances of functional connectivity (p < 0.05). In the poor outcome group, contralateral MSC and WPLI were lower than in the good outcome group, although these differences did not reach statistical significance. Conclusions: Short conventional EEG measurements show robust changes of brain activity and functional connectivity in both ipsilateral and contralateral hemispheres of patients with acute ischemic stroke. Changes of remote functional connectivity tend to interact with functional recovery. Future studies should estimate predictive values for individual patients and interactions with plasticity enhancing treatments.
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13
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Fanciullacci C, Bertolucci F, Lamola G, Panarese A, Artoni F, Micera S, Rossi B, Chisari C. Delta Power Is Higher and More Symmetrical in Ischemic Stroke Patients with Cortical Involvement. Front Hum Neurosci 2017; 11:385. [PMID: 28804453 PMCID: PMC5532374 DOI: 10.3389/fnhum.2017.00385] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 07/10/2017] [Indexed: 01/21/2023] Open
Abstract
A brain injury resulting from unilateral stroke critically alters brain functionality and the complex balance within the cortical activity. Such modifications may critically depend on lesion location and cortical involvement. Indeed, recent findings pointed out the necessity of applying a stratification based on lesion location when investigating inter-hemispheric balance in stroke. Here, we tested whether cortical involvement could imply differences in band-specific activity and brain symmetry in post stroke patients with cortico-subcortical and subcortical strokes. We explored brain activity related to lesion location through EEG power analysis and quantitative Electroencephalography (qEEG) measures. Thirty stroke patients in the subacute phase and 10 neurologically intact age-matched right-handed subjects were enrolled. Stroke patients were equally subdivided in two groups based on lesion location: cortico-subcortical (CS, mean age ± SD: 72.21 ± 10.97 years; time since stroke ± SD: 31.14 ± 11.73 days) and subcortical (S, mean age ± SD: 68.92 ± 10.001 years; time since stroke ± SD: 26.93 ± 13.08 days) group. We assessed patients’ neurological status by means of National Institutes of Health Stroke Scale (NIHSS). High density EEG at rest was recorded and power spectral analysis in Delta (1–4 Hz) and Alpha (8–14 Hz) bands was performed. qEEG metrics as pairwise derived Brain Symmetry Index (pdBSI) and Delta/Alpha Ratio (DAR) were computed and correlated with NIHSS score. S showed a lower Delta power in the Unaffected Hemisphere (UH) compared to Affected Hemisphere (AH; z = −1.98, p < 0.05) and a higher Alpha power compared to CS (z = −2.18, p < 0.05). pdBSI was negatively correlated with NIHSS (R = −0.59, p < 0.05). CS showed a higher value and symmetrical distribution of Delta band activity (z = −2.37, p < 0.05), confirmed also by a higher DAR value compared to S (z = −2.48, p < 0.05). Patients with cortico-subcortical and subcortical lesions show different brain symmetry in the subacute phase. Interestingly, in subcortical stroke patient brain activity is related with the clinical function. qEEG measures can be explicative of brain activity related to lesion location and they could allow precise definition of diagnostic-therapeutic algorithms in stroke patients.
