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Washabaugh EP, Foley SA, Czopek EG, Krishnan C. Altered Corticospinal and Intracortical Excitability After Stroke: A Systematic Review With Meta-Analysis. Neurorehabil Neural Repair 2024:15459683241281299. [PMID: 39275953 DOI: 10.1177/15459683241281299] [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: 09/16/2024]
Abstract
BACKGROUND Intracortical inhibitory/faciliatory measures are affected after stroke; however, the evidence is conflicting. OBJECTIVE This meta-analysis aimed to investigate the changes in motor threshold (MT), motor evoked potential (MEP), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF), and identify sources of study variability using a machine learning approach. METHODS We identified studies that objectively evaluated corticospinal excitability and intracortical inhibition/facilitation after stroke using transcranial magnetic stimulation. Pooled within- (ie, affected hemisphere [AH] vs unaffected hemisphere [UH]) and between-subjects (ie, AH and UH vs Control) standardized mean differences were computed. Decision trees determined which factors accurately predicted studies that showed alterations in corticospinal excitability and intracortical inhibition/facilitation. RESULTS A total of 35 studies (625 stroke patients and 328 healthy controls) were included. MT was significantly increased and MEP was significantly decreased (ie, reduced excitability) in the AH when compared with the UH and Control (P < .01). SICI was increased (ie, reduced inhibition) for the AH when compared with the UH, and for the AH and UH when compared with Control (P < .001). ICF was significantly increased (ie, increased facilitation) in the AH when compared with UH (P = .016) and decreased in UH when compared with Control (P < 0.001). Decision trees indicated that demographic and methodological factors accurately predicted (73%-86%) studies that showed alterations in corticospinal and intracortical excitability measures. CONCLUSIONS The findings indicate that stroke alters corticospinal and intracortical excitability measures. Alterations in SICI and ICF may reflect disinhibition of the motor cortex after stroke, which is contrary to the notion that stroke increases inhibition of the affected side.
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Affiliation(s)
- Edward P Washabaugh
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Sierra A Foley
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Emily G Czopek
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Chandramouli Krishnan
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
- Robotics Institute, University of Michigan, Ann Arbor, MI, USA
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
- Physical Therapy Department, University of Michigan-Flint, Flint, MI, USA
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2
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Huang X, Gao H, Fu H. Effects of transcranial direct current stimulation combined with Bosu ball training on the injury potential during drop landing in people with chronic ankle instability. Front Physiol 2024; 15:1451556. [PMID: 39210968 PMCID: PMC11359566 DOI: 10.3389/fphys.2024.1451556] [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: 06/19/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024] Open
Abstract
Purpose To investigate the effects of transcranial direct current stimulation (tDCS) combined with Bosu ball training on the injury potential during drop landing in people with chronic ankle instability (CAI). Methods A total of 40 participants with CAI were recruited and randomly divided into the tDCS + Bosu and Bosu groups. The people in the tDCS + Bosu group received intervention of tDCS combined with Bosu ball training, and those in the Bosu group received intervention of sham tDCS and Bosu ball training, for 6 weeks with three 20-min sessions per week. Before (week0) and after (week7) the intervention, all participants drop-landed on a trap-door device, with their affected limbs on a moveable platform, which could be flipped 24° inward and 15° forward to mimic an ankle inversion condition. The kinematic data were captured using a twelve-camera motion capture system. Two-way ANOVA with repeated measures was used to analyze data. Results Significant group-by-intervention interactions were detected in the peak ankle inversion angular velocity (p = 0.047, η2 p = 0.118), the time to peak ankle inversion (p = 0.030, η2 p = 0.139), and the plantarflexion angle at the moment of peak ankle inversion (p = 0.014, η2 p = 0.173). Post hoc comparisons showed that compared with week0, the peak ankle inversion angular velocity and the plantarflexion angle at the moment of peak ankle inversion were reduced, the time to peak ankle inversion was advanced in both groups at week7, and the changes were greater in the tDCS + Bosu group compared to the Bosu group. And, a significant intervention main effect was detected in the peak ankle inversion angle in the two groups (p < 0.001, η2 p = 0.337). Conclusion Compared with the Bosu ball training, the tDCS combined with Bosu ball training was more effective in reducing the injury potential during drop landing in people with CAI.
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Affiliation(s)
- Xueke Huang
- Graduate school, Shandong Sport University, Jinan, China
| | - He Gao
- Graduate school, Shandong Sport University, Jinan, China
| | - Haitao Fu
- School of physical education, Shandong Sport University, Jinan, China
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3
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Sato T, Katagiri N, Suganuma S, Laakso I, Tanabe S, Osu R, Tanaka S, Yamaguchi T. Simulating tDCS electrode placement to stimulate both M1 and SMA enhances motor performance and modulates cortical excitability depending on current flow direction. Front Neurosci 2024; 18:1362607. [PMID: 39010941 PMCID: PMC11246916 DOI: 10.3389/fnins.2024.1362607] [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: 12/28/2023] [Accepted: 06/18/2024] [Indexed: 07/17/2024] Open
Abstract
Introduction The conventional method of placing transcranial direct current stimulation (tDCS) electrodes is just above the target brain area. However, this strategy for electrode placement often fails to improve motor function and modulate cortical excitability. We investigated the effects of optimized electrode placement to induce maximum electrical fields in the leg regions of both M1 and SMA, estimated by electric field simulations in the T1and T2-weighted MRI-based anatomical models, on motor performance and cortical excitability in healthy individuals. Methods A total of 36 healthy volunteers participated in this randomized, triple-blind, sham-controlled experiment. They were stratified by sex and were randomly assigned to one of three groups according to the stimulation paradigm, including tDCS with (1) anodal and cathodal electrodes positioned over FCz and POz, respectively, (A-P tDCS), (2) anodal and cathodal electrodes positioned over POz and FCz, respectively, (P-A tDCS), and (3) sham tDCS. The sit-to-stand training following tDCS (2 mA, 10 min) was conducted every 3 or 4 days over 3 weeks (5 sessions total). Results Compared to sham tDCS, A-P tDCS led to significant increases in the number of sit-to-stands after 3 weeks training, whereas P-A tDCS significantly increased knee flexor peak torques after 3 weeks training, and decreased short-interval intracortical inhibition (SICI) immediately after the first session of training and maintained it post-training. Discussion These results suggest that optimized electrode placement of the maximal EF estimated by electric field simulation enhances motor performance and modulates cortical excitability depending on the direction of current flow.
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Affiliation(s)
- Takatsugu Sato
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Japan
| | - Natsuki Katagiri
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Japan
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Saki Suganuma
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
| | - Ilkka Laakso
- Department of Electrical Engineering and Automation, Aalto University, Espoo, Finland
| | - Shigeo Tanabe
- Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Rieko Osu
- Faculty of Human Sciences, Waseda University, Tokorozawa, Japan
| | - Satoshi Tanaka
- Laboratory of Psychology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomofumi Yamaguchi
- Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Japan
- Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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4
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Wessel MJ, Draaisma LR, Durand-Ruel M, Maceira-Elvira P, Moyne M, Turlan JL, Mühl A, Chauvigné L, Koch PJ, Morishita T, Guggisberg AG, Hummel FC. Multi-focal Stimulation of the Cortico-cerebellar Loop During the Acquisition of a Novel Hand Motor Skill in Chronic Stroke Survivors. CEREBELLUM (LONDON, ENGLAND) 2024; 23:341-354. [PMID: 36802021 PMCID: PMC10951005 DOI: 10.1007/s12311-023-01526-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/21/2023]
Abstract
Impairment of hand motor function is a frequent consequence after a stroke and strongly determines the ability to regain a self-determined life. An influential research strategy for improving motor deficits is the combined application of behavioral training and non-invasive brain stimulation of the motor cortex (M1). However, a convincing clinical translation of the present stimulation strategies has not been achieved yet. One alternative and innovative approach is to target the functionally relevant brain network-based architecture, e.g., the dynamic interactions within the cortico-cerebellar system during learning. Here, we tested a sequential multifocal stimulation strategy targeting the cortico-cerebellar loop. Anodal transcranial direct current stimulation (tDCS) was applied simultaneously to a hand-based motor training in N = 11 chronic stroke survivors during four training sessions on two consecutive days. The tested conditions were: sequential multifocal (M1-cerebellum (CB)-M1-CB) vs. monofocal control stimulation (M1-sham-M1-sham). Additionally, skill retention was assessed 1 and 10 days after the training phase. Paired-pulse transcranial magnetic stimulation data were recorded to characterize stimulation response determining features. The application of CB-tDCS boosted motor behavior in the early training phase in comparison to the control condition. No faciliatory effects on the late training phase or skill retention were detected. Stimulation response variability was related to the magnitude of baseline motor ability and short intracortical inhibition (SICI). The present findings suggest a learning phase-specific role of the cerebellar cortex during the acquisition of a motor skill in stroke and that personalized stimulation strategies encompassing several nodes of the underlying brain network should be considered.
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Affiliation(s)
- M J Wessel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
- University Hospital Würzburg (UKW), Department of Neurology, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - L R Draaisma
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - M Durand-Ruel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - P Maceira-Elvira
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - M Moyne
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - J-L Turlan
- Clinique Romande de Réadaptation (CRR Suva), Sion, Switzerland
| | - A Mühl
- Clinique Romande de Réadaptation (CRR Suva), Sion, Switzerland
| | - L Chauvigné
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
| | - P J Koch
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - T Morishita
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland
| | - A G Guggisberg
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland
- Universitäre Neurorehabilitation, Universitätsklinik für Neurologie, Inselspital, University Hospital of Berne, Berne, Switzerland
| | - F C Hummel
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), École Polytechnique Fédérale de Lausanne (EPFL), 9 Chemin des Mines, 1202, Geneva, Switzerland.
- Defitech Chair of Clinical Neuroengineering, Neuro-X Institute (INX) and Brain Mind Institute (BMI), Clinique Romande de Réadaptation, École Polytechnique Fédérale de Lausanne (EPFL Valais), Av. Grand-Champsec 90, 1951, Sion, Switzerland.
- Department of Clinical Neurosciences, Geneva University Hospital (HUG), Geneva, Switzerland.
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McCane LM, Wolpaw JR, Thompson AK. Effects of active and sham tDCS on the soleus H-reflex during standing. Exp Brain Res 2023; 241:1611-1622. [PMID: 37145136 PMCID: PMC10224818 DOI: 10.1007/s00221-023-06624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/22/2023] [Indexed: 05/06/2023]
Abstract
Weak transcranial direct current stimulation (tDCS) is known to affect corticospinal excitability and enhance motor skill acquisition, whereas its effects on spinal reflexes in actively contracting muscles are yet to be established. Thus, in this study, we examined the acute effects of Active and Sham tDCS on the soleus H-reflex during standing. In fourteen adults without known neurological conditions, the soleus H-reflex was repeatedly elicited at just above M-wave threshold throughout 30 min of Active (N = 7) or Sham (N = 7) 2-mA tDCS over the primary motor cortex in standing. The maximum H-reflex (Hmax) and M-wave (Mmax) were also measured before and immediately after 30 min of tDCS. The soleus H-reflex amplitudes became significantly larger (by 6%) ≈1 min into Active or Sham tDCS and gradually returned toward the pre-tDCS values, on average, within 15 min. With Active tDCS, the amplitude reduction from the initial increase appeared to occur more swiftly than with Sham tDCS. An acute temporary increase in the soleus H-reflex amplitude within the first minute of Active and Sham tDCS found in this study indicates a previously unreported effect of tDCS on the H-reflex excitability. The present study suggests that neurophysiological characterization of Sham tDCS effects is just as important as investigating Active tDCS effects in understanding and defining acute effects of tDCS on the excitability of spinal reflex pathways.
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Affiliation(s)
- Lynn M McCane
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, RI, 02881, USA
- National Center for Adaptive Neurotechnologies, Stratton VAMC, Albany, NY, 12208, USA
| | - Jonathan R Wolpaw
- National Center for Adaptive Neurotechnologies, Stratton VAMC, Albany, NY, 12208, USA
| | - Aiko K Thompson
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, MSC 700, Charleston, SC, 29425, USA.
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Seamon BA, Bowden MG, Kindred JH, Embry AE, Kautz SA. Transcranial Direct Current Stimulation Electrode Montages May Differentially Impact Variables of Walking Performance in Individuals Poststroke: A Preliminary Study. J Clin Neurophysiol 2023; 40:71-78. [PMID: 34009847 PMCID: PMC8497641 DOI: 10.1097/wnp.0000000000000848] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Transcranial direct current stimulation (tDCS) has mixed effects on walking performance in individuals poststroke. This is likely the result of variations in tDCS electrode montages and individualized responses. The purpose of this study was to quantify the effects of a single session of tDCS using various electrode montages on poststroke walking performance. METHODS Individuals with chronic stroke ( n = 16) participated in a double-blind, randomized cross-over study with sham stimulation and three tDCS electrode montages. Gait speed, paretic step ratio, and paretic propulsion were assessed prestimulation and poststimulation at self-selected and fastest comfortable speeds. Changes in muscle activation patterns with self-selected walking were quantified by the number of modules derived from nonnegative matrix factorization of EMG signals for hypothesis generation. RESULTS There was no significant effect of active stimulation montages compared with sham. Comparisons between each participant's best response to tDCS and sham show personalized tDCS may have a positive effect on fastest comfortable overground gait speed ( P = 0.084), paretic step ratio ( P = 0.095) and paretic propulsion ( P = 0.090), and self-selected paretic step ratio ( P = 0.012). Participants with two or three modules at baseline increased module number in response to the all experimental montages and sham, but responses were highly variable. CONCLUSIONS A single session of tDCS may affect clinical and biomechanical walking performance, but effects seem to be dependent on individual response variability to different electrode montages. Findings of this study are consistent with responses to various tDCS electrode montages being the result of underlying neuropathology, and the authors recommend examining how individual factors affect responses to tDCS.
