1
|
Lewis A, Rattray B, Flood A. Does Cathodal Preconditioning Enhance the Effects of Subsequent Anodal Transcranial Direct Current Stimulation on Corticospinal Excitability and Grip Strength? J Strength Cond Res 2024:00124278-990000000-00567. [PMID: 39316764 DOI: 10.1519/jsc.0000000000004954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
ABSTRACT Lewis, A, Rattray, B, and Flood, A. Does cathodal preconditioning enhance the effects of subsequent anodal transcranial direct current stimulation on corticospinal excitability and grip strength? J Strength Cond Res XX(X): 000-000, 2024-Inconsistent effects of transcranial direct current stimulation (tDCS) on corticospinal excitability (CSE) and exercise performance are commonly reported. Cathodal preconditioning, involving cathodal tDCS delivered before anodal tDCS over the same region, may enhance changes in CSE and exercise beyond that resulting from anodal tDCS alone. This study aimed to investigate whether the effects of anodal tDCS on CSE and isometric grip strength can be enhanced by cathodal preconditioning. Thirty-five healthy subjects aged 19-37 years completed a familiarization session followed by 4 stimulation conditions presented in a randomized cross-over design across 4 separate sessions. tDCS doses were applied at 2 mA over the primary motor cortex for 10 minutes. Corticospinal excitability was assessed using 120% of resting motor threshold and an input/output curve of motor evoked potentials of the first dorsal interosseous. Grip strength was evaluated as time to exhaustion (TTE) in a sustained isometric contraction. Relative to conventional sham stimulation, TTE was significantly increased by 15% after conventional anodal tDCS. Corticospinal excitability increased in response to tDCS, but this effect did not differ across conditions. Cathodal preconditioning before anodal stimulation did not increase CSE or grip strength beyond that seen in the other stimulation conditions. Our findings did not reveal any significant impact of stimulation type on CSE. Notably, anodal tDCS led to a significant improvement in grip strength endurance. However, cathodal preconditioning did not seem to increase the effect of subsequent anodal stimulation on CSE nor grip strength.
Collapse
Affiliation(s)
- Aidan Lewis
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australia; and
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Ben Rattray
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Andrew Flood
- Discipline of Psychology, Faculty of Health, University of Canberra, Canberra, Australia; and
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| |
Collapse
|
2
|
Jiménez-García AM, Bonnel G, Álvarez-Mota A, Arias N. Current perspectives on neuromodulation in ALS patients: A systematic review and meta-analysis. PLoS One 2024; 19:e0300671. [PMID: 38551974 PMCID: PMC10980254 DOI: 10.1371/journal.pone.0300671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/01/2024] [Indexed: 04/01/2024] Open
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a progressive neurodegenerative disease that affects motor neurons, resulting in muscle weakness, paralysis, and eventually patient mortality. In recent years, neuromodulation techniques have emerged as promising potential therapeutic approaches to slow disease progression and improve the quality of life of ALS patients. A systematic review was conducted until August 8, 2023, to evaluate the neuromodulation methods used and their potential in the treatment of ALS. The search strategy was applied in the Cochrane Central database, incorporating results from other databases such as PubMed, Embase, CTgov, CINAHL, and ICTRP. Following the exclusion of papers that did not fulfil the inclusion criteria, a total of 2090 records were found, leaving a total of 10 studies. R software was used to conduct meta-analyses based on the effect sizes between the experimental and control groups. This revealed differences in muscle stretch measures with manual muscle testing (p = 0.012) and resting motor threshold (p = 0.0457), but not with voluntary isometric contraction (p = 0.1883). The functionality of ALS was also different (p = 0.007), but not the quality of life. Although intracortical facilitation was not seen in motor cortex 1 (M1) (p = 0.1338), short-interval intracortical inhibition of M1 was significant (p = 0.0001). BDNF showed no differences that were statistically significant (p = 0.2297). Neuromodulation-based treatments are proposed as a promising therapeutic approach for ALS that can produce effects on muscle function, spasticity, and intracortical connections through electrical, magnetic, and photonic stimulation. Photobiomodulation stands out as an innovative approach that uses specific wavelengths to influence mitochondria, with the aim of improving mitochondrial function and reducing excitotoxicity. The lack of reliable placebo controls and the variation in stimulation frequency are some of the drawbacks of neuromodulation.
Collapse
Affiliation(s)
- Ana M. Jiménez-García
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, Madrid, Spain
| | - Gaspard Bonnel
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, Madrid, Spain
| | - Alicia Álvarez-Mota
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, Madrid, Spain
| | - Natalia Arias
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, University of Nebrija, Madrid, Spain
- Health Research Institute of the Principality of Asturias (Instituto de Investigación Universitaria del Principado de Asturias), Oviedo, Spain
- INEUROPA, Instituto de Neurociencias del Principado de Asturias, Plaza Feijoo, Oviedo, Spain
| |
Collapse
|
3
|
Calderone A, Cardile D, Gangemi A, De Luca R, Quartarone A, Corallo F, Calabrò RS. Traumatic Brain Injury and Neuromodulation Techniques in Rehabilitation: A Scoping Review. Biomedicines 2024; 12:438. [PMID: 38398040 PMCID: PMC10886871 DOI: 10.3390/biomedicines12020438] [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: 01/09/2024] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic Brain Injury (TBI) is a condition in which an external force, usually a violent blow to the head, causes functional impairment in the brain. Neuromodulation techniques are thought to restore altered function in the brain, resulting in improved function and reduced symptoms. Brain stimulation can alter the firing of neurons, boost synaptic strength, alter neurotransmitters and excitotoxicity, and modify the connections in their neural networks. All these are potential effects on brain activity. Accordingly, this is a promising therapy for TBI. These techniques are flexible because they can target different brain areas and vary in frequency and amplitude. This review aims to investigate the recent literature about neuromodulation techniques used in the rehabilitation of TBI patients. MATERIALS AND METHODS The identification of studies was made possible by conducting online searches on PubMed, Web of Science, Cochrane, Embase, and Scopus databases. Studies published between 2013 and 2023 were selected. This review has been registered on OSF (JEP3S). RESULTS We have found that neuromodulation techniques can improve the rehabilitation process for TBI patients in several ways. Transcranial Magnetic Stimulation (TMS) can improve cognitive functions such as recall ability, neural substrates, and overall improved performance on neuropsychological tests. Repetitive TMS has the potential to increase neural connections in many TBI patients but not in all patients, such as those with chronic diffuse axonal damage. CONCLUSIONS This review has demonstrated that neuromodulation techniques are promising instruments in the rehabilitation field, including those affected by TBI. The efficacy of neuromodulation can have a significant impact on their lives and improve functional outcomes for TBI patients.