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Affiliation(s)
- Chiara Fanciullacci
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy.,The BioRobotic Institute, Scuola Superiore Sant'AnnaPisa, Italy
| | - Federica Bertolucci
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy
| | - Giuseppe Lamola
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy
| | | | - Fiorenzo Artoni
- The BioRobotic Institute, Scuola Superiore Sant'AnnaPisa, Italy
| | - Silvestro Micera
- The BioRobotic Institute, Scuola Superiore Sant'AnnaPisa, Italy.,Translational Neuroengineering Lab, School of Engineering, École Polytechnique Fèdèrale de LausanneLausanne, Switzerland
| | - Bruno Rossi
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy
| | - Carmelo Chisari
- Neurorehabilitation Unit, University Hospital of PisaUniversity of Pisa, Pisa, Italy
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14
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Stewart JC, Cramer SC. Genetic Variation and Neuroplasticity: Role in Rehabilitation After Stroke. J Neurol Phys Ther 2017; 41 Suppl 3:S17-S23. [PMID: 28628592 PMCID: PMC5477674 DOI: 10.1097/npt.0000000000000180] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE In many neurologic diagnoses, significant interindividual variability exists in the outcomes of rehabilitation. One factor that may impact response to rehabilitation interventions is genetic variation. Genetic variation refers to the presence of differences in the DNA sequence among individuals in a population. Genetic polymorphisms are variations that occur relatively commonly and, while not disease-causing, can impact the function of biological systems. The purpose of this article is to describe genetic polymorphisms that may impact neuroplasticity, motor learning, and recovery after stroke. SUMMARY OF KEY POINTS Genetic polymorphisms for brain-derived neurotrophic factor (BDNF), dopamine, and apolipoprotein E have been shown to impact neuroplasticity and motor learning. Rehabilitation interventions that rely on the molecular and cellular pathways of these factors may be impacted by the presence of the polymorphism. For example, it has been hypothesized that individuals with the BDNF polymorphism may show a decreased response to neuroplasticity-based interventions, decreased rate of learning, and overall less recovery after stroke. However, research to date has been limited and additional work is needed to fully understand the role of genetic variation in learning and recovery. RECOMMENDATIONS FOR CLINICAL PRACTICE Genetic polymorphisms should be considered as possible predictors or covariates in studies that investigate neuroplasticity, motor learning, or motor recovery after stroke. Future predictive models of stroke recovery will likely include a combination of genetic factors and other traditional factors (eg, age, lesion type, corticospinal tract integrity) to determine an individual's expected response to a specific rehabilitation intervention.
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Affiliation(s)
- Jill Campbell Stewart
- Physical Therapy Program, Department of Exercise Science, University of South Carolina
| | - Steven C. Cramer
- Departments of Neurology, Anatomy & Neurobiology, and Physical Medicine & Rehabilitation, University of California, Irvine
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15
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Lamola G, Fanciullacci C, Sgherri G, Bertolucci F, Panarese A, Micera S, Rossi B, Chisari C. Neurophysiological Characterization of Subacute Stroke Patients: A Longitudinal Study. Front Hum Neurosci 2016; 10:574. [PMID: 27899888 PMCID: PMC5110528 DOI: 10.3389/fnhum.2016.00574] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/31/2016] [Indexed: 11/14/2022] Open
Abstract
Various degrees of neural reorganization may occur in affected and unaffected hemispheres in the early phase after stroke and several months later. Recent literature suggests to apply a stratification based on lesion location and to consider patients with cortico-subcortical and subcortical strokes separately: different lesion location may also influence therapeutic response. In this study we used a longitudinal approach to perform TMS assessment (Motor Evoked Potentials, MEP, and Silent Period, SP) and clinical evaluations (Barthel Index, Fugl-Meyer Assessment for upper limb motor function and Wolf Motor Function Test) in 10 cortical-subcortical and 10 subcortical ischemic stroke patients. Evaluations were performed in a window between 10 and 45 days (t0) and at 3 months after the acute event (t1). Our main finding is that 3 months after the acute event patients affected by subcortical stroke presented a reduction in contralateral SP duration in the unaffected hemisphere; this trend is related to clinical improvement of upper limb motor function. In conclusion, SP proved to be a valid parameter to characterize cortical reorganization patterns in stroke survivors and provided useful information about motor recovery within 3 months in subcortical patients.