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Affiliation(s)
- Bryant A. Seamon
- Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401, USA
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, Charleston, SC 29425, USA
| | - Mark G. Bowden
- Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401, USA
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, Charleston, SC 29425, USA
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Avenue, Charleston, SC 29425, USA
| | - John H. Kindred
- Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401, USA
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Avenue, Charleston, SC 29425, USA
| | - Aaron E. Embry
- Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401, USA
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, Charleston, SC 29425, USA
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Avenue, Charleston, SC 29425, USA
| | - Steven A. Kautz
- Ralph H. Johnson VA Medical Center, 109 Bee St, Charleston, SC 29401, USA
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, 77 President Street, Charleston, SC 29425, USA
- Division of Physical Therapy, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Avenue, Charleston, SC 29425, USA
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7
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Dumont AJL, Cimolin V, Parreira RB, Armbrust D, Fonseca DRP, Fonseca AL, Cordeiro L, Franco RC, Duarte NAC, Galli M, Oliveira CS. Effects of Transcranial Direct Current Stimulation Combined with Treadmill Training on Kinematics and Spatiotemporal Gait Variables in Stroke Survivors: A Randomized, Triple-Blind, Sham-Controlled Study. Brain Sci 2022; 13:brainsci13010011. [PMID: 36671993 PMCID: PMC9856811 DOI: 10.3390/brainsci13010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
The present study assessed the effects of anodal transcranial direct current stimulation (tDCS) combined with treadmill training on spatiotemporal and kinematic variables in stroke survivors using gait speed as the primary outcome. A randomized, sham-controlled, triple-blind, study was conducted involving 28 patients with hemiparesis allocated to two groups. The experimental group was submitted to treadmill training combined with anodal tDCS over the primary motor cortex (M1) of the damaged hemisphere. The control group was submitted to treadmill training combined with sham tDCS. Stimulation was administered (2 mA, 20 min) five times a week for two weeks during treadmill training. No significant differences (p > 0.05) in spatiotemporal variables were found in the intra-group and inter-group analyses. However, the experimental group demonstrated improvements in kinematic variables of the knee and ankle (p < 0.05) and these results were maintained one month after the end of the intervention. The inter-group analysis revealed significant differences (p < 0.05) with regard to the pelvis, hip and knee. Anodal tDCS over M1 of the damaged hemisphere combined with treadmill training did not affect spatiotemporal variables, but promoted improvements in kinematic variables of the pelvis, hip, knee and ankle and results were maintained one month after treatment.
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Affiliation(s)
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
- Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, 28824 Piancavallo, Italy
| | - Rodolfo Borges Parreira
- Health Sciences Program, Santa Casa School of Medical Sciences of São Paulo, St. Jaguaribe 155, São Paulo 01224-001, Brazil
| | - Danilo Armbrust
- Health Sciences Program, Santa Casa School of Medical Sciences of São Paulo, St. Jaguaribe 155, São Paulo 01224-001, Brazil
| | - Daniela Rosana Pedro Fonseca
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
| | - Adriano Luís Fonseca
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
| | - Lorraine Cordeiro
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
| | - Renata Calhes Franco
- Departamento de Fisioterapia, University Center of Americas, Campus Consolação, Street Augusta 1508, São Paulo 01304-001, Brazil
| | - Natália Almeida Carvalho Duarte
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Cláudia Santos Oliveira
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
- Correspondence: ; Tel.: +55-(62)-3310-6600
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8
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McCabe JP, Pundik S, Daly JJ. Targeting CNS Neural Mechanisms of Gait in Stroke Neurorehabilitation. Brain Sci 2022; 12:1055. [PMID: 36009118 PMCID: PMC9405607 DOI: 10.3390/brainsci12081055] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 01/17/2023] Open
Abstract
The central nervous system (CNS) control of human gait is complex, including descending cortical control, affective ascending neural pathways, interhemispheric communication, whole brain networks of functional connectivity, and neural interactions between the brain and spinal cord. Many important studies were conducted in the past, which administered gait training using externally targeted methods such as treadmill, weight support, over-ground gait coordination training, functional electrical stimulation, bracing, and walking aids. Though the phenomenon of CNS activity-dependent plasticity has served as a basis for more recently developed gait training methods, neurorehabilitation gait training has yet to be precisely focused and quantified according to the CNS source of gait control. Therefore, we offer the following hypotheses to the field: Hypothesis 1. Gait neurorehabilitation after stroke will move forward in important ways if research studies include brain structural and functional characteristics as measures of response to treatment. Hypothesis 2. Individuals with persistent gait dyscoordination after stroke will achieve greater recovery in response to interventions that incorporate the current and emerging knowledge of CNS function by directly engaging CNS plasticity and pairing it with peripherally directed, plasticity-based motor learning interventions. These hypotheses are justified by the increase in the study of neural control of motor function, with emerging research beginning to elucidate neural factors that drive recovery. Some are developing new measures of brain function. A number of groups have developed and are sharing sophisticated, curated databases containing brain images and brain signal data, as well as other types of measures and signal processing methods for data analysis. It will be to the great advantage of stroke survivors if the results of the current state-of-the-art and emerging neural function research can be applied to the development of new gait training interventions.
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Affiliation(s)
- Jessica P. McCabe
- Brain Plasticity and NeuroRecovery Laboratory, Cleveland VA Medical Center, Cleveland, OH 44106, USA
| | - Svetlana Pundik
- Brain Plasticity and NeuroRecovery Laboratory, Cleveland VA Medical Center, Cleveland, OH 44106, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH 44016, USA
| | - Janis J. Daly
- Brain Plasticity and NeuroRecovery Laboratory, Cleveland VA Medical Center, Cleveland, OH 44106, USA
- Department of Neurology, Case Western Reserve University, Cleveland, OH 44016, USA
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL 32608, USA
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32608, USA
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9
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da Cunha MJ, Pinto C, Schifino GP, Sant'Anna Py I, Cimolin V, Pagnussat AS. Bicephalic Transcranial Direct-Current Stimulation Does Not Add Benefits to a Footdrop Stimulator for Improving Functional Mobility in People With Chronic Hemiparesis After Stroke: A Double-Blind, Randomized Controlled Trial. Phys Ther 2022; 102:6605113. [PMID: 35689805 DOI: 10.1093/ptj/pzac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/23/2021] [Accepted: 06/04/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effects of applying transcranial direct-current stimulation (tDCS), a footdrop stimulator (FDS), and gait training simultaneously on functional mobility in people with chronic hemiparesis after stroke. METHODS In this double-blind controlled trial, 32 individuals with mild, moderate, and severe chronic hemiparesis after stroke were randomized to tDCS plus FDS or sham tDCS plus FDS groups. Both groups underwent 10 concurrent tDCS and FDS gait training sessions 5 times per week for 2 weeks. Functional mobility was evaluated by the Timed "Up & Go" test (TUG). Secondary outcomes included spasticity of plantarflexors, knee extensors, and hip adductors; quality of life; and walking endurance (distance covered during each treadmill gait training session). Clinical assessments were performed before treatment, after treatment, and at a 1-month follow-up. A generalized estimating equation was used to compare the effects of time, group, and time × group interaction. RESULTS No difference between groups was observed during performance of the TUG or other outcomes. TUG performance was improved in both the tDCS plus FDS group (before treatment = 24.29 [95% CI = 17.72-33.28]; after treatment = 21.75 [95% CI = 15.75-30.08]) and the sham tDCS plus FDS group (before treatment = 19.63 [95% CI = 16.06-23.0]; after treatment = 18.45 [95% CI = 15.26-22.3]). This improvement remained at the follow-up evaluation. Both groups also showed reduced spasticity of plantarflexors and knee extensors, increased quality of life, and increased total distance walked. CONCLUSION This study provided no evidence that bicephalic tDCS improves functional mobility, spasticity, quality of life, or walking endurance in people with chronic hemiparesis after stroke. IMPACT Bicephalic tDCS does not add relevant benefits to FDS and gait training in people who have chronic hemiparesis after stroke. Given that tDCS has few additional effects and given its costs for clinical practice, tDCS for rehabilitation in people with chronic hemiparesis after stroke is discouraged. FDS and gait training improve functional mobility, walking resistance, and quality of life in people with chronic hemiparesis after stroke.
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Affiliation(s)
- Maira Jaqueline da Cunha
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Camila Pinto
- Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Giulia Palermo Schifino
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Isabela Sant'Anna Py
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Veronica Cimolin
- Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Aline Souza Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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10
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Cleland BT, Madhavan S. Motor overflow in the lower limb after stroke: insights into mechanisms. Eur J Neurosci 2022; 56:4455-4468. [PMID: 35775788 PMCID: PMC9380181 DOI: 10.1111/ejn.15753] [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: 01/19/2022] [Revised: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022]
Abstract
Motor overflow (involuntary muscle activation) is common after stroke, particularly in the non-paretic upper limb. Two potential cortical mechanisms are: 1) the contralesional hemisphere controls both limbs, and 2) inhibition from the ipsilesional to the contralesional hemisphere is diminished. Few studies have differentiated between these hypotheses or investigated motor overflow in the lower limb after stroke. To investigate these potential mechanisms, individuals with chronic stroke performed unilateral isometric and dynamic dorsiflexion. Motor overflow was quantified in the contralateral, resting (non-target) ankle. Transcranial magnetic stimulation was applied, and responses were measured in both legs. Relations between motor overflow, excitability of ipsilateral motor pathways, and interhemispheric inhibition were assessed. Non-target muscle activity (motor overflow) was greater during isometric and dynamic conditions than rest in both legs (p≤0.001) and was higher in the non-paretic than the paretic leg (p=0.03). Some participants (25%) had motor overflow >4SD above the group mean in the non-paretic leg. Greater motor overflow in the non-paretic leg was associated with lesser inhibition from the ipsilesional to the contralesional hemisphere (p=0.04). In both legs, non-target TMS responses were greater during the isometric and dynamic than the rest condition (p≤0.01), but not when normalized to background muscle activity. Overall, motor overflow occurred in both legs after stroke, suggesting a common bilateral mechanism. Our correlational results suggest that alterations in interhemispheric inhibition may contribute to motor overflow. Furthermore, the lack of differences in non-target MEPs between rest, isometric, and dynamic conditions, suggests that subcortical and/or spinal pathways may contribute to motor overflow.
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Affiliation(s)
- Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences University of Illinois at Chicago, Chicago, IL, USA
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11
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Non-invasive brain stimulation as therapeutic approach for ischemic stroke: Insights into the (sub)cellular mechanisms. Pharmacol Ther 2022; 235:108160. [PMID: 35183592 DOI: 10.1016/j.pharmthera.2022.108160] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 01/12/2023]
Abstract
Although spontaneous recovery can occur following ischemic stroke due to endogenous neuronal reorganization and neuroplastic events, the degree of functional improvement is highly variable, causing many patients to remain permanently impaired. In the last decades, non-invasive brain stimulation (NIBS) techniques have emerged as potential add-on interventions to the standard neurorehabilitation programs to improve post-stroke recovery. Due to their ability to modulate cortical excitability and to induce neuroreparative processes in the brain, multiple studies have assessed the safety, efficacy and (sub)cellular mechanisms of NIBS following ischemic stroke. In this review, an overview will be provided of the different NIBS techniques that are currently being investigated in (pre)clinical stroke studies. The NIBS therapies that will be discussed include transcranial magnetic stimulation, transcranial direct current stimulation and extremely low frequency electromagnetic stimulation. First, an overview will be given of the cellular mechanisms induced by NIBS that are associated with enhanced stroke outcome in preclinical models. Furthermore, the current knowledge on safety and efficacy of these NIBS techniques in stroke patients will be reviewed.