Collapse
Affiliation(s)
| | - Davide Cardile
- IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C. da Casazza; 98124 Messina, Italy; (A.C.); (A.G.); (R.D.L.); (A.Q.); (F.C.); (R.S.C.)
| | | | | | | | | | | |
Collapse
|
4
|
Amaya-Pascasio L, García-Pinteño J, Sánchez-Kuhn A, Uceda Sánchez C, Fernández-Martín P, León Domene JJ, Rodríguez-Herrera R, Flores P, Martínez-Sánchez P. Neuromodulation of Executive Dysfunction in Patients with Acute Stroke Using Transcranial Direct Current Stimulation: Study Protocol for a Triple-Blind, Randomized Sham-Controlled Trial. Cerebrovasc Dis 2023; 53:335-345. [PMID: 39250901 DOI: 10.1159/000531860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/19/2023] [Indexed: 09/11/2024] Open
Abstract
Research on the benefits of non-invasive brain stimulation in stroke patients to improve executive functions is scarce. The objective of this study was to investigate the effectiveness of transcranial direct current stimulation (tDCS) in combination with cognitive training for the rehabilitation of executive functions in acute and subacute stroke patients as well as to explore the underlying physiological mechanisms. A triple-blinded, randomized-controlled clinical trial will be conducted involving 60 stroke patients with frontal or basal ganglia lesions and a Montreal Cognitive Assessment (MoCA) score less than 26. Participants will be randomly assigned to receive active tDCS (anode over the left dorsolateral prefrontal cortex, cathode at the right supraorbital region, 20 min at 2 mA) or sham tDCS in a 1:1 ratio for 10 sessions, followed by targeted executive function training. The primary efficacy outcome will be the MoCA score, while secondary outcomes will include the five-digit test (inhibitory control), the Digit Span Task (working memory), the abbreviated version of the Wisconsin Card Sorting test (cognitive flexibility), modified Rankin scale (functional state), Beck-II depression inventory, apathy evaluation scale, and the WHOQOL-BREF (quality of life), assessed immediately after the intervention and at 1, 3, 6, and 12 months post-intervention. Additionally, resting-state functional connectivity and blood biomarkers, such as neurotrophins, growth factors, and inflammatory molecules, will be evaluated before and after the intervention. This study will contribute to the investigation of the efficacy of tDCS in rehabilitating executive functions in acute and subacute stroke patients. The multidimensional approach utilized in this study, which includes analysis of resting-state connectivity and neuroplasticity-related blood biomarkers, is expected to provide insights into the underlying brain mechanisms involved in the rehabilitation of dysexecutive syndrome.
Collapse
Affiliation(s)
| | - José García-Pinteño
- Department of Psychology and Centre for Health Research (CEINSA), University of Almería, Almería, Spain
| | - Ana Sánchez-Kuhn
- Department of Psychology and Centre for Health Research (CEINSA), University of Almería, Almería, Spain
| | - Cristina Uceda Sánchez
- Department of Psychology and Centre for Health Research (CEINSA), University of Almería, Almería, Spain
| | - Pilar Fernández-Martín
- Department of Psychology and Centre for Health Research (CEINSA), University of Almería, Almería, Spain
| | - José Juan León Domene
- Department of Psychology and Centre for Health Research (CEINSA), University of Almería, Almería, Spain
| | - Rocio Rodríguez-Herrera
- Department of Psychology and Centre for Health Research (CEINSA), University of Almería, Almería, Spain
| | - Pilar Flores
- Department of Psychology and Centre for Health Research (CEINSA), University of Almería, Almería, Spain
| | | |
Collapse
|
5
|
Wang Y, Dong T, Li X, Zhao H, Yang L, Xu R, Fu Y, Li L, Gai X, Qin D. Research progress on the application of transcranial magnetic stimulation in spinal cord injury rehabilitation: a narrative review. Front Neurol 2023; 14:1219590. [PMID: 37533475 PMCID: PMC10392830 DOI: 10.3389/fneur.2023.1219590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Traumatic or non-traumatic spinal cord injury (SCI) can lead to severe disability and complications. The incidence of SCI is high, and the rehabilitation cycle is long, which increases the economic burden on patients and the health care system. However, there is no practical method of SCI treatment. Recently, transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique, has been shown to induce changes in plasticity in specific areas of the brain by regulating the activity of neurons in the stimulation site and its functionally connected networks. TMS is a new potential method for the rehabilitation of SCI and its complications. In addition, TMS can detect the activity of neural circuits in the central nervous system and supplement the physiological evaluation of SCI severity. This review describes the pathophysiology of SCI as well as the basic principles and classification of TMS. We mainly focused on the latest research progress of TMS in the physiological evaluation of SCI as well as the treatment of motor dysfunction, neuropathic pain, spasticity, neurogenic bladder, respiratory dysfunction, and other complications. This review provides new ideas and future directions for SCI assessment and treatment.
Collapse
Affiliation(s)
- Yuhong Wang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Tingting Dong
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xiahuang Li
- Department of Neurosurgery, Mengzi People’s Hospital, Mengzi, China
| | - Huiyun Zhao
- Department of Rehabilitation Medicine, Dongchuan District People’s Hospital, Kunming, China
| | - Lili Yang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Rui Xu
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yi Fu
- Department of Pulmonary and Critical Care Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
| | - Li Li
- Department of Emergency Trauma Surgery, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xuesong Gai
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Neuropsychiatric Diseases, Yunnan University of Chinese Medicine, Kunming, China
| |
Collapse
|
6
|
Schwertfeger JL, Beyer C, Hung P, Ung N, Madigan C, Cortes AR, Swaminathan B, Madhavan S. A map of evidence using transcranial direct current stimulation (tDCS) to improve cognition in adults with traumatic brain injury (TBI). FRONTIERS IN NEUROERGONOMICS 2023; 4:1170473. [PMID: 38234478 PMCID: PMC10790940 DOI: 10.3389/fnrgo.2023.1170473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/04/2023] [Indexed: 01/19/2024]
Abstract
Introduction Cognition impairments often occur after a traumatic brain injury and occur at higher rates in military members. Cognitive symptoms impair daily function, including balance and life quality, years after the TBI. Current treatments to regain cognitive function after TBI, including medications and cognitive rehabilitation, have shown limited effectiveness. Transcranial direct current stimulation (tDCS) is a low-cost, non-invasive brain stimulation intervention that improves cognitive function in healthy adults and people with neuropsychologic diagnoses beyond current interventions. Despite the available evidence of the effectiveness of tDCS in improving cognition generally, only two small TBI trials have been conducted based on the most recent systematic review of tDCS effectiveness for cognition following neurological impairment. We found no tDCS studies that addressed TBI-related balance impairments. Methods A scoping review using a peer-reviewed search of eight databases was completed in July 2022. Two assessors completed a multi-step review and completed data extraction on included studies using a priori items recommended in tDCS and TBI research guidelines. Results A total of 399 results were reviewed for inclusion and 12 met the criteria and had data extracted from them by two assessors using Google Forms. Consensus on combined data results included a third assessor when needed. No studies using tDCS for cognition-related balance were found. Discussion Guidelines and technology measures increase the identification of brain differences that alter tDCS effects on cognition. People with mild-severe and acute-chronic TBI tolerated and benefited from tDCS. TBI-related cognition is understudied, and systematic research that incorporates recommended data elements is needed to advance tDCS interventions to improve cognition after TBI weeks to years after injury.