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Affiliation(s)
- Giuseppe Lamola
- Unit of Neurorehabilitation, Department of Neuroscience, University of Pisa Pisa, Italy
| | - Chiara Fanciullacci
- Unit of Neurorehabilitation, Department of Neuroscience, University of PisaPisa, Italy; The BioRobotics Institute, Scuola Superiore Sant'AnnaPisa, Italy
| | - Giada Sgherri
- Unit of Neurorehabilitation, Department of Neuroscience, University of Pisa Pisa, Italy
| | - Federica Bertolucci
- Unit of Neurorehabilitation, Department of Neuroscience, University of Pisa Pisa, Italy
| | | | - Silvestro Micera
- The BioRobotics Institute, Scuola Superiore Sant'AnnaPisa, Italy; Translational Neural Engineering Lab, Center for NeuroprostheticsLausanne, Switzerland
| | - Bruno Rossi
- Unit of Neurorehabilitation, Department of Neuroscience, University of Pisa Pisa, Italy
| | - Carmelo Chisari
- Unit of Neurorehabilitation, Department of Neuroscience, University of Pisa Pisa, Italy
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16
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Peters HT, Edwards DJ, Wortman-Jutt S, Page SJ. Moving Forward by Stimulating the Brain: Transcranial Direct Current Stimulation in Post-Stroke Hemiparesis. Front Hum Neurosci 2016; 10:394. [PMID: 27555811 PMCID: PMC4977294 DOI: 10.3389/fnhum.2016.00394] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/22/2016] [Indexed: 12/13/2022] Open
Abstract
Stroke remains a leading cause of disability worldwide, with a majority of survivors experiencing long term decrements in motor function that severely undermine quality of life. While many treatment approaches and adjunctive strategies exist to remediate motor impairment, many are only efficacious or feasible for survivors with active hand and wrist function, a population who constitute only a minority of stroke survivors. Transcranial direct current stimulation (tDCS), a type of non-invasive brain stimulation, has been increasingly utilized to increase motor function following stroke as it is able to be used with stroke survivors of varying impairment levels, is portable, is relatively inexpensive and has few side effects and contraindications. Accordingly, in recent years the number of studies investigating its efficacy when utilized as an adjunct to motor rehabilitation regimens has drastically increased. While many of these trials have reported positive and promising efficacy, methodologies vary greatly between studies, including differences in stimulation parameters, outcome measures and the nature of physical practice. As such, an urgent need remains, centering on the need to investigate these methodological differences and synthesize the most current evidence surrounding the application of tDCS for post-stroke motor rehabilitation. Accordingly, the purpose of this paper is to provide a detailed overview of the most recent tDCS literature (published 2014-2015), while highlighting these variations in methodological approach, as well to elucidate the mechanisms associated with tDCS and post-stroke motor re-learning and neuroplasticity.
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Affiliation(s)
- Heather T. Peters
- Division of Occupational Therapy, The Ohio State UniversityColumbus, OH, USA
- Better Rehabilitation and Assessment for Improved Neuro-recovery (B.R.A.I.N.) Laboratory, Ohio State UniversityColumbus, OH, USA
| | - Dylan J. Edwards
- Laboratory for Non-Invasive Brain Stimulation and Human Motor Control, The Burke Medical Research InstituteWhite Plains, NY, USA
- Department of Neurology, Weill Cornell Medical CollegeWhite Plains, NY, USA
| | | | - Stephen J. Page
- Division of Occupational Therapy, The Ohio State UniversityColumbus, OH, USA
- Better Rehabilitation and Assessment for Improved Neuro-recovery (B.R.A.I.N.) Laboratory, Ohio State UniversityColumbus, OH, USA
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17
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Simis M, Di Lazzaro V, Kirton A, Pennisi G, Bella R, Kim YH, Takeuchi N, Khedr EM, Rogers LM, Harvey R, Koganemaru S, Turman B, Tarlacı S, Gagliardi RJ, Fregni F. Neurophysiological measurements of affected and unaffected motor cortex from a cross-sectional, multi-center individual stroke patient data analysis study. Neurophysiol Clin 2016; 46:53-61. [PMID: 26970808 DOI: 10.1016/j.neucli.2016.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 12/28/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Transcranial magnetic stimulation (TMS) has been used to measure cortical excitability as a functional measurement of corticomotor pathways. Given its potential application as an assessment tool in stroke, we aimed to analyze the correlation of TMS parameters with clinical features in stroke using data from 10 different centers. METHODS Data of 341 patients with a clinical diagnosis of stroke were collected from studies assessing cortical excitability using TMS. We used a multivariate regression model in which the baseline cortical excitability parameter "resting Motor Threshold (rMT)" was the main outcome and the demographic, anatomic and clinical characteristics were included as independent variables. RESULTS The variable "severity of motor deficit" consistently remained significant in predicting rMT in the affected hemisphere, with a positive β coefficient, in the multivariate models after sensitive analyses and adjusting for important confounders such as site center. Additionally, we found that the correlations between "age" or "time since stroke" and the rMT in the affected hemisphere were significant, as well as the interaction between "time since stroke" and "severity of motor deficit". CONCLUSIONS We have shown that severity of motor deficit is an important predictor for rMT in the affected hemisphere. Additionally, time since stroke seems to be an effect modifier for the correlation between motor deficit and rMT. In the unaffected motor cortex, these correlations were not significant. We discuss these findings in the context of stroke rehabilitation.