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12
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Stance Phase Gait Training Post Stroke Using Simultaneous Transcranial Direct Current Stimulation and Motor Learning-Based Virtual Reality-Assisted Therapy: Protocol Development and Initial Testing. Brain Sci 2022; 12:brainsci12060701. [PMID: 35741586 PMCID: PMC9221094 DOI: 10.3390/brainsci12060701] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 01/27/2023] Open
Abstract
Gait deficits are often persistent after stroke, and current rehabilitation methods do not restore normal gait for everyone. Targeted methods of focused gait therapy that meet the individual needs of each stroke survivor are needed. Our objective was to develop and test a combination protocol of simultaneous brain stimulation and focused stance phase training for people with chronic stroke (>6 months). We combined Transcranial Direct Current Stimulation (tDCS) with targeted stance phase therapy using Virtual Reality (VR)-assisted treadmill training and overground practice. The training was guided by motor learning principles. Five users (>6 months post-stroke with stance phase gait deficits) completed 10 treatment sessions. Each session began with 30 min of VR-assisted treadmill training designed to apply motor learning (ML)-based stance phase targeted practice. During the first 15 min of the treadmill training, bihemispheric tDCS was simultaneously delivered. Immediately after, users completed 30 min of overground (ML)-based gait training. The outcomes included the feasibility of protocol administration, gait speed, Timed Up and Go (TUG), Functional Gait Assessment (FGA), paretic limb stance phase control capability, and the Fugl−Meyer for lower extremity coordination (FMLE). The changes in the outcome measures (except the assessments of stance phase control capability) were calculated as the difference from baseline. Statistically and clinically significant improvements were observed after 10 treatment sessions in gait speed (0.25 ± 0.11 m/s) and FGA (4.55 ± 3.08 points). Statistically significant improvements were observed in TUG (2.36 ± 3.81 s) and FMLE (4.08 ± 1.82 points). A 10-session intervention combining tDCS and ML-based task-specific gait rehabilitation was feasible and produced clinically meaningful improvements in lower limb function in people with chronic gait deficits after stroke. Because only five users tested the new protocol, the results cannot be generalized to the whole population. As a contribution to the field, we developed and tested a protocol combining brain stimulation and ML-based stance phase training for individuals with chronic stance phase deficits after stroke. The protocol was feasible to administer; statistically and/or clinically significant improvements in gait function across an array of gait performance measures were observed with this relatively short treatment protocol.
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13
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Klomjai W, Aneksan B. A randomized sham-controlled trial on the effects of dual-tDCS "during" physical therapy on lower limb performance in sub-acute stroke and a comparison to the previous study using a "before" stimulation protocol. BMC Sports Sci Med Rehabil 2022; 14:68. [PMID: 35428346 PMCID: PMC9013129 DOI: 10.1186/s13102-022-00463-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background Dual-transcranial direct current stimulation (tDCS) has been used to rebalance the cortical excitability of both hemispheres following unilateral-stroke. Our previous study showed a positive effect from a single-session of dual-tDCS applied before physical therapy (PT) on lower limb performance. However, it is still undetermined if other timings of brain stimulation (i.e., during motor practice) induce better effects. The objective of this study was to examine the effect of a single-session of dual-tDCS “during” PT on lower limb performance in sub-acute stroke and then compare the results with our previous data using a “before” stimulation paradigm. Method For the current “during” protocol, 19 participants were participated in a randomized sham-controlled crossover trial. Dual-tDCS over the M1 of both cortices (2 mA) was applied during the first 20 min of PT. The Timed Up and Go and Five-Times-Sit-To-Stand tests were assessed at pre- and post-intervention and 1-week follow-up. Then, data from the current study were compared with those of the previous “before” study performed in a different group of 19 subjects. Both studies were compared by the difference of mean changes from the baseline. Results Dual-tDCS “during” PT and the sham group did not significantly improve lower limb performance. By comparing with the previous data, performance in the “before” group was significantly greater than in the “during” and sham groups at post-intervention, while at follow-up the “before” group had better improvement than sham, but not greater than the “during” group. Conclusion A single-session of dual-tDCS during PT induced no additional advantage on lower limb performance. The “before” group seemed to induce better acute effects; however, the benefits of the after-effects on motor learning for both stimulation protocols were probably not different. Trial registration Current randomized controlled trials was prospectively registered at the clinicaltrials.gov, registration number: NCT04051671. The date of registration was 09/08/2019.
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Affiliation(s)
- Wanalee Klomjai
- Neuro Electrical Stimulation Laboratory (NeuE), Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand.,Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand
| | - Benchaporn Aneksan
- Neuro Electrical Stimulation Laboratory (NeuE), Faculty of Physical Therapy, Mahidol University, Salaya, Nakhon Pathom, 73170, Thailand. .,Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, 73170, Thailand.
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14
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Turnbull C, Boomsma A, Milte R, Stanton TR, Hordacre B. Safety and Adverse Events following Non-invasive Electrical Brain Stimulation in Stroke: A Systematic Review. Top Stroke Rehabil 2022; 30:355-367. [PMID: 35353649 DOI: 10.1080/10749357.2022.2058294] [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: 10/18/2022]
Abstract
BACKGROUND Noninvasive electrical stimulation (ES) could have therapeutic potential in stroke recovery. However, there is no comprehensive evaluation of adverse events. This study systematically searched the literature to document frequency and prevalence of adverse events. A secondary aim was to explore associations between adverse events and ES parameters or participant characteristics.Methods: Databases were searched for studies evaluating ES in adults with stroke. All included studies were required to report on adverse events. Extracted data were: (1) study design; (2) adverse events; (3) participant characteristics; (4) ES parameters. RESULTS Seventy-five studies were included. Adverse events were minor in nature. The most frequently reported adverse events were tingling (37.3% of papers), burning (18.7%), headaches (14.7%) and fatigue (14.7%). Cathodal stimulation was associated with greater frequency of itching (p = .02), intensities of 1-2 mA with increased tingling (p = .04) and discomfort (p = .03), and current density <0.4mA/cm2 with greater discomfort (p = .03). Tingling was the most prevalent adverse event (18.1% of participants), with prevalence data not differing between active and control conditions (all p ≥ 0.37). Individual participants were more likely to report adverse events with increasing current density (r = 0.99, p = .001). Two severe adverse events were noted (a seizure and percutaneous endoscopic gastrostomy placement). CONCLUSION ES appears safe in people with stroke as reported adverse events were predominantly minor in nature. An adverse events questionnaire is proposed to enable a more comprehensive and nuanced analysis of the frequency and prevalence of adverse events.
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Affiliation(s)
- Clare Turnbull
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Aafke Boomsma
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Tasha R Stanton
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Brenton Hordacre
- Innovation, IMPlementation and Clinical Translation (IIMPACT) in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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15
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Wong PL, Yang YR, Tang SC, Huang SF, Wang RY. Comparing different montages of transcranial direct current stimulation on dual-task walking and cortical activity in chronic stroke: double-blinded randomized controlled trial. BMC Neurol 2022; 22:119. [PMID: 35337288 PMCID: PMC8951706 DOI: 10.1186/s12883-022-02644-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation to modulate cortical activity for improving motor function. However, the different tDCS applications for modulating cortical activity and dual task gait performance in chronic stroke have not yet been investigated. This study investigated the effects of different tDCS applications on dual task gait performance and contralesional M1 activation in chronic stroke. METHODS Forty-eight participants were randomized to anodal, bilateral, cathodal, and sham tDCS groups. Each group received 20 min of tDCS stimulation, except the sham group. Gait performance was measured by GaitRite system during cognitive dual task (CDT) walking, motor dual task (MDT) walking, and single walking (SW). Contralesional M1 activity of unaffected tibialis anterior (TA) was measured using transcranial magnetic stimulation (TMS). Intragroup difference was analyzed by Wilconxon sign ranks test with Bonferroni correction, and Kruskal-Wallis one-way analysis of variance by ranks was used for intergroup comparisons, followed by post-hoc Mann-Whitney U tests with Bonferroni correction. RESULTS The bilateral tDCS (p = 0.017) and cathodal tDCS (p = 0.010) improved the CDT walking speed more than sham group. The bilateral tDCS (p = 0.048) and cathodal tDCS (p = 0.048) also improved the MDT walking speed more than sham group. Furthermore, bilateral tDCS (p = 0.012) and cathodal tDCS (p = 0.040) increased the silent period (SP) more than the anodal and sham group. Thus, one-session of bilateral and cathodal tDCS improved dual task walking performance paralleled with increasing contralesional corticomotor inhibition in chronic stroke. CONCLUSIONS Our results indicate that one-session of bilateral and cathodal tDCS increased contralesional corticomotor inhibition and improved dual task gait performance in chronic stroke. TRIAL REGISTRATION Thai Clinical Trials Registry (TCTR20180116001). Registered prospectively on 16th Jan, 2018 at http://www.thaiclinicaltrials.org .
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Affiliation(s)
- Pei-Ling Wong
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shun-Chang Tang
- Division of Nerve Repair- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shi-Fong Huang
- Division of Nerve Repair- Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
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16
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Review of tDCS Configurations for Stimulation of the Lower-Limb Area of Motor Cortex and Cerebellum. Brain Sci 2022; 12:brainsci12020248. [PMID: 35204011 PMCID: PMC8870282 DOI: 10.3390/brainsci12020248] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/17/2022] Open
Abstract
This article presents an exhaustive analysis of the works present in the literature pertaining to transcranial direct current stimulation(tDCS) applications. The aim of this work is to analyze the specific characteristics of lower-limb stimulation, identifying the strengths and weaknesses of these works and framing them with the current knowledge of tDCS. The ultimate goal of this work is to propose areas of improvement to create more effective stimulation therapies with less variability.
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17
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Hu M, Cheng HJ, Ji F, Chong JSX, Lu Z, Huang W, Ang KK, Phua KS, Chuang KH, Jiang X, Chew E, Guan C, Zhou JH. Brain Functional Changes in Stroke Following Rehabilitation Using Brain-Computer Interface-Assisted Motor Imagery With and Without tDCS: A Pilot Study. Front Hum Neurosci 2021; 15:692304. [PMID: 34335210 PMCID: PMC8322606 DOI: 10.3389/fnhum.2021.692304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been proven effective in post-stroke motor function enhancement, yet whether the combination of MI-BCI and tDCS may further benefit the rehabilitation of motor functions remains unknown. This study investigated brain functional activity and connectivity changes after a 2 week MI-BCI and tDCS combined intervention in 19 chronic subcortical stroke patients. Patients were randomized into MI-BCI with tDCS group and MI-BCI only group who underwent 10 sessions of 20 min real or sham tDCS followed by 1 h MI-BCI training with robotic feedback. We derived amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and functional connectivity (FC) from resting-state functional magnetic resonance imaging (fMRI) data pre- and post-intervention. At baseline, stroke patients had lower ALFF in the ipsilesional somatomotor network (SMN), lower ReHo in the contralesional insula, and higher ALFF/Reho in the bilateral posterior default mode network (DMN) compared to age-matched healthy controls. After the intervention, the MI-BCI only group showed increased ALFF in contralesional SMN and decreased ALFF/Reho in the posterior DMN. In contrast, no post-intervention changes were detected in the MI-BCI + tDCS group. Furthermore, higher increases in ALFF/ReHo/FC measures were related to better motor function recovery (measured by the Fugl-Meyer Assessment scores) in the MI-BCI group while the opposite association was detected in the MI-BCI + tDCS group. Taken together, our findings suggest that brain functional re-normalization and network-specific compensation were found in the MI-BCI only group but not in the MI-BCI + tDCS group although both groups gained significant motor function improvement post-intervention with no group difference. MI-BCI and tDCS may exert differential or even opposing impact on brain functional reorganization during post-stroke motor rehabilitation; therefore, the integration of the two strategies requires further refinement to improve efficacy and effectiveness.
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Affiliation(s)
- Mengjiao Hu
- NTU Institute for Health Technologies, Interdisciplinary Graduate Programme, Nanyang Technological University, Singapore, Singapore.,Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hsiao-Ju Cheng
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, Singapore
| | - Fang Ji
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Joanna Su Xian Chong
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhongkang Lu
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Weimin Huang
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Kai Keng Ang
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore.,School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Kok Soon Phua
- Institute for Infocomm Research, Agency for Science Technology and Research, Singapore, Singapore
| | - Kai-Hsiang Chuang
- Singapore Bioimaging Consortium, Agency for Science Technology and Research, Singapore, Singapore.,Queensland Brain Institute and Centre for Advanced Imaging, The University of Queensland, Brisbane, QLD, Australia
| | - Xudong Jiang
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore, Singapore
| | - Effie Chew
- Division of Neurology, University Medicine Cluster, National University Health System, Singapore, Singapore
| | - Cuntai Guan
- School of Computer Science and Engineering, Nanyang Technological University, Singapore, Singapore
| | - Juan Helen Zhou
- Center for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Electrical and Computer Engineering, National University of Singapore, Singapore, Singapore.,Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore, Singapore
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18
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Patel P, Casamento-Moran A, Christou EA, Lodha N. Force-Control vs. Strength Training: The Effect on Gait Variability in Stroke Survivors. Front Neurol 2021; 12:667340. [PMID: 34335442 PMCID: PMC8319601 DOI: 10.3389/fneur.2021.667340] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose: Increased gait variability in stroke survivors indicates poor dynamic balance and poses a heightened risk of falling. Two primary motor impairments linked with impaired gait are declines in movement precision and strength. The purpose of the study is to determine whether force-control training or strength training is more effective in reducing gait variability in chronic stroke survivors. Methods: Twenty-two chronic stroke survivors were randomized to force-control training or strength training. Participants completed four training sessions over 2 weeks with increasing intensity. The force-control group practiced increasing and decreasing ankle forces while tracking a sinusoid. The strength group practiced fast ankle motor contractions at a percentage of their maximal force. Both forms of training involved unilateral, isometric contraction of the paretic, and non-paretic ankles in plantarflexion and dorsiflexion. Before and after the training, we assessed gait variability as stride length and stride time variability, and gait speed. To determine the task-specific effects of training, we measured strength, accuracy, and steadiness of ankle movements. Results: Stride length variability and stride time variability reduced significantly after force-control training, but not after strength training. Both groups showed modest improvements in gait speed. We found task-specific effects with strength training improving plantarflexion and dorsiflexion strength and force control training improving motor accuracy and steadiness. Conclusion: Force-control training is superior to strength training in reducing gait variability in chronic stroke survivors. Improving ankle force control may be a promising approach to rehabilitate gait variability and improve safe mobility post-stroke.