Collapse
Affiliation(s)
- Julie Lynn Schwertfeger
- Captain James A. Lovell Federal Health Care Center, United States Department of Veteran Affairs, North Chicago, IL, United States
- Clinical Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Charlotte Beyer
- Department of Foundational Sciences and Humanities, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Paul Hung
- Captain James A. Lovell Federal Health Care Center, United States Department of Veteran Affairs, North Chicago, IL, United States
- Psychiatry Residency Program, Clinical Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Nathaniel Ung
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Caroline Madigan
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Alvi Renzyl Cortes
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Bharathi Swaminathan
- Physical Medicine and Rehabilitation, Captain James A. Lovell Federal health Care Center, North Chicago, IL, United States
- PM&R Residency Program, Clinical Medicine, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, United States
| | - Sangeetha Madhavan
- Rehabilitation Sciences Program, and Physical Therapy Program, University of Illinois Chicago, Chicago, IL, United States
| |
Collapse
|
7
|
Kolmos M, Madsen MJ, Liu ML, Karabanov A, Johansen KL, Thielscher A, Gandrup K, Lundell H, Fuglsang S, Thade E, Christensen H, Iversen HK, Siebner HR, Kruuse C. Patient-tailored transcranial direct current stimulation to improve stroke rehabilitation: study protocol of a randomized sham-controlled trial. Trials 2023; 24:216. [PMID: 36949490 PMCID: PMC10035265 DOI: 10.1186/s13063-023-07234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 03/09/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Many patients do not fully regain motor function after ischemic stroke. Transcranial direct current stimulation (TDCS) targeting the motor cortex may improve motor outcome as an add-on intervention to physical rehabilitation. However, beneficial effects on motor function vary largely among patients within and across TDCS trials. In addition to a large heterogeneity of study designs, this variability may be caused by the fact that TDCS was given as a one-size-fits-all protocol without accounting for anatomical differences between subjects. The efficacy and consistency of TDCS might be improved by a patient-tailored design that ensures precise targeting of a physiologically relevant area with an appropriate current strength. METHODS In a randomized, double-blinded, sham-controlled trial, patients with subacute ischemic stroke and residual upper-extremity paresis will receive two times 20 min of focal TDCS of ipsilesional primary motor hand area (M1-HAND) during supervised rehabilitation training three times weekly for 4 weeks. Anticipated 60 patients will be randomly assigned to active or sham TDCS of ipsilesional M1-HAND, using a central anode and four equidistant cathodes. The placement of the electrode grid on the scalp and current strength at each cathode will be personalized based on individual electrical field models to induce an electrical current of 0.2 V/m in the cortical target region resulting in current strengths between 1 and 4 mA. Primary endpoint will be the difference in change of Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score between active TDCS and sham at the end of the intervention. Exploratory endpoints will include UE-FMA at 12 weeks. Effects of TDCS on motor network connectivity and interhemispheric inhibition will be assessed with functional MRI and transcranial magnetic stimulation. DISCUSSION The study will show the feasibility and test the efficacy of personalized, multi-electrode anodal TDCS of M1-HAND in patients with subacute stroke patients with upper-extremity paresis. Concurrent multimodal brain mapping will shed light into the mechanisms of action of therapeutic personalized TDCS of M1-HAND. Together, the results from this trial may inform future personalized TDCS studies in patients with focal neurological deficits after stroke.
Collapse
Affiliation(s)
- Mia Kolmos
- Neurovascular Research Unit (NVRU), Department of Neurology, Copenhagen University Hospital -Herlev and Gentofte, Copenhagen, Denmark
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Mads Just Madsen
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Marie Louise Liu
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Anke Karabanov
- Department of Nutrition, Exercise and Sport (NEXS), Copenhagen University, Copenhagen, Denmark
| | - Katrine Lyders Johansen
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Axel Thielscher
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Karen Gandrup
- Department of Radiology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Henrik Lundell
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Søren Fuglsang
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
| | - Esben Thade
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Kgs Lyngby, Denmark
| | - Hanne Christensen
- Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helle Klingenberg Iversen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance (DRCMR), Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Neurovascular Research Unit (NVRU), Department of Neurology, Copenhagen University Hospital -Herlev and Gentofte, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| |
Collapse
|
8
|
Tedla JS, Sangadala DR, Reddy RS, Gular K, Kakaraparthi VN, Asiri F. Transcranial direct current stimulation (tDCS) effects on upper limb motor function in stroke: an overview review of the systematic reviews. Brain Inj 2023; 37:122-133. [PMID: 36617689 DOI: 10.1080/02699052.2022.2163289] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Stroke is the prime cause of disability in the elderly population. Transcranial direct current stimulation (tDCS) is an emerging noninvasive brain stimulation in rehabilitating upper limb function post-stroke. However, mixed evidence exists in the literature and ambiguous conclusions regarding the effect of tDCS on upper limb function. OBJECTIVE This study aimed to assess the current evidence on the effect of (tDCS) on upper limb motor function and activities of daily living in patients after stroke by conducting an overview of systematic reviews. METHODOLOGY We performed electronic database searches and gray literature searches for the articles. RESULTS Two distinct literature searches gathered a total of 203 studies. Out of them, six systematic reviews and meta-analyses were included for methodological quality assessment and data extraction. All included studies were determined to be of good to high quality based on a methodological appraisal using the Assessment of Multiple Systematic Reviews checklist. CONCLUSION Identified evidence suggests that tDCS has superior effects to control interventions in improving functions of the upper limb and activities of daily living in patients who have had a stroke. Moreover, cathodal stimulation over the non-affected brain region was more effective than anodal and dual tDCS stimulation.