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Affiliation(s)
- Marcel Simis
- Harvard Medical School, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Laboratory of Neuromodulation, Boston, USA; Santa Casa Medical School, Division of Neurology, Sao Paulo, Brazil; University of Sao Paulo Medical School General Hospital, Physical and Rehabilitation Medicine Institute, Sao Paulo, Brazil
| | | | - Adam Kirton
- University of Calgary, Alberta Children's Hospital Research Institute, Calgary Pediatric Stroke Program, Calgary, Alberta, Canada
| | - Giovanni Pennisi
- University of Catania, Section of Neurosciences, Department GF Ingrassia, Catania, Italy
| | - Rita Bella
- University of Catania, Section of Neurosciences, Department GF Ingrassia, Catania, Italy
| | - Yun-Hee Kim
- Sungkyunkwan University, School of Medicine, Samsung Medical Center, Heart Vascular Stroke Institute, Department of Physical and Rehabilitation Medicine, Seoul, Republic of Korea
| | - Naoyuki Takeuchi
- Tohoku University Graduates School of Medicine, Department of Physical Medicine and Rehabilitation, Sendai, Japan
| | - Eman M Khedr
- Assiut University Hospital, Faculty of Medicine, Department of Neurology, Assiut, Egypt
| | - Lynn M Rogers
- Rehabilitation Institute of Chicago, Sensory Motor Performance Program, Chicago, USA; Northwestern University Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation, Chicago, USA
| | - Richard Harvey
- Rehabilitation Institute of Chicago, Sensory Motor Performance Program, Chicago, USA; Northwestern University Feinberg School of Medicine, Department of Physical Medicine and Rehabilitation, Chicago, USA
| | - Satoko Koganemaru
- Kyoto University Graduate School of Medicine, Human Brain Research Center, Kyoto, Japan
| | - Bulent Turman
- Bond University, School of Medicine, Robina, Australia
| | | | | | - Felipe Fregni
- Harvard Medical School, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Laboratory of Neuromodulation, Boston, USA.
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18
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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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19
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Labar D, Labar AS, Edwards D. Long-Term Distributed Repetitive Transcranial Magnetic Stimulation for Tinnitus: A Feasibility Study. Neuromodulation 2016; 19:249-53. [DOI: 10.1111/ner.12390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/23/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Douglas Labar
- Non-invasive Brain Stimulation Laboratory; Burke Medical Research Institute; White Plains NY USA
- Division of Clinical Neurophysiology; Weill-Cornell Medical College; New York NY USA
| | - Amy S. Labar
- Non-invasive Brain Stimulation Laboratory; Burke Medical Research Institute; White Plains NY USA
- Division of Clinical Neurophysiology; Weill-Cornell Medical College; New York NY USA
| | - Dylan Edwards
- Non-invasive Brain Stimulation Laboratory; Burke Medical Research Institute; White Plains NY USA
- Division of Clinical Neurophysiology; Weill-Cornell Medical College; New York NY USA
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