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Affiliation(s)
- Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Agostina Casamento-Moran
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
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19
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Dong K, Meng S, Guo Z, Zhang R, Xu P, Yuan E, Lian T. The Effects of Transcranial Direct Current Stimulation on Balance and Gait in Stroke Patients: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:650925. [PMID: 34113308 PMCID: PMC8186497 DOI: 10.3389/fneur.2021.650925] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Balance dysfunction after stroke often results in individuals unable to maintain normal posture, limits the recovery of gait and functional independence. We explore the short-term effects of transcranial direct current stimulation (tDCS) on improving balance function and gait in stroke patients. Methods: We systematically searched on PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar for studies that explored the effects of tDCS on balance after stroke until August 2020. All involved studies used at least one measurement of balance, gait, or postural control as the outcome. Results: A total of 145 studies were found, of which 10 (n = 246) met the inclusion criteria and included in our studies. The present meta-analysis showed that active tDCS have beneficial effects on timed up and go test (TUGT) [mean difference (MD): 0.35; 95% confidence interval (CI): 0.11 to 0.58] and Functional Ambulation Category (FAC) (MD: −2.54; 95% CI: −3.93 to −1.15) in stroke patients. However, the results were not significant on the berg balance scale (BBS) (MD: −0.20; 95% CI: −1.44 to 1.04), lower extremity subscale of Fugl-Meyer Assessment (FMA-LE) (MD: −0.43; 95% CI: −1.70 to 0.84), 10-m walk test (10 MWT) (MD: −0.93; 95% CI: −2.68 to 0.82) and 6-min walking test (6 MWT) (MD: −2.55; 95% CI: −18.34 to 13.23). Conclusions: In conclusion, we revealed that tDCS might be an effective option for restoring walking independence and functional ambulation for stroke patients in our systematic review and meta-analysis. Systematic Review Registration: CRD42020207565.
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Affiliation(s)
- Ke Dong
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Shifeng Meng
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ziqi Guo
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Rufang Zhang
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Panpan Xu
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Erfen Yuan
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China.,First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Tao Lian
- Department of Rehabilitation Medicine, First Hospital of Shanxi Medical University, Taiyuan, China
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20
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Fregni F, El-Hagrassy MM, Pacheco-Barrios K, Carvalho S, Leite J, Simis M, Brunelin J, Nakamura-Palacios EM, Marangolo P, Venkatasubramanian G, San-Juan D, Caumo W, Bikson M, Brunoni AR. Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders. Int J Neuropsychopharmacol 2021; 24:256-313. [PMID: 32710772 PMCID: PMC8059493 DOI: 10.1093/ijnp/pyaa051] [Citation(s) in RCA: 251] [Impact Index Per Article: 83.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. OBJECTIVE We convened a team of transcranial direct current stimulation experts to conduct a systematic review of clinical trials with more than 1 session of stimulation testing: pain, Parkinson's disease motor function and cognition, stroke motor function and language, epilepsy, major depressive disorder, obsessive compulsive disorder, Tourette syndrome, schizophrenia, and drug addiction. METHODS Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into Levels A (definitely effective), B (probably effective), C (possibly effective), or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. RESULTS Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A), such as depression, and probably effective (Level B), such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson's disease (motor and cognition), stroke (motor), epilepsy, schizophrenia, and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases, and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with the largest effect size being in postoperative acute pain and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). CONCLUSION All recommendations listed here are based on current published PubMed-indexed data. Despite high levels of evidence in some conditions, it must be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.
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Affiliation(s)
- Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Mirret M El-Hagrassy
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
| | - Kevin Pacheco-Barrios
- Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Sandra Carvalho
- Neurotherapeutics and experimental Psychopathology Group (NEP), Psychological Neuroscience Laboratory, CIPsi, School of Psychology, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jorge Leite
- I2P-Portucalense Institute for Psychology, Universidade Portucalense, Porto, Portugal
| | - Marcel Simis
- Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital, Sao Paulo, Brazil
| | - Jerome Brunelin
- CH Le Vinatier, PSYR2 team, Lyon Neuroscience Research Center, UCB Lyon 1, Bron, France
| | - Ester Miyuki Nakamura-Palacios
- Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Federal University of Espírito Santo, Espírito Santo, Brasil (Dr Nakamura-Palacios)
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, Università Federico II, Naples, Italy
- IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Ganesan Venkatasubramanian
- Translational Psychiatry Laboratory, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Daniel San-Juan
- Neurophysiology Department, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico City, Mexico
| | - Wolnei Caumo
- Post-Graduate Program in Medical Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS) Surgery Department, School of Medicine, UFRGS; Pain and Palliative Care Service at Hospital de Clínicas de Porto Alegre (HCPA) Laboratory of Pain and Neuromodulation at HCPA, Porto Alegre, Brazil
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, New York
| | - André R Brunoni
- Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27), Department and Institute of Psychiatry & Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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21
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Navarro-López V, Molina-Rueda F, Jiménez-Jiménez S, Alguacil-Diego IM, Carratalá-Tejada M. Effects of Transcranial Direct Current Stimulation Combined with Physiotherapy on Gait Pattern, Balance, and Functionality in Stroke Patients. A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11040656. [PMID: 33916442 PMCID: PMC8066876 DOI: 10.3390/diagnostics11040656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 01/24/2023] Open
Abstract
Background: The effectiveness of transcranial direct current stimulation (tDCS) together with conventional physiotherapy in motor rehabilitation after stroke has been widely studied. Despite this, few studies have focused on its application in gait and balance rehabilitation. This review aimed to determine the efficacy of transcranial direct current stimulation combined with conventional physiotherapy on gait, balance, and the functionality of the lower limb after stroke. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases were systematically searched for relevant articles. Randomized clinical trials in English or Spanish that evaluated the use of the transcranial direct current stimulation, combined with physiotherapy, to improve gait, balance, and lower limb functionality after stroke were included. Main results: 10 articles were included, with a total of 222 subjects. Data about population, assessment tools, protocols, sessions, and results were extracted. The methodological quality of the included studies ranged between 3 and 5. Conclusion: The use of transcranial direct current stimulation combined with physiotherapy improves gait parameters, static and dynamic balance, and lower limb functionality in stroke patients. Long-term effects have not yet been demonstrated.
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Affiliation(s)
- Víctor Navarro-López
- International Doctoral School, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Francisco Molina-Rueda
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (M.C.-T.)
| | | | - Isabel M Alguacil-Diego
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (M.C.-T.)
- Correspondence:
| | - María Carratalá-Tejada
- Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Faculty of Health Sciences, Rey Juan Carlos University, 28922 Madrid, Spain; (F.M.-R.); (M.C.-T.)
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22
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Cleland BT, Madhavan S. Ipsilateral Motor Pathways and Transcallosal Inhibition During Lower Limb Movement After Stroke. Neurorehabil Neural Repair 2021; 35:367-378. [PMID: 33703951 DOI: 10.1177/1545968321999049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stroke rehabilitation may be improved with a better understanding of the contribution of ipsilateral motor pathways to the paretic limb and alterations in transcallosal inhibition. Few studies have evaluated these factors during dynamic, bilateral lower limb movements, and it is unclear whether they relate to functional outcomes. OBJECTIVE Determine if lower limb ipsilateral excitability and transcallosal inhibition after stroke depend on target limb, task, or number of limbs involved, and whether these factors are related to clinical measures. METHODS In 29 individuals with stroke, ipsilateral and contralateral responses to transcranial magnetic stimulation were measured in the paretic and nonparetic tibialis anterior during dynamic (unilateral or bilateral ankle dorsiflexion/plantarflexion) and isometric (unilateral dorsiflexion) conditions. Relative ipsilateral excitability and transcallosal inhibition were assessed. Fugl-Meyer, ankle movement accuracy, and walking characteristics were assessed. RESULTS Relative ipsilateral excitability was greater during dynamic than isometric conditions in the paretic limb (P ≤ .02) and greater in the paretic than the nonparetic limb during dynamic conditions (P ≤ .004). Transcallosal inhibition was greater in the ipsilesional than contralesional hemisphere (P = .002) and during dynamic than isometric conditions (P = .03). Greater ipsilesional transcallosal inhibition was correlated with better ankle movement accuracy (R2 = 0.18, P = .04). Greater contralateral excitability to the nonparetic limb was correlated with improved walking symmetry (R2 = 0.19, P = .03). CONCLUSIONS Ipsilateral pathways have increased excitability to the paretic limb, particularly during dynamic tasks. Transcallosal inhibition is greater in the ipsilesional than contralesional hemisphere and during dynamic than isometric tasks. Ipsilateral pathways and transcallosal inhibition may influence walking asymmetry and ankle movement accuracy.
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23
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Li Y, Koldenhoven RM, Liu T, Venuti CE. Age-related gait development in children with autism spectrum disorder. Gait Posture 2021; 84:260-266. [PMID: 33383537 DOI: 10.1016/j.gaitpost.2020.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND A better understanding of gait development and asymmetries in children with autism spectrum disorder (ASD) may improve the development of treatment programs and thus, patient outcomes. RESEARCH QUESTION Does age affect walking kinematics and symmetry in children with ASD? METHOD Twenty-nine children (aged 6-14 years old) with mild ASD (level one) were recruited and assigned to one of the three groups based on their ages: 6-8 years (U8), 9-11 years (U11) and 12-14 years (U14). Walking kinematics were captured using an inertia measurement unit system placed bilaterally on participants' foot, lower leg, upper leg, upper arm, pelvis, and thoracic spine. Joint angles were computed and compared among the age groups. Symmetry angles were used to assess the gait symmetry and were compared among the age groups. RESULTS Older children exhibited less ankle dorsiflexion and knee flexion angles at heel-strike and greater plantarflexion angles at toe-off compared with younger children. In addition, a decreased pelvis and thorax axial rotation range of motion and increased shoulder flexion/extension range of motion were observed for older children. However, no age-related difference in gait symmetry was observed. SIGNIFICANCE These findings could suggest that older children with ASD may develop gait kinematics to a more energy-efficient walking pattern.
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Affiliation(s)
- Yumeng Li
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA.
| | - Rachel M Koldenhoven
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
| | - Ting Liu
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
| | - Carrie E Venuti
- Department of Health and Human Performance, Texas State University, San Marcos, TX, USA
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24
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Yang CL, Gad A, Creath RA, Magder L, Rogers MW, Waller SM. Effects of transcranial direct current stimulation (tDCS) on posture, movement planning, and execution during standing voluntary reach following stroke. J Neuroeng Rehabil 2021; 18:5. [PMID: 33413441 PMCID: PMC7791870 DOI: 10.1186/s12984-020-00799-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022] Open
Abstract
Background Impaired movement preparation of both anticipatory postural adjustments and goal directed movement as shown by a marked reduction in the incidence of StartReact responses during a standing reaching task was reported in individuals with stroke. We tested how transcranial direct current stimulation (tDCS) applied over the region of premotor areas (PMAs) and primary motor area (M1) affect movement planning and preparation of a standing reaching task in individuals with stroke. Methods Each subject performed two sessions of tDCS over the lesioned hemisphere on two different days: cathodal tDCS over PMAs and anodal tDCS over M1. Movement planning and preparation of anticipatory postural adjustment-reach sequence was examined by startReact responses elicited by a loud acoustic stimulus of 123 dB. Kinetic, kinematic, and electromyography data were recorded to characterize anticipatory postural adjustment-reach movement response. Results Anodal tDCS over M1 led to significant increase of startReact responses incidence at loud acoustic stimulus time point − 500 ms. Increased trunk involvement during movement execution was found after anodal M1 stimulation compared to PMAs stimulation. Conclusions The findings provide novel evidence that impairments in movement planning and preparation as measured by startReact responses for a standing reaching task can be mitigated in individuals with stroke by the application of anodal tDCS over lesioned M1 but not cathodal tDCS over PMAs. This is the first study to show that stroke-related deficits in movement planning and preparation can be improved by application of anodal tDCS over lesioned M1. Trial registration ClinicalTrial.gov, NCT04308629, Registered 16 March 2020—Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT04308629
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Affiliation(s)
- Chieh-Ling Yang
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA. .,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z2G9, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, BC, V6T1Z3, Canada.