Collapse
Affiliation(s)
- Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Devika Rani Sangadala
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Kumar Gular
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Venkata Nagaraj Kakaraparthi
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Faisal Asiri
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| |
Collapse
|
9
|
Schwell G, Kozol Z, Tarshansky D, Einat M, Frenkel-Toledo S. The effect of action observation combined with high-definition transcranial direct current stimulation on motor performance in healthy adults: A randomized controlled trial. Front Hum Neurosci 2023; 17:1126510. [PMID: 36936614 PMCID: PMC10014919 DOI: 10.3389/fnhum.2023.1126510] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Action observation (AO) can improve motor performance in humans, probably via the human mirror neuron system. In addition, there is some evidence that transcranial direct current stimulation (tDCS) can improve motor performance. However, it is yet to be determined whether AO combined with tDCS has an enhanced effect on motor performance. We investigated the effect of AO combined with high-definition tDCS (HD-tDCS) targeting the inferior parietal lobe (IPL) and inferior frontal gyrus (IFG), the main aggregates of the human mirror neuron system, on motor performance in healthy adults and compared the immediate vs. 24-h retention test effects (anodal electrodes were placed over these regions of interest). Sixty participants were randomly divided into three groups that received one of the following single-session interventions: (1) observation of a video clip that presented reaching movement sequences toward five lighted units + active HD-tDCS stimulation (AO + active HD-tDCS group); (2) observation of a video clip that presented the same reaching movement sequences + sham HD-tDCS stimulation (AO + sham HD-tDCS group); and (3) observation of a video clip that presented neutral movie while receiving sham stimulation (NM + sham HD-tDCS group). Subjects' reaching performance was tested before and immediately after each intervention and following 24 h. Subjects performed reaching movements toward units that were activated in the same order as the observed sequence during pretest, posttest, and retest. Occasionally, the sequence order was changed by beginning the sequence unexpectedly with a different activated unit. Outcome measures included mean Reaching Time and difference between the Reaching Time of the unexpected and expected reaching movements (Delta). In the posttest and retest, Reaching Time and Delta improved in the AO + sham HD-tDCS group compared to the NM + HD-sham tDCS group. In addition, at posttest, Delta improved in the AO + active HD-tDCS group compared to the NM + sham HD-tDCS group. It appears that combining a montage of active HD-tDCS, which targets the IPL and IFG, with AO interferes with the positive effects of AO alone on the performance of reaching movement sequences.
Collapse
Affiliation(s)
- Gidon Schwell
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - Zvi Kozol
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - David Tarshansky
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
| | - Moshe Einat
- Department of Electrical and Electronic Engineering, Ariel University, Ariel, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, School of Health Sciences, Ariel University, Ariel, Israel
- Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra’anana, Israel
- *Correspondence: Silvi Frenkel-Toledo,
| |
Collapse
|
10
|
Massonet H, Goeleven A, Van den Steen L, Vergauwen A, Baudelet M, Van Haesendonck G, Vanderveken O, Bollen H, van der Molen L, Duprez F, Tomassen P, Nuyts S, Van Nuffelen G. Home-based intensive treatment of chronic radiation-associated dysphagia in head and neck cancer survivors (HIT-CRAD trial). Trials 2022; 23:893. [PMID: 36273210 PMCID: PMC9587548 DOI: 10.1186/s13063-022-06832-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/06/2022] [Indexed: 12/03/2022] Open
Abstract
Background Chronic radiation-associated dysphagia (C-RAD) is considered to be one of the most severe functional impairments in head and neck cancer survivors treated with radiation (RT) or chemoradiation (CRT). Given the major impact of these late toxicities on patients’ health and quality of life, there is a strong need for evidence-based dysphagia management. Although studies report the benefit of strengthening exercises, transference of changes in muscle strength to changes in swallowing function often remains limited. Therefore, combining isolated strengthening exercises with functional training in patients with C-RAD may lead to greater functional gains. Methods This 3-arm multicenter randomized trial aims to compare the efficacy and possible detraining effects of mere strengthening exercises (group 1) with a combination of strengthening exercises and functional swallowing therapy (group 2) and non-invasive brain stimulation added to that combination (group 3) in 105 patients with C-RAD. Patients will be evaluated before and during therapy and 4 weeks after the last therapy session by means of swallowing-related and strength measures and quality of life questionnaires. Discussion Overall, this innovative RCT is expected to provide new insights into the rehabilitation of C-RAD to optimize post-treatment swallowing function. Trial registration International Standard Randomized Controlled Trials Number (ISRCTN) registry ID ISRCTN57028065. Registration was accepted on 15 July 2021.
Collapse
Affiliation(s)
- Hanne Massonet
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology - Delgutology, KU Leuven, Leuven, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. .,Department of Head and Neck Surgery, Swallowing Clinic, University Hospitals Leuven, Leuven, Belgium. .,Department of ENT, Swallowing Clinic, University Hospitals Leuven, Leuven, Belgium.
| | - Ann Goeleven
- Faculty of Medicine, Department of Neurosciences, Research Group Experimental Oto-Rhino-Laryngology - Delgutology, KU Leuven, Leuven, Belgium.,Department of Head and Neck Surgery, Swallowing Clinic, University Hospitals Leuven, Leuven, Belgium.,Department of ENT, Swallowing Clinic, University Hospitals Leuven, Leuven, Belgium
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Alice Vergauwen
- Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Margot Baudelet
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Gilles Van Haesendonck
- Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Olivier Vanderveken
- Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Heleen Bollen
- Department of Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,Faculty of Humanities, University of Amsterdam, Amsterdam, The Netherlands
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Peter Tomassen
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Sandra Nuyts
- Department of Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otolaryngology and Head and Neck Surgery, Rehabilitation Centre for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
11
|
Swissa Y, Hacohen S, Friedman J, Frenkel-Toledo S. Sensorimotor performance after high-definition transcranial direct current stimulation over the primary somatosensory or motor cortices in men versus women. Sci Rep 2022; 12:11117. [PMID: 35778465 PMCID: PMC9249866 DOI: 10.1038/s41598-022-15226-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022] Open
Abstract
The primary somatosensory (S1) cortex is a central structure in motor performance. However, transcranial direct current stimulation (tDCS) research aimed at improving motor performance usually targets the primary motor cortex (M1). Recently, sex was found to mediate tDCS response. Thus, we investigated whether tDCS with an anodal electrode placed over S1 improves motor performance and sensation perception in men versus women. Forty-five participants randomly received 15-min high-definition tDCS (HD-tDCS) at 1 mA to S1, M1, or sham stimulation. Reaching performance was tested before and immediately following stimulation. Two-point orientation discrimination (TPOD) of fingers and proprioception of a reaching movement were also tested. Although motor performance did not differ between groups, reaching reaction time improved in the M1 group men. Reaching movement time and endpoint error improved in women and men, respectively. Correct trials percentage for TPOD task was higher in the S1 compared to the M1 group in the posttest and improved only in the S1 group. Reaching movement time for the proprioception task improved, overall, and endpoint error did not change. Despite the reciprocal connections between S1 and M1, effects of active tDCS over S1 and M1 may specifically influence sensation perception and motor performance, respectively. Also, sex may mediate effects of HD-tDCS on motor performance.
