scholarly journals Using theoretical models from adult stroke recovery to improve use of noninvasive brain stimulation for children with congenital hemiparesis

2017 ◽  
Vol 118 (3) ◽  
pp. 1435-1438 ◽  
Author(s):  
Yin-Liang Lin ◽  
Kelsey A. Potter-Baker
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Theoretical Models ◽  
Cortical Reorganization ◽  
Stroke Recovery ◽  
Noninvasive Brain Stimulation ◽  
Motor Improvement

Noninvasive brain stimulation has been widely used for adults with stroke to improve upper limb motor function. A recent study by Kirton and colleagues (Kirton A, Ciechanski P, Zewdie E, Andersen J, Nettel-Aguirre A, Carlson H, Carsolio L, Herrero M, Quigley J, Mineyko A, Hodge J, Hill M. Neurology 88: 259–267, 2017) applied noninvasive brain stimulation to children with congenital hemiparesis but found no significant effect of noninvasive brain stimulation on motor function. Here, we explore theories about cortical reorganization in both adult and children with hemiparesis and discuss how to improve the approaches of noninvasive brain stimulation to generate optimal motor improvement and development for children with congenital hemiparesis.

scholarly journals β-Oscillations Reflect Recovery of the Paretic Upper Limb in Subacute Stroke

2020 ◽  
Vol 34 (5) ◽  
pp. 450-462 ◽  
Author(s):  
Chih-Wei Tang ◽  
Fu-Jung Hsiao ◽  
Po-Lei Lee ◽  
Yun-An Tsai ◽  
Ya-Fang Hsu ◽  
...  
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Primary Motor Cortex ◽  
Hand Movement ◽  
Stroke Recovery ◽  
Stroke Survivors ◽  
Healthy Controls ◽  
Functional Changes ◽  
Post Stroke ◽  
Subacute Stroke

Background. Recovery of upper limb function post-stroke can be partly predicted by initial motor function, but the mechanisms underpinning these improvements have yet to be determined. Here, we sought to identify neural correlates of post-stroke recovery using longitudinal magnetoencephalography (MEG) assessments in subacute stroke survivors. Methods. First-ever, subcortical ischemic stroke survivors with unilateral mild to moderate hand paresis were evaluated at 3, 5, and 12 weeks after stroke using a finger-lifting task in the MEG. Cortical activity patterns in the β-band (16-30 Hz) were compared with matched healthy controls. Results. All stroke survivors (n=22; 17 males) had improvements in action research arm test (ARAT) and Fugl-Meyer upper extremity (FM-UE) scores between 3 and 12 weeks. At 3 weeks post-stroke the peak amplitudes of the movement-related ipsilesional β-band event-related desynchronization (β-ERD) and synchronization (β-ERS) in primary motor cortex (M1) were significantly lower than the healthy controls (p<0.001) and were correlated with both the FM-UE and ARAT scores (r=0.51-0.69, p<0.017). The decreased β-ERS peak amplitudes were observed both in paretic and non-paretic hand movement particularly at 3 weeks post-stroke, suggesting a generalized disinhibition status. The peak amplitudes of ipsilesional β-ERS at week 3 post-stroke correlated with the FM-UE score at 12 weeks (r=0.54, p=0.03) but no longer significant when controlling for the FM-UE score at 3 weeks post-stroke. Conclusions. Although early β-band activity does not independently predict outcome at 3 months after stroke, it mirrors functional changes, giving a potential insight into the mechanisms underpinning recovery of motor function in subacute stroke.

scholarly journals Interhemispheric Modulation of Dual-Mode, Noninvasive Brain Stimulation on Motor Function

2014 ◽  
Vol 38 (3) ◽  
pp. 297 ◽  
Author(s):  
Eunhee Park ◽  
Yun-Hee Kim ◽  
Won Hyuk Chang ◽  
Tae Gun Kwon ◽  
Yong-Il Shin
Keyword(s):  
Motor Function ◽  
Brain Stimulation ◽  
Dual Mode ◽  
Noninvasive Brain Stimulation

scholarly journals Noninvasive Brain Stimulation for Motor Recovery after Stroke: Mechanisms and Future Views