| | - Alon Gad
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Robert A Creath
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA.,Lewis Human Performance Lab, Department of Exercise Science, Lebanon Valley College, Annville, PA, 17003, USA
| | - Laurence Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Mark W Rogers
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA
| | - Sandy McCombe Waller
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, 100 Penn Street, Baltimore, MD, 21201, USA.,Division of Health, Business, Technology and Science, Frederick Community College, 7932 Oppossumtown Pike, Frederick, MD, 21702, USA
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25
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Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke. Cochrane Database Syst Rev 2020; 11:CD009645. [PMID: 33175411 PMCID: PMC8095012 DOI: 10.1002/14651858.cd009645.pub4] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Stroke is one of the leading causes of disability worldwide. Functional impairment, resulting in poor performance in activities of daily living (ADL) among stroke survivors is common. Current rehabilitation approaches have limited effectiveness in improving ADL performance, function, muscle strength, and cognitive abilities (including spatial neglect) after stroke, with improving cognition being the number one research priority in this field. A possible adjunct to stroke rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve these outcomes in people after stroke. OBJECTIVES To assess the effects of tDCS on ADL, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register, CENTRAL, MEDLINE, Embase and seven other databases in January 2019. In an effort to identify further published, unpublished, and ongoing trials, we also searched trials registers and reference lists, handsearched conference proceedings, and contacted authors and equipment manufacturers. SELECTION CRITERIA This is the update of an existing review. In the previous version of this review, we focused on the effects of tDCS on ADL and function. In this update, we broadened our inclusion criteria to compare any kind of active tDCS for improving ADL, function, muscle strength and cognitive abilities (including spatial neglect) versus any kind of placebo or control intervention. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and risk of bias, extracted data, and applied GRADE criteria. If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports. MAIN RESULTS We included 67 studies involving a total of 1729 patients after stroke. We also identified 116 ongoing studies. The risk of bias did not differ substantially for different comparisons and outcomes. The majority of participants had ischaemic stroke, with mean age between 43 and 75 years, in the acute, postacute, and chronic phase after stroke, and level of impairment ranged from severe to less severe. Included studies differed in terms of type, location and duration of stimulation, amount of current delivered, electrode size and positioning, as well as type and location of stroke. We found 23 studies with 781 participants examining the effects of tDCS versus sham tDCS (or any other passive intervention) on our primary outcome measure, ADL after stroke. Nineteen studies with 686 participants reported absolute values and showed evidence of effect regarding ADL performance at the end of the intervention period (standardised mean difference (SMD) 0.28, 95% confidence interval (CI) 0.13 to 0.44; random-effects model; moderate-quality evidence). Four studies with 95 participants reported change scores, and showed an effect (SMD 0.48, 95% CI 0.02 to 0.95; moderate-quality evidence). Six studies with 269 participants assessed the effects of tDCS on ADL at the end of follow-up and provided absolute values, and found improved ADL (SMD 0.31, 95% CI 0.01 to 0.62; moderate-quality evidence). One study with 16 participants provided change scores and found no effect (SMD -0.64, 95% CI -1.66 to 0.37; low-quality evidence). However, the results did not persist in a sensitivity analysis that included only trials with proper allocation concealment. Thirty-four trials with a total of 985 participants measured upper extremity function at the end of the intervention period. Twenty-four studies with 792 participants that presented absolute values found no effect in favour of tDCS (SMD 0.17, 95% CI -0.05 to 0.38; moderate-quality evidence). Ten studies with 193 participants that presented change values also found no effect (SMD 0.33, 95% CI -0.12 to 0.79; low-quality evidence). Regarding the effects of tDCS on upper extremity function at the end of follow-up, we identified five studies with a total of 211 participants (absolute values) without an effect (SMD -0.00, 95% CI -0.39 to 0.39; moderate-quality evidence). Three studies with 72 participants presenting change scores found an effect (SMD 1.07; 95% CI 0.04 to 2.11; low-quality evidence). Twelve studies with 258 participants reported outcome data for lower extremity function and 18 studies with 553 participants reported outcome data on muscle strength at the end of the intervention period, but there was no effect (high-quality evidence). Three studies with 156 participants reported outcome data on muscle strength at follow-up, but there was no evidence of an effect (moderate-quality evidence). Two studies with 56 participants found no evidence of effect of tDCS on cognitive abilities (low-quality evidence), but one study with 30 participants found evidence of effect of tDCS for improving spatial neglect (very low-quality evidence). In 47 studies with 1330 participants, the proportions of dropouts and adverse events were comparable between groups (risk ratio (RR) 1.25, 95% CI 0.74 to 2.13; random-effects model; moderate-quality evidence). AUTHORS' CONCLUSIONS: There is evidence of very low to moderate quality on the effectiveness of tDCS versus control (sham intervention or any other intervention) for improving ADL outcomes after stroke. However, the results did not persist in a sensitivity analyses including only trials with proper allocation concealment. Evidence of low to high quality suggests that there is no effect of tDCS on arm function and leg function, muscle strength, and cognitive abilities in people after stroke. Evidence of very low quality suggests that there is an effect on hemispatial neglect. There was moderate-quality evidence that adverse events and numbers of people discontinuing the treatment are not increased. Future studies should particularly engage with patients who may benefit the most from tDCS after stroke, but also should investigate the effects in routine application. Therefore, further large-scale randomised controlled trials with a parallel-group design and sample size estimation for tDCS are needed.
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Affiliation(s)
- Bernhard Elsner
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
- Department of Physiotherapy, SRH Hochschule für Gesundheit Gera, 07548 Gera, Germany
| | - Joachim Kugler
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
| | - Marcus Pohl
- Neurological Rehabilitation, Helios Klinik Schloss Pulsnitz, Pulsnitz, Germany
| | - Jan Mehrholz
- Department of Public Health, Dresden Medical School, Technical University Dresden, Dresden, Germany
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26
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Feasibility and Safety of Transcranial Direct Current Stimulation in an Outpatient Rehabilitation Setting After Stroke. Brain Sci 2020; 10:brainsci10100719. [PMID: 33050340 PMCID: PMC7599981 DOI: 10.3390/brainsci10100719] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has strong potential for outpatient clinical use, but feasibility and safety of tDCS has only been evaluated in laboratory and inpatient clinical settings. The objective of this study was to assess feasibility and safety of tDCS for stroke in an outpatient clinical setting. Individuals with stroke in outpatient therapy received tDCS during physical therapy sessions. Feasibility was assessed with screening, enrollment, withdrawal, and adherence numbers, tDCS impressions, and perceived benefits and detriments of tDCS. Acute changes in fatigue and self-reported function and pre-post changes in fatigue were also assessed. Safety was assessed as adverse events and side effects. In total, 85 individuals were screened, and 10 were enrolled. Most exclusions were unrelated to clinical feasibility. In total, 3 participants withdrew, so 7 participants completed 2 sessions/week for 5–6 weeks with 100% adherence. In total, 71% reported positive impressions of tDCS. tDCS setup decreased to 5–7 min at end of study. There was one adverse event unrelated to tDCS. Mild to moderate side effects (tingling, itching, pinching, and fatigue) were experienced. In total, 86% of participants recounted benefits of tDCS. There were acute improvements in function and energy. Results support the feasibility and safety of tDCS in an outpatient clinical setting.
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27
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Madhavan S, Cleland BT, Sivaramakrishnan A, Freels S, Lim H, Testai FD, Corcos DM. Cortical priming strategies for gait training after stroke: a controlled, stratified trial. J Neuroeng Rehabil 2020; 17:111. [PMID: 32799922 PMCID: PMC7429759 DOI: 10.1186/s12984-020-00744-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/05/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Stroke survivors experience chronic gait impairments, so rehabilitation has focused on restoring ambulatory capacity. High-intensity speed-based treadmill training (HISTT) is one form of walking rehabilitation that can improve walking, but its effectiveness has not been thoroughly investigated. Additionally, cortical priming with transcranial direct current stimulation (tDCS) and movement may enhance HISTT-induced improvements in walking, but there have been no systematic investigations. The objective of this study was to determine if motor priming can augment the effects of HISTT on walking in chronic stroke survivors. METHODS Eighty-one chronic stroke survivors participated in a controlled trial with stratification into four groups: 1) control-15 min of rest (n = 20), 2) tDCS-15 min of stimulation-based priming with transcranial direct current stimulation (n = 21), 3) ankle motor tracking (AMT)-15 min of movement-based priming with targeted movements of the ankle and sham tDCS (n = 20), and 4) tDCS+AMT-15 min of concurrent tDCS and AMT (n = 20). Participants performed 12 sessions of HISTT (40 min/day, 3 days/week, 4 weeks). Primary outcome measure was walking speed. Secondary outcome measures included corticomotor excitability (CME). Outcomes were measured at pre, post, and 3-month follow-up assessments. RESULTS HISTT improved walking speed for all groups, which was partially maintained 3 months after training. No significant difference in walking speed was seen between groups. The tDCS+AMT group demonstrated greater changes in CME than other groups. Individuals who demonstrated up-regulation of CME after tDCS increased walking speed more than down-regulators. CONCLUSIONS Our results support the effectiveness of HISTT to improve walking; however, motor priming did not lead to additional improvements. Upregulation of CME in the tDCS+AMT group supports a potential role for priming in enhancing neural plasticity. Greater changes in walking were seen in tDCS up-regulators, suggesting that responsiveness to tDCS might play an important role in determining the capacity to respond to priming and HISTT. TRIAL REGISTRATION ClinicalTrials.gov , NCT03492229. Registered 10 April 2018 - retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03492229 .
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Affiliation(s)
- Sangeetha Madhavan
- Department of Physical Therapy, Brain Plasticity Lab, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA.
| | - Brice T Cleland
- Department of Physical Therapy, Brain Plasticity Lab, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | - Anjali Sivaramakrishnan
- Department of Physical Therapy, Brain Plasticity Lab, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | - Sally Freels
- University of Illinois at Chicago, Epidemiology and Biostatistics, Chicago, IL, USA
| | - Hyosok Lim
- Department of Physical Therapy, Brain Plasticity Lab, University of Illinois at Chicago, 1919 W. Taylor St, Chicago, IL, 60612, USA
| | - Fernando D Testai
- University of Illinois at Chicago, Department of Neurology and Rehabilitation, Chicago, IL, USA
| | - Daniel M Corcos
- Northwestern University, Physical Therapy & Human Movement Sciences, Chicago, IL, USA
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Lim H, Madhavan S. Differential corticomotor mechanisms of ankle motor control in post stroke individuals with and without motor evoked potentials. Brain Res 2020; 1739:146833. [PMID: 32298662 DOI: 10.1016/j.brainres.2020.146833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/05/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Deficits in ankle motor control has been identified as a significant contributor to impaired walking after stroke. Corticomotor excitability has been related to impaired upper limb motor control and poor recovery in stroke, however contributions to lower limb function are still unclear. This study used transcranial magnetic stimulation (TMS) to determine the influence of corticomotor characteristics on lower limb motor control in chronic stroke survivors. METHODS This retrospective study assessed 28 individuals with post stroke hemiparesis. Motor evoked potentials (MEP) measured from the paretic and non-paretic tibialis anterior (TA) muscles were used to calculate corticomotor excitability symmetry (CMEsym) and relative ipsilateral corticomotor excitability (ICE). Participants were assigned to MEP+ and MEP- groups depending on the presence (+) or absence (-) of MEPs. Ankle motor control was quantified by the ability of participants to track a sinusoidal target using dorsiflexion-plantarflexion movements of the paretic ankle and tracking error was calculated using root mean square error (RMSE). RESULTS Multiple linear regression model for all participants revealed only CMEsym and FMLE (p < 0.01) to significantly predict RMSE. In the MEP+ group, CMEsym significantly predicted RMSE (p = 0.03) while FMLE (p = 0.02) was a significant predictor for the MEP-. CONCLUSION Our results indicate that CMEsym between the ipsilesional and contralesional hemispheres does not necessarily translate to better paretic ankle motor control in chronic stroke. Presence or absence of a MEP in the TA muscle did not affect the ankle tracking performance, however, it was noted that different strategies maybe used by those with and without a MEP.
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Affiliation(s)
- Hyosok Lim
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA; Graduate Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA.