Collapse
Affiliation(s)
- Yochai Swissa
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Shlomi Hacohen
- Department of Mechanical Engineering, Ariel University, Ariel, Israel
| | - Jason Friedman
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel. .,Department of Neurological Rehabilitation, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.
| |
Collapse
|
12
|
Kold S, Graven-Nielsen T. Modulation Of Experimental Prolonged Pain and Sensitization Using High-Definition Transcranial Direct Current Stimulation: A Double-Blind, Sham-Controlled Study. THE JOURNAL OF PAIN 2022; 23:1220-1233. [PMID: 35202795 DOI: 10.1016/j.jpain.2022.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/05/2022] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
Abstract
High definition transcranial direct current stimulation (HD-tDCS) targeting brain areas involved in pain processing has shown analgesic effects in some chronic pain conditions, but less modulatory effect on mechanical and thermal pain thresholds in asymptomatic subjects. This double-blinded study assessed the HD-tDCS effects on experimental pain and hyperalgesia maintained for several days in healthy participants. Hyperalgesia and pain were assessed during three consecutive days following provocation of experimental pain (nerve growth factor injected into the right-hand muscle) and daily HD-tDCS sessions (20-minutes). Forty subjects were randomly assigned to Active-tDCS targeting primary motor cortex and dorsolateral prefrontal cortex simultaneously or Sham-tDCS. Tactile and pressure pain sensitivity were assessed before and after each HD-tDCS session, as well as the experimentally-induced pain intensity scored on a numerical rating scale (NRS). Subjects were effectively blinded to the type of HD-tDCS protocol. The Active-tDCS did not significantly reduce the NGF-induced NRS pain score (3.5±2.4) compared to Sham-tDCS (3.9±2.0, P > .05) on day 3 and both groups showed similarly NGF-decreased pressure pain threshold in the right hand (P < .001). Comparing Active-tDCS with Sham-tDCS, the manifestation of pressure hyperalgesia was delayed on day 1, and an immediate (pre-HD-tDCS to post-HD-tDCS) reduction in pressure hyperalgesia was found across all days (P < .05). PERSPECTIVE: The non-significant differences between Active-tDCS and Sham-tDCS on experimental prolonged pain and hyperalgesia suggest that HD-tDCS has no effect on moderate persistent experimental pain. The intervention may still have a positive effect in more severe pain conditions, with increased intensity, more widespread distribution, or increased duration and/or involving stronger affective components.
Collapse
Affiliation(s)
- Sebastian Kold
- Center for Neuroplasticity and Pain (CNAP), Aalborg University, Denmark
| | | |
Collapse
|
13
|
Efficacy of Transcranial Direct Current Stimulation (tDCS) on Balance and Gait in Multiple Sclerosis Patients: A Machine Learning Approach. J Clin Med 2022; 11:jcm11123505. [PMID: 35743575 PMCID: PMC9224780 DOI: 10.3390/jcm11123505] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/05/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) has emerged as an appealing rehabilitative approach to improve brain function, with promising data on gait and balance in people with multiple sclerosis (MS). However, single variable weights have not yet been adequately assessed. Hence, the aim of this pilot randomized controlled trial was to evaluate the tDCS effects on balance and gait in patients with MS through a machine learning approach. In this pilot randomized controlled trial (RCT), we included people with relapsing−remitting MS and an Expanded Disability Status Scale >1 and <5 that were randomly allocated to two groups—a study group, undergoing a 10-session anodal motor cortex tDCS, and a control group, undergoing a sham treatment. Both groups underwent a specific balance and gait rehabilitative program. We assessed as outcome measures the Berg Balance Scale (BBS), Fall Risk Index and timed up-and-go and 6-min-walking tests at baseline (T0), the end of intervention (T1) and 4 (T2) and 6 weeks after the intervention (T3) with an inertial motion unit. At each time point, we performed a multiple factor analysis through a machine learning approach to allow the analysis of the influence of the balance and gait variables, grouping the participants based on the results. Seventeen MS patients (aged 40.6 ± 14.4 years), 9 in the study group and 8 in the sham group, were included. We reported a significant repeated measures difference between groups for distances covered (6MWT (meters), p < 0.03). At T1, we showed a significant increase in distance (m) with a mean difference (MD) of 37.0 [−59.0, 17.0] (p = 0.003), and in BBS with a MD of 2.0 [−4.0, 3.0] (p = 0.03). At T2, these improvements did not seem to be significantly maintained; however, considering the machine learning analysis, the Silhouette Index of 0.34, with a low cluster overlap trend, confirmed the possible short-term effects (T2), even at 6 weeks. Therefore, this pilot RCT showed that tDCS may provide non-sustained improvements in gait and balance in MS patients. In this scenario, machine learning could suggest evidence of prolonged beneficial effects.
Collapse
|
14
|
Tedla JS, Rodrigues E, Ferreira AS, Vicente J, Reddy RS, Gular K, Sangadala DR, Kakaraparthi VN, Asiri F, Midde AK, Dixit S. Transcranial direct current stimulation combined with trunk-targeted, proprioceptive neuromuscular facilitation in subacute stroke: a randomized controlled trial. PeerJ 2022; 10:e13329. [PMID: 35505681 PMCID: PMC9057289 DOI: 10.7717/peerj.13329] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 04/04/2022] [Indexed: 01/13/2023] Open
Abstract
Background Stroke is the foremost cause of death and disability worldwide. Improving upper extremity function and quality of life are two paramount therapeutic targets during rehabilitation. Aim of the study To investigate the effects of transcranial direct current stimulation (tDCS) combined with trunk-targeted proprioceptive neuromuscular facilitation (PNF) on impairments, activity limitations, and participation restrictions of subjects with subacute stroke. Methodology Fifty-four subjects with subacute stroke were divided into three groups using block randomization. All three groups received rehabilitation sessions lasting 90 min in duration, four times per week, for 6 weeks. Group 1 (n = 18) received conventional physical therapy (CPT); group 2 (n = 18) received CPT, trunk-targeted PNF, and sham tDCS; and group 3 (n = 18) received CPT, trunk-targeted PNF, and bihemispheric motor cortex stimulation with tDCS. Changes in motor impairment, motor activity, and health-related quality of life assessments were outcome measures. Results A two-way linear mixed model analysis revealed interaction effects (group × time) for all outcome measurements (Trunk Impairment Scale, Fugl-Meyer Assessment of Motor Recovery after stroke upper extremity subsection, Wolf Motor Function Test, 10-Meter Walk Test, and the Stroke-Specific Quality of Life scale; all p < 0.01 or lower). Overall, post-pre mean differences demonstrate more substantial improvement in the active tDCS group, followed by sham stimulation associated with the PNF group and the group that received CPT alone. Conclusion Trunk-targeted PNF combined with bihemispheric tDCS along with CPT engender larger improvements in upper extremity and trunk impairment, upper limb function, gait speed, and quality of life in the subacute stroke population.