2012 ◽  
Vol 2012 ◽  
pp. 1-10 ◽  
Author(s):  
Naoyuki Takeuchi ◽  
Shin-Ichi Izumi
Keyword(s):  
Brain Stimulation ◽  
Neural Plasticity ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Recovery ◽  
Cortical Reorganization ◽  
Motor Deficits ◽  
Stroke Patients ◽  
Noninvasive Brain Stimulation ◽  
Interhemispheric Competition ◽  
Underlying Mechanisms

Repetitive transcranial magnetic stimulation and transcranial direct current stimulation are noninvasive brain stimulation (NIBS) techniques that can alter excitability of the human cortex. Considering the interhemispheric competition occurring after stroke, improvement in motor deficits can be achieved by increasing the excitability of the affected hemisphere or decreasing the excitability of the unaffected hemisphere. Many reports have shown that NIBS application improves motor function in stroke patients by using their physiological peculiarity. For continuous motor improvement, it is important to impart additional motor training while NIBS modulates the neural network between both hemispheres and remodels the disturbed network in the affected hemisphere. NIBS can be an adjuvant therapy for developed neurorehabilitation strategies for stroke patients. Moreover, recent studies have reported that bilateral NIBS can more effectively facilitate neural plasticity and induce motor recovery after stroke. However, the best NIBS pattern has not been established, and clinicians should select the type of NIBS by considering the NIBS mechanism. Here, we review the underlying mechanisms and future views of NIBS therapy and propose rehabilitation approaches for appropriate cortical reorganization.

scholarly journals Models to Tailor Brain Stimulation Therapies in Stroke

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
E. B. Plow ◽  
V. Sankarasubramanian ◽  
D. A. Cunningham ◽  
K. Potter-Baker ◽  
N. Varnerin ◽  
...  
Keyword(s):  
Upper Limb ◽  
Brain Stimulation ◽  
Stroke Rehabilitation ◽  
Theoretical Models ◽  
Present Evidence ◽  
Heterogeneous Samples ◽  
Lack Of Information ◽  
Pros And Cons ◽  
Mixed Efficacy

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.

scholarly journals Restorative Therapies after Stroke: Drugs, Devices and Robotics

2017 ◽  
Vol 53 (01) ◽  
pp. 051-065
Author(s):  
MV Padma Srivastava
Keyword(s):  
Stem Cells ◽  
Brain Stimulation ◽  
Adult Stem Cells ◽  
Time Window ◽  
Embryonic Stem ◽  
Stroke Recovery ◽  
Current Evidence ◽  
Noninvasive Brain Stimulation ◽  
Self Repair ◽  
Repair Systems

ABSTRACTRestorative therapies aim to improve outcome and function by promoting plasticity within a therapeutic time window between days to weeks to years. In this article, the mechanisms by which cell-based, pharmacological and robotic treatments stimulate endogenous brain remodelling after stroke, particularly neurogenesis, axonal plasticity and white-matter integrity are described with a brief outline of the potential of neuroimaging (fMRI) techniques. Stem cells aid stroke recovery via mechanisms depending on the type of cells used. Transplanted embryonic stem cells (ESCs), induced pluripotent stem cells (iPSCs), and neural stem cells (NSCs) can replace the missing brain cells in the Infarcted area, while adult stem cells, such as mesenchymal stem cells or multipotent stromal cells (MSCs) and MNCs, provide trophic support to enhance self-repair systems such as endogenous neurogenesis. Most preclinical studies of stem cell therapy for stroke have emphasized the need to enhance self-repair systems rather than to replace lost cells, regardless of the type of cells used. Noninvasive brain stimulation (NIBS) provides a valuable tool for interventional neurophysiology by modulating brain activity in a specific distributed, cortico-subcortical network. The two most commonly used techniques for noninvasive brain stimulation are transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). The article also discusses the potential role and current evidence for the use of pharmacological therapy, robotics and specific forms of physiotherapy regimes in optimizing stroke recovery. Neurorestoration is a concept that has been proven emphatically in several experimental models and clinical studies of stroke. Elucidating the underlying mechanisms of cell-based, pharmacological and rehabilitative therapies is of primary interest and crucial for translation of treatments to clinical use. The knowledge must provide an impetus for the development of superior, advanced and cost effective neuro restorative interventions that will enhance stroke recovery.