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Multi-session anodal transcranial direct current stimulation enhances lower extremity functional performance in healthy older adults. Exp Brain Res 2020; 238:1925-1936. [DOI: 10.1007/s00221-020-05827-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/02/2020] [Indexed: 12/22/2022]
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Lopes JBP, Miziara IM, Galli M, Cimolin V, Oliveira CS. Effect of Transcranial Direct Current Stimulation Combined With Xbox-Kinect Game Experience on Upper Limb Movement in Down Syndrome: A Case Report. Front Bioeng Biotechnol 2020; 8:514. [PMID: 32548102 PMCID: PMC7273846 DOI: 10.3389/fbioe.2020.00514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 04/30/2020] [Indexed: 11/28/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique used to enhance local synaptic efficacy and modulate the electrical activity of the cortex in neurological disorders. Researchers have sought to combine this type of stimulation with well-established therapeutic modalities, such as motor training involving Xbox Kinect games, which has demonstrated promising results. Thus, this study aimed to determine whether tDCS can enhance upper limb motor training in an eight-year-old child with Down Syndrome (DS) (cognitive age: five years, based on the Wechsler Intelligence Scale for Children). The evaluations consisted of three-dimensional analysis of upper limb kinematics during a reaching task performed before, after10 session, and one month after the intervention. The intervention protocol involved 1 20-min sessions of tDCS over the primary motor cortex at an intensity of 1 mA during Xbox Kinect game training involving an upper limb motor task. The analysis of the kinematic data revealed that in the pre-intervention evaluation, the dominant limb executed the task slowly and over a long path. These aspects improved at the post-intervention and follow-up evaluations, as demonstrated by the shorter total movement duration (3.05 vs. 1.58 vs. 1.52 s, respectively). Similar changes occurred with the non-dominant upper limb; a significant increase in movement velocity at the post-intervention and follow-up evaluations was observed (0.53 vs. 0.54 vs. 0.85 m/s, respectively). The present case report offers preliminary data from a protocol study, and the results confirm the notion that anodal tDCS combined with upper limb motor training leads to improvements in different kinematic variables.
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Affiliation(s)
- Jamile Benite Palma Lopes
- Health Sciences Program, Faculty of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil
- Undergraduate Department, Faculty of Taquaritinga - FTGA, Taquaritinga, Brazil
| | - Isabela Marques Miziara
- Undergraduate Department, Faculty of Electrical Engineering, Federal University of Uberlândia, Uberlândia, Brazil
- Undergraduate Department, Faculty of Electrical and Biomedical Engineering, Federal University of Pará, Belém, Brazil
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Claudia Santos Oliveira
- Program in Human Movement and Rehabilitation Center of Anápolis, Anápolis, Brazil
- Master's and Doctoral Program in Health Sciences, São Paulo Santa Casa School of Medical Sciences, São Paulo, Brazil
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Gowan S, Hordacre B. Transcranial Direct Current Stimulation to Facilitate Lower Limb Recovery Following Stroke: Current Evidence and Future Directions. Brain Sci 2020; 10:brainsci10050310. [PMID: 32455671 PMCID: PMC7287858 DOI: 10.3390/brainsci10050310] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/30/2022] Open
Abstract
Stroke remains a global leading cause of disability. Novel treatment approaches are required to alleviate impairment and promote greater functional recovery. One potential candidate is transcranial direct current stimulation (tDCS), which is thought to non-invasively promote neuroplasticity within the human cortex by transiently altering the resting membrane potential of cortical neurons. To date, much work involving tDCS has focused on upper limb recovery following stroke. However, lower limb rehabilitation is important for regaining mobility, balance, and independence and could equally benefit from tDCS. The purpose of this review is to discuss tDCS as a technique to modulate brain activity and promote recovery of lower limb function following stroke. Preliminary evidence from both healthy adults and stroke survivors indicates that tDCS is a promising intervention to support recovery of lower limb function. Studies provide some indication of both behavioral and physiological changes in brain activity following tDCS. However, much work still remains to be performed to demonstrate the clinical potential of this neuromodulatory intervention. Future studies should consider treatment targets based on individual lesion characteristics, stage of recovery (acute vs. chronic), and residual white matter integrity while accounting for known determinants and biomarkers of tDCS response.
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Affiliation(s)
- Samuel Gowan
- Interdisciplinary Neuroscience Program, Department of Biology, University of Wisconsin—La Crosse, La Crosse, WI 54601, USA
- Correspondence: ; Tel.: +61-8-83021286
| | - Brenton Hordacre
- IIMPACT in Health, University of South Australia, Adelaide, SA 5001, Australia;
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Aljuhni R, Cleland BT, Roth S, Madhavan S. Genetic polymorphisms for BDNF, COMT, and APOE do not affect gait or ankle motor control in chronic stroke: A preliminary cross-sectional study. Top Stroke Rehabil 2020; 28:72-80. [PMID: 32378476 DOI: 10.1080/10749357.2020.1762060] [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: 10/24/2022]
Abstract
Background: Motor deficits after stroke are a primary cause of long-term disability. The extent of functional recovery may be influenced by genetic polymorphisms. Objectives: Determine the effect of genetic polymorphisms for brain-derived neurotrophic factor (BDNF), catechol-O-methyltransferase (COMT), and apolipoprotein E (APOE) on walking speed, walking symmetry, and ankle motor control in individuals with chronic stroke. Methods: 38 participants with chronic stroke were compared based upon genetic polymorphisms for BDNF (presence [MET group] or absence [VAL group] of a Met allele), COMT (presence [MET group] or absence [VAL group] of a Met allele), and APOE (presence [ε4+ group] of absence [ε4- group] of ε4 allele). Comfortable and maximal walking speed were measured with the 10-m walk test. Gait spatiotemporal symmetry was measured with the GAITRite electronic mat; symmetry ratios were calculated for step length, step time, swing time, and stance time. Ankle motor control was measured as the accuracy of performing an ankle tracking task. Results: No significant differences were detected (p ≥ 0.11) between the BDNF, COMT, or APOE groups for any variables. Conclusions: In these preliminary findings, genetic polymorphisms for BDNF, COMT, and APOE do not appear to affect walking speed, walking symmetry, or ankle motor performance in chronic stroke.
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Affiliation(s)
- Rehab Aljuhni
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL, USA
| | - Brice T Cleland
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL, USA
| | - Stephen Roth
- Department of Kinesiology, School of Public Health, University of Maryland , College Park, MD, USA
| | - Sangeetha Madhavan
- Brain Plasticity Lab, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago , Chicago, IL, USA
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Comparison of Transcranial Direct Current Stimulation of the Primary Motor Cortex and Cerebellum on Static Balance in Older Adults. IRANIAN RED CRESCENT MEDICAL JOURNAL 2020. [DOI: 10.5812/ircmj.96259] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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A Review of US Army Research Contributing to Cognitive Enhancement in Military Contexts. JOURNAL OF COGNITIVE ENHANCEMENT 2020. [DOI: 10.1007/s41465-020-00167-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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35
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Bao SC, Khan A, Song R, Kai-yu Tong R. Rewiring the Lesioned Brain: Electrical Stimulation for Post-Stroke Motor Restoration. J Stroke 2020; 22:47-63. [PMID: 32027791 PMCID: PMC7005350 DOI: 10.5853/jos.2019.03027] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 02/06/2023] Open
Abstract
Electrical stimulation has been extensively applied in post-stroke motor restoration, but its treatment mechanisms are not fully understood. Stimulation of neuromotor control system at multiple levels manipulates the corresponding neuronal circuits and results in neuroplasticity changes of stroke survivors. This rewires the lesioned brain and advances functional improvement. This review addresses the therapeutic mechanisms of different stimulation modalities, such as noninvasive brain stimulation, peripheral electrical stimulation, and other emerging techniques. The existing applications, the latest progress, and future directions are discussed. The use of electrical stimulation to facilitate post-stroke motor recovery presents great opportunities in terms of targeted intervention and easy applicability. Further technical improvements and clinical studies are required to reveal the neuromodulatory mechanisms and to enhance rehabilitation therapy efficiency in stroke survivors and people with other movement disorders.
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Affiliation(s)
- Shi-chun Bao
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Ahsan Khan
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Rong Song
- School of Biomedical Engineering, Sun Yat-Sen University, Guangzhou, China
| | - Raymond Kai-yu Tong
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China
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36
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Silva LVDCD, Porto F, Fregni F, Gurgel JL. TRANSCRANIAL DIRECT-CURRENT STIMULATION IN COMBINATION WITH EXERCISE: A SYSTEMATIC REVIEW. REV BRAS MED ESPORTE 2019. [DOI: 10.1590/1517-869220192506215836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Introduction Transcranial direct-current stimulation (tDCS) is a noninvasive technique that allows the modulation of cortical excitability and can produce changes in neuronal plasticity. The application of tDCS has recently been associated with physical activity. Objectives To verify the effect of Transcranial Direct-Current Stimulation (tDCS) in combination with physical exercise, characterizing methodological aspects of the technique. Methods In the database search, studies with animals, other neuromodulation techniques and opinion and review articles were excluded. Publications up to 2016 were selected and the methodological quality of the articles was verified through the PEDro scale. Results The majority of studies (86%) used tDCS on the motor cortex area, with anodal current and the allocation of monocephalic electrodes (46.5%). The prevalent current intensity was 2mA (72%), with duration of 20min (55.8%). The profile of the research participants was predominantly of subjects aged up to 60 years (72.1%). The outcomes were favorable for the use of anodal tDCS in combination with physical exercise. Conclusion Transcranial Direct-Current Stimulation is a promising technique when used in combination with aerobic and anaerobic exercises; however, it is necessary to investigate concurrent exercise. Level of Evidence II; Therapeutic Studies Investigating the Results of Treatment (systematic review of Level II studies or Level I studies with inconsistent results).
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Affiliation(s)
| | - Flávia Porto
- Universidade do Estado do Rio de Janeiro, Brazil
| | - Felipe Fregni
- Spaulding Neuromodulation Center, United States of America
| | - Jonas Lírio Gurgel
- Universidade Federal Fluminense, Brazil; Universidade Federal Fluminense, Brazil
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37
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Koganemaru S, Kitatani R, Fukushima-Maeda A, Mikami Y, Okita Y, Matsuhashi M, Ohata K, Kansaku K, Mima T. Gait-Synchronized Rhythmic Brain Stimulation Improves Poststroke Gait Disturbance: A Pilot Study. Stroke 2019; 50:3205-3212. [PMID: 31500557 DOI: 10.1161/strokeaha.119.025354] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Gait disturbance is one of serious impairments lowering activity of daily life in poststroke patients. The patients often show reduced hip and knee joint flexion and ankle dorsiflexion of the lower limbs during the swing phase of gait, which is partly controlled by the primary motor cortex (M1). In the present study, we investigated whether gait-synchronized rhythmic brain stimulation targeting swing phase-related M1 activity can improve gait function in poststroke patients. Methods- Eleven poststroke patients in the chronic phase participated in this single-blind crossover study. Each patient received oscillatory transcranial direct current stimulation over the affected M1 foot area and sham stimulation during treadmill gait. The brain stimulation was synchronized with individual gait rhythm, and the electrical current peaks reached immediately before initiation of the swing phase of the paretic lower limb. Ankle dorsiflexion was assisted by electrical neuromuscular stimulation in both real and sham conditions. Results- Regarding the effects of a single intervention, the speed of self-paced gait was significantly increased after oscillatory transcranial direct current stimulation, but not after sham stimulation (paired t test, P=0.009). After we administered the intervention repeatedly, self- and maximally paced gait speed and timed up and go test performance were significantly improved (self-paced: F(1,21)=8.91, P=0.007, maximally paced: F(1,21)=7.09, P=0.015 and timed up and go test: F(1,21)=12.27, P=0.002), along with improved balance function and increased joint flexion of the paretic limbs during gait. Conclusions- These findings suggest that rhythmic brain stimulation synchronized with gait rhythm might be a promising approach to induce gait recovery in poststroke patients. Clinical Trial Registration- URL: https://www.umin.ac.jp/ctr/. Unique identifier: UMIN000013676.
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Affiliation(s)
- Satoko Koganemaru
- From the Department of Physiology and Biological Information, Dokkyo Medical University, Tochigi, Japan (S.K., K.K.)
| | - Ryosuke Kitatani
- Kansai Rehabilitation Hospital, Osaka, Japan (R.K., A.F.-M.).,Department of Physical Therapy (R.K., Y.O., K.O.), The Graduate School of Medicine, Kyoto University, Japan
| | | | - Yusuke Mikami
- Human Brain Research Center (Y.M., M.M.), The Graduate School of Medicine, Kyoto University, Japan
| | - Yusuke Okita
- Department of Physical Therapy (R.K., Y.O., K.O.), The Graduate School of Medicine, Kyoto University, Japan
| | - Masao Matsuhashi
- Human Brain Research Center (Y.M., M.M.), The Graduate School of Medicine, Kyoto University, Japan
| | - Koji Ohata
- Department of Physical Therapy (R.K., Y.O., K.O.), The Graduate School of Medicine, Kyoto University, Japan
| | - Kenji Kansaku
- From the Department of Physiology and Biological Information, Dokkyo Medical University, Tochigi, Japan (S.K., K.K.)
| | - Tatsuya Mima
- The Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University, Kyoto, Japan (T.M.)