Collapse
Affiliation(s)
- Jaya Shanker Tedla
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Aseer, Saudi Arabia,Postgraduate Program in Rehabilitation Science, University Center Augusto Motta UNISUAM, Rio de Janeiro, Brazil
| | - Erika Rodrigues
- Postgraduate Program in Rehabilitation Science, University Center Augusto Motta UNISUAM, Rio de Janeiro, Brazil
| | - Arthur S. Ferreira
- Postgraduate Program in Rehabilitation Science, University Center Augusto Motta UNISUAM, Rio de Janeiro, Brazil
| | - Jose Vicente
- Professor of Neurological Physiotherapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ravi Shankar Reddy
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Aseer, Saudi Arabia
| | - Kumar Gular
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Aseer, Saudi Arabia
| | - Devika Rani Sangadala
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Aseer, Saudi Arabia
| | - Venkata Nagaraj Kakaraparthi
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Aseer, Saudi Arabia
| | - Faisal Asiri
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Aseer, Saudi Arabia
| | - Ajaya Kumar Midde
- Head of Neurorehabilitation, Department of Physiotherapy, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
| | - Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Aseer, Saudi Arabia
| |
Collapse
|
15
|
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 .
Collapse
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.
| |
Collapse
|
16
|
Wong PL, Yang YR, Huang SF, Fuh JL, Chiang HL, Wang RY. Transcranial Direct Current Stimulation on Different Targets to Modulate Cortical Activity and Dual-Task Walking in Individuals With Parkinson’s Disease: A Double Blinded Randomized Controlled Trial. Front Aging Neurosci 2022; 14:807151. [PMID: 35197844 PMCID: PMC8859467 DOI: 10.3389/fnagi.2022.807151] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation to modulate cortical activity for improving motor function. However, the information of tDCS stimulation on different brain regions for dual-task walking and cortical modulation in Parkinson’s disease (PD) has not yet been compared. Objective The objective of this study was to investigate the effects of different tDCS targets on dual-task gait performance and cortical activity in patients with PD. Methods A total of 36 participants were randomly assigned to primary motor cortex (M1) tDCS, dorsal lateral prefrontal cortex (DLPFC) tDCS, cerebellum tDCS, or Sham tDCS group. Each group received 20 min of tDCS stimulation, except for the Sham group. Gait performance was measured by the GAITRite system during dual-task walking and single walking. Corticomotor activity of the tibialis anterior (TA) was measured using transcranial magnetic stimulation (TMS). The functional mobility was assessed using the timed up and go (TUG) test. Results All participants showed no significant differences in baseline data. Following the one session of tDCS intervention, M1 (p = 0.048), DLPFC (p < 0.001), and cerebellum (p = 0.001) tDCS groups demonstrated significant improvements in dual-task gait speed compared with a pretest. The time × group interaction [F(3, 32) = 5.125, p = 0.005] was detected in dual-task walking speed. The post hoc Tukey’s test showed that the differences in gait speed were between the Sham tDCS group and the DLPFC tDCS group (p = 0.03). Moreover, DLPFC tDCS also increased the silent period (SP) more than M1 tDCS (p = 0.006) and Sham tDCS (p = 0.002). Conclusion The results indicate that DLPFC tDCS exerted the most beneficial effects on dual-task walking and cortical modulation in participants with PD. Clinical trial registration [http://www.thaiclinicaltrials.org/show/TCTR20200909005], Thai Clinical Trials Registry [TCTR20200909005].
Collapse
Affiliation(s)
- Pei-Ling Wong
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yea-Ru Yang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Fong Huang
- Division of Nerve Repair, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jong-Ling Fuh
- Division of General Neurology, Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Lin Chiang
- Division of General Neurology, Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ray-Yau Wang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan
- *Correspondence: Ray-Yau Wang, ; orcid.org/0000-0002-8738-796X
| |
Collapse
|
17
|
Rudroff T, Fietsam AC, Deters JR, Workman CD, Boles Ponto LL. On the Effects of Transcranial Direct Current Stimulation on Cerebral Glucose Uptake During Walking: A Report of Three Patients With Multiple Sclerosis. Front Hum Neurosci 2022; 16:833619. [PMID: 35145388 PMCID: PMC8824586 DOI: 10.3389/fnhum.2022.833619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Common symptoms of multiple sclerosis (MS) include motor impairments of the lower extremities, particularly gait disturbances. Loss of balance and muscle weakness, representing some peripheral effects, have been shown to influence these symptoms, however, the individual role of cortical and subcortical structures in the central nervous system is still to be understood. Assessing [18F]fluorodeoxyglucose (FDG) uptake in the CNS can assess brain activity and is directly associated with regional neuronal activity. One potential modality to increase cortical excitability and improve motor function in patients with MS (PwMS) is transcranial direct current stimulation (tDCS). However, tDCS group outcomes may not mirror individual subject responses, which impedes our knowledge of the pathophysiology and management of diseases like MS. Three PwMS randomly received both 3 mA tDCS and SHAM targeting the motor cortex (M1) that controls the more-affected leg for 20 min on separate days before walking on a treadmill. The radiotracer, FDG, was injected at minute two of the 20 min walk and the subjects underwent a Positron emission tomography (PET) scan immediately after the task. Differences in relative regional metabolism of areas under the tDCS anode and the basal ganglia were calculated and investigated. The results indicated diverse and individualized responses in regions under the anode and consistent increases in some basal ganglia areas (e.g., caudate nucleus). Thus, anodal tDCS targeting the M1 that controls the more-affected leg of PwMS might be capable of affecting remote subcortical regions and modulating the activity (motor, cognitive, and behavioral functions) of the circuitry connected to these regions.