scholarly journals Transcranial electrostimulation with special waveforms enhances upper-limb motor function in patients with chronic stroke: a pilot randomized controlled trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Shih-Ching Chen ◽  
Ling-Yu Yang ◽  
Muhammad Adeel ◽  
Chien-Hung Lai ◽  
Chih-Wei Peng
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Chronic Stroke ◽  
Therapeutic Effects ◽  
The Real ◽  
Therapeutic Benefits ◽  
Transcranial Electrostimulation

Abstract Background Transcranial direct current stimulation (tDCS) and intermittent theta burst stimulation (iTBS) were both demonstrated to have therapeutic potentials to rapidly induce neuroplastic effects in various rehabilitation training regimens. Recently, we developed a novel transcranial electrostimulation device that can flexibly output an electrical current with combined tDCS and iTBS waveforms. However, limited studies have determined the therapeutic effects of this special waveform combination on clinical rehabilitation. Herein, we investigated brain stimulation effects of tDCS-iTBS on upper-limb motor function in chronic stroke patients. Methods Twenty-four subjects with a chronic stroke were randomly assigned to a real non-invasive brain stimulation (NIBS; who received the real tDCS + iTBS output) group or a sham NIBS (who received sham tDCS + iTBS output) group. All subjects underwent 18 treatment sessions of 1 h of a conventional rehabilitation program (3 days a week for 6 weeks), where a 20-min NIBS intervention was simultaneously applied during conventional rehabilitation. Outcome measures were assessed before and immediately after the intervention period: Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Jebsen-Taylor Hand Function Test (JTT), and Finger-to-Nose Test (FNT). Results Both groups showed improvements in FMA-UE, JTT, and FNT scores after the 6-week rehabilitation program. Notably, the real NIBS group had greater improvements in the JTT (p = 0. 016) and FNT (p = 0. 037) scores than the sham NIBS group, as determined by the Mann–Whitney rank-sum test. Conclusions Patients who underwent the combined ipsilesional tDCS-iTBS stimulation with conventional rehabilitation exhibited greater impacts than did patients who underwent sham stimulation-conventional rehabilitation in statistically significant clinical responses of the total JTT time and FNT after the stroke. Preliminary results of upper-limb functional recovery suggest that tDCS-iTBS combined with a conventional rehabilitation intervention may be a promising strategy to enhance therapeutic benefits in future clinical settings. Trial registration: ClinicalTrials.gov Identifier: NCT04369235. Registered on 30 April 2020.

scholarly journals Canadian Platform for Trials in Noninvasive Brain Stimulation (CanStim) Consensus Recommendations for Repetitive Transcranial Magnetic Stimulation in Upper Extremity Motor Stroke Rehabilitation Trials

2021 ◽  
Vol 35 (2) ◽  
pp. 103-116
Author(s):  
Jodi D. Edwards ◽  
Sandra E. Black ◽  
Shaun Boe ◽  
Lara Boyd ◽  
Arthur Chaves ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Upper Extremity ◽  
Brain Stimulation ◽  
Stroke Rehabilitation ◽  
Magnetic Stimulation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Recovery ◽  
Noninvasive Brain Stimulation ◽  
Consensus Recommendations ◽  
Expert Working Group