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Cattagni T, Geiger M, Supiot A, de Mazancourt P, Pradon D, Zory R, Roche N. A single session of anodal transcranial direct current stimulation applied over the affected primary motor cortex does not alter gait parameters in chronic stroke survivors. Neurophysiol Clin 2019; 49:283-293. [DOI: 10.1016/j.neucli.2019.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/10/2019] [Accepted: 07/10/2019] [Indexed: 01/20/2023] Open
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Iyer PC, Rosenberg A, Baynard T, Madhavan S. Influence of neurovascular mechanisms on response to tDCS: an exploratory study. Exp Brain Res 2019; 237:2829-2840. [PMID: 31455998 DOI: 10.1007/s00221-019-05626-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
The beneficial effects of transcranial direct current stimulation (tDCS) for stroke rehabilitation are limited by the variability in changes in corticomotor excitability (CME) after tDCS. Neuronal activity is closely related to cerebral blood flow; however, the cerebral hemodynamics of neuromodulation in relation to neural effects have been less explored. In this study, we examined the effects of tDCS on cerebral blood velocity (CBv) in chronic stroke survivors using transcranial Doppler (TCD) ultrasound in relation to changes in CME and described the neurovascular characteristics of tDCS responders. Middle cerebral artery (MCA) CBv, cerebrovascular resistance (CVRi) and other cerebral hemodynamics-related variables were continuously measured before and after 15 min of 1 mA anodal tDCS to the lesioned lower limb M1. tDCS did not modulate CBv in the whole group and upon TMS-based stratification of responders and non-responders. However, at baseline, responders demonstrated lower CME levels, lower CBv and higher CVRi as compared to non-responders. These results indicate a possible difference in baseline CME and CBv in tDCS responders that may influence their response to neuromodulation. Future trials with a large sample size and repeated baseline measurements may help validate these findings and establish a relationship between neuromodulation and neurovascular mechanisms in stroke.
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Affiliation(s)
- Pooja C Iyer
- Graduate Program in Rehabilitation Science, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Alexander Rosenberg
- Department of Physiology and Anatomy, University of North Texas Health Science Center, Fort Worth, TX, USA.,Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Tracy Baynard
- Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Sangeetha Madhavan
- Brain Plasticity Laboratory, Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Chicago, IL, 60612, USA.
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40
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Modulating Neuronal Networks to Enhance Postural Control: A Review of Transcranial Direct Current Stimulation Approach. IRANIAN RED CRESCENT MEDICAL JOURNAL 2019. [DOI: 10.5812/ircmj.90337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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41
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Patel R, Madhavan S. Comparison of Transcranial Direct Current Stimulation Electrode Montages for the Lower Limb Motor Cortex. Brain Sci 2019; 9:brainsci9080189. [PMID: 31390741 PMCID: PMC6721300 DOI: 10.3390/brainsci9080189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 12/19/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has been widely explored as a neuromodulatory adjunct to modulate corticomotor excitability and improve motor behavior. However, issues with the effectiveness of tDCS have led to the exploration of empirical and experimental alternate electrode placements to enhance neuromodulatory effects. Here, we conducted a preliminary study to compare a novel electrode montage (which involved placing 13 cm2 electrodes anterior and posterior to the target location) to the traditionally used electrode montage (13 cm2 stimulating electrode over the target area and the 35 cm2 reference electrode over the contralateral orbit). We examined the effects of tDCS of the lower limb motor area (M1) by measuring the corticomotor excitability (CME) of the tibialis anterior muscle using transcranial magnetic stimulation in twenty healthy participants. We examined behavioral effects using a skilled motor control task performed with the ankle. We did not find one electrode montage to be superior to the other for changes in the CME or motor control. When the group was dichotomized into responders and non-responders (based on upregulation in CME), we found that the responders showed significant upregulation from baseline after tDCS for both montages. However, only the responders in the traditional montage group showed significant changes in motor control after tDCS. These results do not support the superiority of the new anterior–posterior montage over the traditional montage. Further work with a larger cohort and multiple cumulative sessions may be necessary to confirm our results.
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Affiliation(s)
- Radhika Patel
- Department of Physical Therapy, University of Illinois at Chicago (UIC), Chicago, IL 60612, USA
| | - Sangeetha Madhavan
- Department of Physical Therapy, University of Illinois at Chicago (UIC), Chicago, IL 60612, USA.
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Ojardias E, Azé OD, Luneau D, Mednieks J, Condemine A, Rimaud D, Chassagne F, Giraux P. The Effects of Anodal Transcranial Direct Current Stimulation on the Walking Performance of Chronic Hemiplegic Patients. Neuromodulation 2019; 23:373-379. [PMID: 31124218 DOI: 10.1111/ner.12962] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 02/11/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the effect of a single session of tDCS over the primary motor cortex of the lower limb (M1-LL) vs. placebo on the walking performance in chronic hemiplegic patients. PATIENTS AND METHODS Randomized, cross-over, double-blinded study. Eighteen patients with initially complete hemiplegia and poststroke delay >6 months were included. Each patient received a single session of anodal stimulation (2 mA, 20 min) over M1-LL (a-tDCS condition) and a pseudostimulation session (SHAM condition). The order of the two sessions was randomly assigned, with an 11-day interval between the two sessions. The anodal electrode was centered on the hotspot identified with Transcranial magnetic stimulation. The cathode was placed above the contralesional orbitofrontal cortex. Walking performance was evaluated with the Wade test and the 6-minute walk test (6MWT), gait parameters with GAITRite, and balance with posturography. These tests were performed during and 1 hour after the stimulation. Baseline assessments were performed the day before and 10 days after each session. RESULTS The comparison between the 6MWT under a-tDCS vs. SHAM conditions demonstrated a nonsignificant positive effect of the stimulation by 15% during stimulation (p = 0.360) and a significant positive effect of 25% 1 hour after stimulation (p = 0.038). No significant differences were observed for the other evaluations. DISCUSSION These results showed a significant positive effect of a single session of anodal tDCS of the M1-LL in chronic hemiplegic patients. This proof-of-concept study supports the conduct of clinical studies evaluating the effectiveness of a walking training program associated with iterative tDCS stimulation. CONFLICT OF INTEREST The authors reported no conflict of interest.
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Affiliation(s)
- Etienne Ojardias
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA, 7424, 42023, Saint-Etienne, France.,CHU Saint-Etienne, Service Médecine Physique et Réadaptation, F-42055, Saint-Etienne, France
| | - Oscar Dagbémabou Azé
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA, 7424, 42023, Saint-Etienne, France.,Laboratoire de Biomécanique et de Performance, Institut National de la Jeunesse, de l'Education Physique et du Sport (INJEPS)/ Université d'Abomey-Calavi (UAC), Porto-Novo, Bénin, Africa
| | - Davy Luneau
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA, 7424, 42023, Saint-Etienne, France
| | - Janis Mednieks
- CHU Saint-Etienne, Service Médecine Physique et Réadaptation, F-42055, Saint-Etienne, France.,Department of Neurology and Neurosurgery, Riga Stradins University, Riga, Latvia
| | - Agnès Condemine
- CHU Saint-Etienne, Service Médecine Physique et Réadaptation, F-42055, Saint-Etienne, France
| | - Diana Rimaud
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA, 7424, 42023, Saint-Etienne, France.,CHU Saint-Etienne, Service Médecine Physique et Réadaptation, F-42055, Saint-Etienne, France
| | - Fanette Chassagne
- Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, Sainbiose, F-42023, Saint-Etienne, France
| | - Pascal Giraux
- Univ Lyon, UJM Saint-Etienne, Laboratoire Interuniversitaire de Biologie de la Motricité, EA, 7424, 42023, Saint-Etienne, France.,CHU Saint-Etienne, Service Médecine Physique et Réadaptation, F-42055, Saint-Etienne, France
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Anodal Transcranial Direct Current Stimulation over the Vertex Enhances Leg Motor Cortex Excitability Bilaterally. Brain Sci 2019; 9:brainsci9050098. [PMID: 31035662 PMCID: PMC6562544 DOI: 10.3390/brainsci9050098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 12/16/2022] Open
Abstract
In many studies, anodal transcranial Direct Current Stimulation (tDCS) is applied near the vertex to simultaneously facilitate leg motor cortex (M1) of both hemispheres and enhance recovery of gait and balance in neurological disorders. However, its effect on the excitability of leg M1 in either hemisphere is not well known. In this double-blind sham-controlled study, corticospinal excitability changes induced in leg M1 of both hemispheres by anodal (2 mA for 20 minutes) or sham tDCS (for 20 min) over the vertex were evaluated. Peak amplitudes of Transcranial Magnetic Stimulation (TMS) induced motor evoked potentials (MEPs) were measured over the contralateral Tibialis Anterior (TA) muscle before and up to 40 min after tDCS in 11 normal participants. Analysis of data from all participants found significant overall increase in the excitability of leg M1 after tDCS. However, in individual subjects there was variability in observed effects. In 4 participants, 20 min of tDCS increased mean MEPs of TAs on both sides; in 4 participants there was increased mean MEP only on one side and in 3 subjects there was no change. It’s not known if the benefits of tDCS in improving gait and balance are dependent on excitability changes induced in one or both leg M1; such information may be useful to predict treatment outcomes.
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Lodha N, Patel P, Casamento-Moran A, Hays E, Poisson SN, Christou EA. Strength or Motor Control: What Matters in High-Functioning Stroke? Front Neurol 2019; 9:1160. [PMID: 30687217 PMCID: PMC6333669 DOI: 10.3389/fneur.2018.01160] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/14/2018] [Indexed: 01/13/2023] Open
Abstract
Background: The two primary motor impairments that hinder function after stroke are declines in strength and motor control. The impact of motor impairments on functional capacity may vary with the severity of stroke motor impairments. In this study, we focus on high-functioning stroke individuals who experience mild to moderate motor impairments and often resume prior activities or return to work. These tasks require the ability to move independently, placing high demands on their functional mobility. Therefore, the purpose of this study was to quantify impairments in strength and motor control and their contribution to functional mobility in high-functioning stroke. Methods:Twenty-one high-functioning stroke individuals (Fugl Meyer Lower Extremity Score = 28.67 ± 4.85; Functional Activity Index = 28.47 ± 7.04) and 21 age-matched healthy controls participated in this study. To examine motor impairments in strength and motor control, participants performed the following tasks with the paretic ankle (1) maximum voluntary contractions (MVC) and (2) visuomotor tracking of a sinusoidal trajectory. Strength was quantified as the maximum force produced during ankle plantarflexion and dorsiflexion. Motor control was quantified as (a) the accuracy and (b) variability of ankle movement during the visuomotor tracking task. For functional mobility, participants performed (1) overground walking for 7 meters and (2) simulated driving task. Functional mobility was determined by walking speed, stride length variability, and braking reaction time. Results: Compared with the controls, the stroke group showed decreased plantarflexion strength, decreased accuracy, and increased variability of ankle movement. In addition, the stroke group demonstrated decreased walking speed, increased stride length variability, and increased braking reaction time. The multiple-linear regression model revealed that motor accuracy was a significant predictor of the walking speed and braking reaction time. Further, motor variability was a significant predictor of stride length variability. Finally, the dorsiflexion or plantarflexion strength did not predict walking speed, stride length variability or braking reaction time. Conclusions: The impairments in motor control but not strength predict functional deficits in walking and driving in high-functioning stroke individuals. Therefore, rehabilitation interventions assessing and improving motor control will potentially enhance functional outcomes in high-functioning stroke survivors.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Agostina Casamento-Moran
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Emily Hays
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Sharon N Poisson
- Department of Neurology, University of Colorado, Aurora, CO, United States
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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Jayaraman A, O'Brien MK, Madhavan S, Mummidisetty CK, Roth HR, Hohl K, Tapp A, Brennan K, Kocherginsky M, Williams KJ, Takahashi H, Rymer WZ. Stride management assist exoskeleton vs functional gait training in stroke: A randomized trial. Neurology 2018; 92:e263-e273. [PMID: 30568009 DOI: 10.1212/wnl.0000000000006782] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 09/17/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the hypothesis that gait training with a hip-assistive robotic exoskeleton improves clinical outcomes and strengthens the descending corticospinal drive to the lower limb muscles in persons with chronic stroke. METHODS Fifty participants completed the randomized, single-blind, parallel study. Participants received over-ground gait training with the Honda Stride Management Assist (SMA) exoskeleton or intensity-matched functional gait training, delivered in 18 sessions over 6-8 weeks. Performance-based and self-reported clinical outcomes were measured at baseline, midpoint, and completion, and at a 3-month follow-up. Corticomotor excitability (CME) of 3 bilateral leg muscles was measured using transcranial magnetic stimulation. RESULTS The primary outcome, walking speed, improved for the SMA group by completion of the program (0.24 ± 0.14 m/s difference, p < 0.001). Compared to the functional group, SMA users had greater improvement in walking endurance (46.0% ± 27.4% vs 35.7% ± 20.8%, p = 0.033), took more steps during therapy days (4,366 ± 2,426 vs 3,028 ± 1,510; p = 0.013), and demonstrated larger changes in CME of the paretic rectus femoris (178% ± 75% vs 33% ± 32%, p = 0.010). Participants with hemorrhagic stroke demonstrated greater improvement in balance when using the SMA (24.7% ± 20% vs 6.8% ± 6.7%, p = 0.029). CONCLUSIONS Gait training with the SMA improved walking speed in persons with chronic stroke, and may promote greater walking endurance, balance, and CME than functional gait training. CLINICALTRIALSGOV IDENTIFIER NCT01994395. CLASSIFICATION OF EVIDENCE This study provides Class I evidence that gait training with a hip-assistive exoskeleton increases clinical outcomes and CME in persons with chronic stroke, but does not significantly improve walking speeds compared to intensity-matched functional gait training.