Collapse
Affiliation(s)
- Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
- Department of Neurology, University of Iowa Health Clinics, Iowa City, IA, United States
- *Correspondence: Thorsten Rudroff,
| | - Alexandra C. Fietsam
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Justin R. Deters
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Craig D. Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, United States
| | - Laura L. Boles Ponto
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| |
Collapse
|
18
|
Split-Belt Training but Not Cerebellar Anodal tDCS Improves Stability Control and Reduces Risk of Fall in Patients with Multiple Sclerosis. Brain Sci 2021; 12:brainsci12010063. [PMID: 35053807 PMCID: PMC8773736 DOI: 10.3390/brainsci12010063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
The objective of this study was to examine the therapeutic potential of multiple sessions of training on a split-belt treadmill (SBT) combined with cerebellar anodal transcranial direct current stimulation (tDCS) on gait and balance in People with Multiple Sclerosis (PwMS). Twenty-two PwMS received six sessions of anodal (PwMSreal, n = 12) or sham (PwMSsham, n = 10) tDCS to the cerebellum prior to performing the locomotor adaptation task on the SBT. To evaluate the effect of the intervention, functional gait assessment (FGA) scores and distance walked in 2 min (2MWT) were measured at the baseline (T0), day 6 (T5), and at the 4-week follow up (T6). Locomotor performance and changes of motor outcomes were similar in PwMSreal and PwMSsham independently from tDCS mode applied to the cerebellum (anodal vs. sham, on FGA, p = 0.23; and 2MWT, p = 0.49). When the data were pooled across the groups to investigate the effects of multiple sessions of SBT training alone, significant improvement of gait and balance was found on T5 and T6, respectively, relative to baseline (FGA, p < 0.001 for both time points). The FGA change at T6 was significantly higher than at T5 (p = 0.01) underlining a long-lasting improvement. An improvement of the distance walked during the 2MWT was also observed on T5 and T6 relative to T0 (p = 0.002). Multiple sessions of SBT training resulted in a lasting improvement of gait stability and endurance, thus potentially reducing the risk of fall as measured by FGA and 2MWT. Application of cerebellar tDCS during SBT walking had no additional effect on locomotor outcomes.
Collapse
|
19
|
Hiew S, Nguemeni C, Zeller D. Efficacy of transcranial direct current stimulation in people with multiple sclerosis: a review. Eur J Neurol 2021; 29:648-664. [PMID: 34725881 DOI: 10.1111/ene.15163] [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: 09/13/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is a chronic inflammatory disease causing a wide range of symptoms including motor and cognitive impairment, fatigue and pain. Over the last two decades, non-invasive brain stimulation, especially transcranial direct current stimulation (tDCS), has increasingly been used to modulate brain function in various physiological and pathological conditions. However, its experimental applications for people with MS were noted only as recently as 2010 and have been growing since then. The efficacy for use in people with MS remains questionable with the results of existing studies being largely conflicting. Hence, the aim of this review is to paint a picture of the current state of tDCS in MS research grounded on studies applying tDCS that have been done to date. METHODS A keyword search was performed to retrieve articles from the earliest article identified until 14 February 2021 using a combination of the groups (1) 'multiple sclerosis', 'MS' and 'encephalomyelitis' and (2) 'tDCS' and 'transcranial direct current stimulation'. RESULTS The analysis of the 30 articles included in this review underlined inconsistent effects of tDCS on the motor symptoms of MS based on small sample sizes. However, tDCS showed promising benefits in ameliorating fatigue, pain and cognitive symptoms. CONCLUSION Transcranial direct current stimulation is attractive as a non-drug approach in ameliorating MS symptoms, where other treatment options remain limited. The development of protocols tailored to the individual's own neuroanatomy using high definition tDCS and the introduction of network mapping in the experimental designs might help to overcome the variability between studies.
Collapse
Affiliation(s)
- Shawn Hiew
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Carine Nguemeni
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Daniel Zeller
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| |
Collapse
|
20
|
Nascimento LR, do Carmo WA, de Oliveira GP, Arêas FZDS, Dias FMV. Transcranial direct current stimulation provides no clinically important benefits over walking training for improving walking in Parkinson's disease: a systematic review. J Physiother 2021; 67:190-196. [PMID: 34147400 DOI: 10.1016/j.jphys.2021.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022] Open
Abstract
QUESTIONS Does walking training combined with transcranial direct current stimulation (tDCS) improve walking (ie, speed, cadence and step length) and reduce falls and freezing, compared with no/sham intervention, in people with Parkinson's disease? Is walking training combined with tDCS superior to walking training alone? Are any benefits carried over to social participation and/or maintained beyond the intervention period? DESIGN A systematic review with meta-analyses of randomised clinical trials. PARTICIPANTS Ambulatory adults with a clinical diagnosis of Parkinson's disease. INTERVENTION tDCS combined with walking training. OUTCOME MEASURES Primary outcomes were walking speed, cadence and step length. Secondary outcomes were number of falls, fear of falling, freezing of gait and social participation. RESULTS Five trials involving 117 participants were included. The mean PEDro score of the included trials was 8 out of 10. Participants undertook training for 30 to 60 minutes, two to three times per week, on average for 4 weeks. Moderate-quality evidence indicated that the addition of tDCS to walking training produced negligible additional benefit over the effect of walking training alone on walking speed (MD -0.01 m/s, 95% CI -0.05 to 0.04), step length (MD 1.2 cm, 95% CI -1.2 to 3.5) or cadence (MD -3 steps/minute, 95% CI -6 to 1). No evidence was identified with which to estimate the effect of the addition of tDCS to walking training on freezing of gait, falls and social participation. CONCLUSION The addition of tDCS to walking training provided no clinically important benefits on walking in ambulatory people with Parkinson's disease. REGISTRATION PROSPERO CRD42020162908.
Collapse
Affiliation(s)
- Lucas Rodrigues Nascimento
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil; NeuroGroup, Discipline of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Willian Assis do Carmo
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Gabriela Pinto de Oliveira
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Fernando Zanela da Silva Arêas
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil; Laboratory of Cognitive Sciences and Neuropsychopharmacology, Department of Physiological Sciences, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Fernanda Moura Vargas Dias
- Center of Health Sciences, Discipline of Physiotherapy, Universidade Federal do Espírito Santo, Vitória, Brazil
| |
Collapse
|
21
|
Lerner O, Friedman J, Frenkel-Toledo S. The effect of high-definition transcranial direct current stimulation intensity on motor performance in healthy adults: a randomized controlled trial. J Neuroeng Rehabil 2021; 18:103. [PMID: 34174914 PMCID: PMC8236155 DOI: 10.1186/s12984-021-00899-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 06/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background The results of transcranial direct current stimulation (tDCS) studies that seek to improve motor performance for people with neurological disorders, by targeting the primary motor cortex, have been inconsistent. One possible reason, among others, for this inconsistency, is that very little is known about the optimal protocols for enhancing motor performance in healthy individuals. The best way to optimize stimulation protocols for enhancing tDCS effects on motor performance by means of current intensity modulation has not yet been determined. We aimed to determine the effect of current intensity on motor performance using–for the first time–a montage optimized for maximal focal stimulation via anodal high-definition tDCS (HD-tDCS) on the right primary motor cortex in healthy subjects. Methods Sixty participants randomly received 20-min HD-tDCS at 1.5, 2 mA, or sham stimulation. Participants’ reaching performance with the left hand on a tablet was tested before, during, and immediately following stimulation, and retested after 24 h. Results In the current montage of HD-tDCS, movement time did not differ between groups in each timepoint. However, only after HD-tDCS at 1.5 mA did movement time improve at posttest as compared to pretest. This reduction in movement time from pretest to posttest was significantly greater compared to HD-tDCS 2 mA. Following HD-tDCS at 1.5 mA and sham HD-tDCS, but not 2 mA, movement time improved at retest compared to pretest, and at posttest and retest compared to the movement time during stimulation. In HD-tDCS at 2 mA, the negligible reduction in movement time from the course of stimulation to posttest was significantly lower compared to sham HD-tDCS. Across all groups, reaction time improved in retest compared to pretest and to the reaction time during stimulation, and did not differ between groups in each timepoint. Conclusions It appears that 2 mA in this particular experimental setup inhibited the learning effects. These results suggest that excitatory effects induced by anodal stimulation do not hold for every stimulation intensity, information that should be taken into consideration when translating tDCS use from the realm of research into more optimal neurorehabilitation. Trial registration: Clinical Trials Gov, NCT04577768. Registered 6 October 2019 -Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000A9B3&selectaction=Edit&uid=U0005AKF&ts=8&cx=buucf0. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00899-z.