Objective. To develop consensus recommendations for the use of repetitive transcranial magnetic stimulation (rTMS) as an adjunct intervention for upper extremity motor recovery in stroke rehabilitation clinical trials. Participants. The Canadian Platform for Trials in Non-Invasive Brain Stimulation (CanStim) convened a multidisciplinary team of clinicians and researchers from institutions across Canada to form the CanStim Consensus Expert Working Group. Consensus Process. Four consensus themes were identified: (1) patient population, (2) rehabilitation interventions, (3) outcome measures, and (4) stimulation parameters. Theme leaders conducted comprehensive evidence reviews for each theme, and during a 2-day Consensus Meeting, the Expert Working Group used a weighted dot-voting consensus procedure to achieve consensus on recommendations for the use of rTMS as an adjunct intervention in motor stroke recovery rehabilitation clinical trials. Results. Based on best available evidence, consensus was achieved for recommendations identifying the target poststroke population, rehabilitation intervention, objective and subjective outcomes, and specific rTMS parameters for rehabilitation trials evaluating the efficacy of rTMS as an adjunct therapy for upper extremity motor stroke recovery. Conclusions. The establishment of the CanStim platform and development of these consensus recommendations is a first step toward the translation of noninvasive brain stimulation technologies from the laboratory to clinic to enhance stroke recovery.

scholarly journals Effects of Cerebellar Transcranial Direct Current Stimulation on Upper Limb Motor Function After Stroke: Study Protocol for the Pilot of a Randomized Controlled Trial

2021 ◽  
Author(s):  
Akiko Yuasa ◽  
Shintaro Uehara ◽  
Kazuki Ushizawa ◽  
Takamichi Toyama ◽  
Jose Gomez-Tames ◽  
...  
Keyword(s):  
Pilot Study ◽  
Motor Function ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Intensive Training ◽  
Direct Current Stimulation ◽  
Randomized Controlled ◽  
Cerebellar Tdcs ◽  
Motor Improvement

Abstract Background: Transcranial direct current stimulation (tDCS) is a technique that can noninvasively modulate neural states in a targeted brain region. As cerebellar activity levels are associated with upper limb motor improvement after stroke, the cerebellum is a plausible target of tDCS. However, the effect of tDCS remains unclear. Here, we designed a pilot study to assess: 1) the feasibility of a study that aims to examine the effects of cerebellar tDCS combined with an intensive rehabilitation approach based on the concept of constraint-induced movement therapy (CIMT), and 2) the preliminary outcome of the combined approach on upper limb motor function in patients with stroke in the chronic stage.Methods: This pilot study has a double-blind randomized controlled design. Twenty-four chronic stroke patients with mild to moderate levels of upper limb motor impairment will be randomly assigned to an active or sham tDCS group. The participants will receive 20 min of active or sham tDCS to the contralesional cerebellum at the commencement of 4 hours of daily intensive training, repeatedly for 5 days per week for 2 weeks. The primary outcome is upper limb motor function which will be evaluated using the Action Research Arm Test. Secondary outcomes comprise scores of the Fugl-Meyer Assessment for the upper extremity and the Motor Activity Log. Additionally, neurophysiological and neuroanatomical assessments of the cerebellum will be performed using transcranial magnetic stimulation and magnetic resonance imaging. These assessments will be conducted before, at the middle, and after the 2-week intervention, and finally 1 month after the intervention. Any adverse events that occur during the study will be recorded.Discussion: Cerebellar tDCS combined with intensive upper limb training may increase the gains of motor improvement when compared to the sham condition. The present study should provide valuable evidence regarding the feasibility of the design and the efficacy of cerebellar tDCS for upper limb motor function in patients with stroke before a future large trial is conducted.Trial registration: This study has been registered at the Japan Registry of Clinical Trials (jRCTs042200078; https://jrct.niph.go.jp/en-latest-detail/jRCTs042200078). Registered 17 December 2020

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