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Affiliation(s)
- Arun Jayaraman
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH.
| | - Megan K O'Brien
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - Sangeetha Madhavan
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - Chaithanya K Mummidisetty
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - Heidi R Roth
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - Kristen Hohl
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - Annie Tapp
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - Kimberly Brennan
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - Masha Kocherginsky
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - Kenton J Williams
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - Hideaki Takahashi
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
| | - William Z Rymer
- From the Max Nader Lab for Rehabilitation Technologies and Outcomes Research (A.J., M.K.O., C.K.M., K.H.), Shirley Ryan AbilityLab (H.R.R., K.H., A.T., K.B., W.Z.R.); Departments of Physical Medicine and Rehabilitation (A.J., M.K.O., W.Z.R.) and Preventative Medicine (M.K.), Northwestern University; Department of Physical Therapy (S.M.), University of Illinois at Chicago; and Honda R&D Americas, Inc. (K.J.W., H.T.), Raymond, OH
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Li Y, Fan J, Yang J, He C, Li S. Effects of transcranial direct current stimulation on walking ability after stroke: A systematic review and meta-analysis. Restor Neurol Neurosci 2018; 36:59-71. [PMID: 29439362 DOI: 10.3233/rnn-170770] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND As a promising technique, transcranial direct current stimulation (tDCS) has gained so much attention in its potential effects on functional recovery of lower limb following stroke. However, individual studies have yielded inconsistent or conflicting results. OBJECTIVE To investigate the efficacy and safety of tDCS for the functional recovery of lower limb following stroke reported in the randomized controlled trials by using a meta-analysis. METHODS MEDLINE, EMBASE, CINAHL, PsycINFO, Web of Science, CENTRAL, and Physiotherapy Evidence Database was comprehensively searched for randomized controlled trials published until April 2017 that investigated the effects of tDCS on lower limb function. Main outcomes included walking speed, walking endurance, mobility, balance function, muscle strength of lower limb and adverse events. RESULTS A total of 10 trials (n = 194) met the inclusion criteria. Meta-analysis demonstrated a significant effect of tDCS on mobility (SMD 0.44, 95% CI: 0.01 to 0.87, P = 0.04) and muscle strength of lower limb (SMD 1.54, 95% CI: 0.29 to 2.78, P = 0.02). No significant effects were found in walking speed (SMD 0.39, 95% CI: -0.06 to 0.85, P = 0.09), walking endurance (SMD 0.28, 95% CI: -0.28 to 0.84, P = 0.33) and balance function (SMD 0.44, 95% CI: -0.06 to 0.94, P = 0.08). CONCLUSION tDCS might have beneficial effects on improving mobility and muscle strength of lower limb among individuals with stroke. Future studies with larger sample sizes and an adequate follow-up period are needed.
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Affiliation(s)
- Yi Li
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Jingjing Fan
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Jingyi Yang
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.,Key Laboratory of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Shasha Li
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,Athinoula A. Martions Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Seo HG, Lee WH, Lee SH, Yi Y, Kim KD, Oh BM. Robotic-assisted gait training combined with transcranial direct current stimulation in chronic stroke patients: A pilot double-blind, randomized controlled trial. Restor Neurol Neurosci 2018; 35:527-536. [PMID: 28800341 DOI: 10.3233/rnn-170745] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although robotic-assisted gait training (RAGT) is becoming a standard method in stroke rehabilitation, its effect on chronic stroke patients is uncertain. OBJECTIVE This study aimed to investigate whether anodal transcranial direct current stimulation (tDCS) enhances the effect of RAGT on functional ambulation in chronic stroke patients. METHODS Chronic hemiplegic stroke patients with a Functional Ambulatory Category (FAC) score≤4 were randomly assigned to either the RAGT with anodal tDCS (Anodal) group the sham tDCS (Sham) group. The patients were provided with RAGT for 45 min after allocated tDCS on the leg motor cortex in the impaired hemisphere for 20 min every weekday for 2 weeks. The primary outcome measure was the FAC, and the secondary outcome measures included 10-m walking test, 6-min walking test, Berg Balance Scale, Fugl-Meyer assessment of the lower extremity, Medical Research Council Scale, and motor-evoked potential (MEP) parameters. They were evaluated before treatment (T0), immediately after treatment (T1), and 4 weeks after the end of treatment (T2). RESULTS Twenty-one patients were finally included. The percentage of participants who achieved improvement in the FAC score was greater in the Anodal group than in the Sham group, and the difference was significant at T2 (66.7% vs. 12.5%, p = 0.024). In secondary outcome measures, the Anodal group showed greater improvement in the 6-min walking test than the Sham group at T2 (56.49±38.87 vs. 23.59±17.00, p = 0.038). The changes in the MEP parameters were not significantly different between the two groups. CONCLUSION This pilot study suggested that anodal tDCS on the leg motor cortex in the impaired hemisphere may facilitate the effect of RAGT on functional ambulation in chronic stroke patients. Larger clinical trials will be needed to confirm the effect of RAGT combined with tDCS in chronic stroke patients based on the present study.
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Affiliation(s)
- Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Hyung Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seung Hak Lee
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Youbin Yi
- Department of Rehabilitation Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Kwang Dong Kim
- Armed Force Cheongpyeong Hospital, Gyeonggi-do, Republic of Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Klomjai W, Aneksan B, Pheungphrarattanatrai A, Chantanachai T, Choowong N, Bunleukhet S, Auvichayapat P, Nilanon Y, Hiengkaew V. Effect of single-session dual-tDCS before physical therapy on lower-limb performance in sub-acute stroke patients: A randomized sham-controlled crossover study. Ann Phys Rehabil Med 2018; 61:286-291. [PMID: 29763676 DOI: 10.1016/j.rehab.2018.04.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/29/2018] [Accepted: 04/29/2018] [Indexed: 11/15/2022]
Abstract
Anodal stimulation increases cortical excitably, whereas cathodal stimulation decreases cortical excitability. Dual transcranial direct current stimulation (tDCS; anodal over the lesioned hemisphere, cathodal over the non-lesioned hemisphere) was found to enhance motor learning. The corresponding tDCS-induced changes were reported to reduce the inhibition exerted by the unaffected hemisphere on the affected hemisphere and restore the normal balance of the interhemispheric inhibition. Most studies were devoted to the possible modification of upper-limb motor function after tDCS; however, almost no study has demonstrated its effects on lower-limb function and gait, which are also commonly disordered in stroke patients with motor deficits. In this randomized sham-controlled crossover study, we included 19 patients with sub-acute stroke. Participants were randomly allocated to receive real or sham dual-tDCS followed by conventional physical therapy with an intervention interval of at least 1 week. Dual-tDCS was applied over the lower-limb M1 at 2-mA intensity for 20min. Lower-limb performance was assessed by the Timed Up and Go (TUG) and Five-Times-Sit-To-Stand (FTSTS) tests and muscle strength was assessed by peak knee torque of extension. We found a significant increase in time to perform the FTSST for the real group, with improvements significantly greater than for the sham group; the TUG score was significantly increased but not higher than for the sham group. An after-effect on FTSTS was found at approximately 1 week after the real intervention. Muscle strength was unchanged in both limbs for both real and sham groups. Our results suggest that a single session of dual-tDCS before conventional physical therapy could improve sit-to-stand performance, which appeared to be improved over conventional physical therapy alone. However, strength performance was not increased after the combination treatment.
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Affiliation(s)
- Wanalee Klomjai
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand.
| | - Benchaporn Aneksan
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
| | | | - Thanwarat Chantanachai
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
| | - Nattha Choowong
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
| | - Soontaree Bunleukhet
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
| | - Paradee Auvichayapat
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Yongchai Nilanon
- Siriraj Stroke Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vimonwan Hiengkaew
- Faculty of Physical Therapy, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom 73170, Thailand
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Kha V, Foerster AS, Bennett S, Nitsche MA, Stefanovic F, Dutta A. Systems Analysis of Human Visuo-Myoelectric Control Facilitated by Anodal Transcranial Direct Current Stimulation in Healthy Humans. Front Neurosci 2018; 12:278. [PMID: 29760645 PMCID: PMC5936985 DOI: 10.3389/fnins.2018.00278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 04/10/2018] [Indexed: 11/23/2022] Open
Abstract
Induction of neuroplasticity by transcranial direct current stimulation (tDCS) applied to the primary motor cortex facilitates motor learning of the upper extremities in healthy humans. The impact of tDCS on lower limb functions has not been studied extensively so far. In this study, we applied a system identification approach to investigate the impact of anodal transcranial direct current stimulation of the leg area of the motor cortex via the human visuo-myoelectric controller. The visuo-myoelectric reaching task (VMT) involves ballistic muscle contraction after a visual cue. We applied a black box approach using a linear ARX (Auto-regressive with eXogenous input) model for a visuomotor myoelectric reaching task. We found that a 20th order finite impulse response (FIR) model captured the TARGET (single input)—CURSOR (single output) dynamics during a VMT. The 20th order FIR model was investigated based on gain/phase margin analysis, which showed a significant (p < 0.01) effect of anodal tDCS on the gain margin of the VMT system. Also, response latency and the corticomuscular coherence (CMC) time delay were affected (p < 0.05) by anodal tDCS when compared to sham tDCS. Furthermore, gray box simulation results from a Simplified Spinal-Like Controller (SSLC) model demonstrated that the input-output function for motor evoked potentials (MEP) played an essential role in increasing muscle activation levels and response time improvement post-tDCS when compared to pre-tDCS baseline performance. This computational approach can be used to simulate the behavior of the neuromuscular controller during VMT to elucidate the effects of adjuvant treatment with tDCS.
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Affiliation(s)
- Vinh Kha
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Aguida S Foerster
- IfADo Leibniz Research Centre for Working Environment and Human Factors (LG), Dortmund, Germany
| | - Susan Bennett
- Department of Rehabilitation Science, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Michael A Nitsche
- IfADo Leibniz Research Centre for Working Environment and Human Factors (LG), Dortmund, Germany.,Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Filip Stefanovic
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
| | - Anirban Dutta
- Department of Biomedical Engineering, University at Buffalo, The State University of New York, Buffalo, NY, United States
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Leon D, Cortes M, Elder J, Kumru H, Laxe S, Edwards DJ, Tormos JM, Bernabeu M, Pascual-Leone A. tDCS does not enhance the effects of robot-assisted gait training in patients with subacute stroke. Restor Neurol Neurosci 2018; 35:377-384. [PMID: 28697574 DOI: 10.3233/rnn-170734] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, which can modulate cortical excitability and combined with rehabilitation therapies may improve motor recovery after stroke. OBJECTIVE Our aim was to study the feasibility of a 4-week robotic gait training protocol combined with tDCS, and to study tDCS to the leg versus hand motor cortex or sham to improve walking ability in patients after a subacute stroke. METHODS Forty-nine subacute stroke patients underwent 20 daily sessions (5 days a week for 4 weeks) of robotic gait training combined with tDCS. Patients were assigned either to the tDCSleg group (n = 9), receiving 2 mA anodal tDCS over the motor cortex leg representation (vertex), or an active control group (n = 17) receiving anodal tDCS over the hand motor cortex area (tDCShand). In addition, we studied 23 matched patients in a control group receiving gait training without tDCS (notDCS). Study outcomes included gait speed (10-meter walking test), and quality of gait, using the Functional Ambulatory Category (FAC) before and after the 4-week training period. RESULTS Only one patient did not complete the treatment because he presented a minor side-effect. Patients in all three groups showed a significantly improvement in gait speed and FAC. The tDCSleg group did not perform better than the tDCShand or notDCS group. CONCLUSION Combined tDCS and robotic training is a safe and feasible procedure in subacute stroke patients. However, adding tDCS to robot-assisted gait training shows no benefit over robotic gait training alone.
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Affiliation(s)
- Daniel Leon
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona -Barcelona, Spain.,Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Mar Cortes
- Human Spinal Cord Injury Laboratory, Burke Medical Research Institute, White Plains, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,Universitat de Barcelona, Gran Via de les Corts Catalanes, Barcelona, Spain
| | - Jessica Elder
- Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA
| | - Hatice Kumru
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona -Barcelona, Spain.,Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Sara Laxe
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona -Barcelona, Spain.,Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Dylan James Edwards
- Brain Stimulation and Robotics Laboratory, Burke Medical Research Institute, White Plains, NY, USA.,Department of Neurology, Weill Cornell Medicine, New York, NY, USA.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Josep Maria Tormos
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona -Barcelona, Spain.,Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Montserrat Bernabeu
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona -Barcelona, Spain.,Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Alvaro Pascual-Leone
- Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona -Barcelona, Spain.,Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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