Collapse
Affiliation(s)
- Ohad Lerner
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel
| | - Jason Friedman
- Department of Physical Therapy, Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Silvi Frenkel-Toledo
- Department of Physical Therapy, Faculty of Health Sciences, Ariel University, Ariel, Israel. .,Department of Neurological Rehabilitation, Loewenstein Hospital, Raanana, Israel.
| |
Collapse
|
22
|
Rudroff T, Workman CD. Transcranial Direct Current Stimulation as a Treatment Tool for Mild Traumatic Brain Injury. Brain Sci 2021; 11:brainsci11060806. [PMID: 34207004 PMCID: PMC8235194 DOI: 10.3390/brainsci11060806] [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: 05/29/2021] [Revised: 06/12/2021] [Accepted: 06/15/2021] [Indexed: 11/16/2022] Open
Abstract
Mild traumatic brain injury (mTBI) has been defined as a transient (<24 h) condition of confusion and/or loss of consciousness for less than 30 min after brain injury and can result in short- and long-term motor and cognitive impairments. Recent studies have documented the therapeutic potential of non-invasive neuromodulation techniques for the enhancement of cognitive and motor function in mTBI. Alongside repetitive transcranial magnetic stimulation (rTMS), the main technique used for this purpose is transcranial direct current stimulation (tDCS). The focus of this review was to provide a detailed, comprehensive (i.e., both cognitive and motor impairment) overview of the literature regarding therapeutic tDCS paradigms after mTBI. A publication search of the PubMed, Scopus, CINAHL, and PsycINFO databases was performed to identify records that applied tDCS in mTBI. The publication search yielded 14,422 records from all of the databases, however, only three met the inclusion criteria and were included in the final review. Based on the review, there is limited evidence of tDCS improving cognitive and motor performance. Surprisingly, there were only three studies that used tDCS in mTBI, which highlights an urgent need for more research to provide additional insights into ideal therapeutic brain targets and optimized stimulation parameters.
Collapse
Affiliation(s)
- Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
- Department of Neurology, University of Iowa Health Clinics, Iowa City, IA 52242, USA
- Correspondence: ; Tel.: +1-319-467-0363
| | - Craig D. Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
| |
Collapse
|
23
|
Katz DI, Dwyer B. Clinical Neurorehabilitation: Using Principles of Neurological Diagnosis, Prognosis, and Neuroplasticity in Assessment and Treatment Planning. Semin Neurol 2021; 41:111-123. [PMID: 33663002 DOI: 10.1055/s-0041-1725132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neurorehabilitation aspires to restore a person to his or her fullest potential after incurring neurological dysfunction. In medical rehabilitation, diagnosis involves assessment of medical conditions and their effects on functioning. It is usually a team effort that involves an amalgam of diagnostic assessments by multiple disciplines, leading to a collection of rehabilitative treatment plans and goals. This article discusses a clinical neurological paradigm, using rigorous clinical assessment of neuropathological and clinical diagnosis, along with prognostication of natural history and recovery. In the context of the role of neuroplasticity in recovery, this paradigm can add significant value to rehabilitation team management and planning. It contributes to enhanced understanding of neurological impairments and syndromes as they relate to functional disability, aiding in targeting deficits and setting treatment goals. Rehabilitation strategies and goals should be informed by natural history and prognosis, and viewed in the framework of the stage of recovery. Prognostic formulations should suggest an emphasis on restorative versus compensatory strategies for functional problems. Treatment planning should be informed by evidence on how interventions modulate brain reorganization in promoting recovery. Strategies that promote adaptive neuroplasticity should be favored, especially with restorative efforts, and evidence supporting optimal techniques, timing, and dosing of rehabilitation should be considered in treatment planning.
Collapse
Affiliation(s)
- Douglas I Katz
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Encompass Health Braintree Rehabilitation Hospital, Braintree, Massachusetts
| | - Brigid Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts.,Encompass Health Braintree Rehabilitation Hospital, Braintree, Massachusetts
| |
Collapse
|
24
|
Keller-Ross ML, Chantigian DP, Nemanich S, Gillick BT. Cardiovascular Effects of Transcranial Direct Current Stimulation and Bimanual Training in Children With Cerebral Palsy. Pediatr Phys Ther 2021; 33:11-16. [PMID: 33337767 PMCID: PMC7755053 DOI: 10.1097/pep.0000000000000762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the influence of combined transcranial direct current stimulation (tDCS) to the motor cortex (M1) and bimanual training on cardiovascular function in children with cerebral palsy (CP). METHODS Mean arterial pressure (MAP), heart rate (HR), and HR variability (HRV) were measured immediately before and after 20 minutes of cathodal tDCS to contralesional M1 and bimanual training on days 1, 6, and 10 of a 10-day trial in 8 participants (5 females, 7-19 years). RESULTS Baseline MAP and HR were similar across days (93 ± 10 mm Hg and 90 ± 10 bpm, P > .05). MAP was similar from baseline to postintervention across all 3 days. Systolic pressure, diastolic pressure, nor HR significantly changed. HRV was not influenced by the 10-day intervention. CONCLUSIONS Combined cathodal tDCS to M1 and bimanual training does not influence autonomic and cardiovascular function in children with CP due to perinatal stroke.
Collapse
Affiliation(s)
- Manda L Keller-Ross
- Division of Rehabilitation Science (Drs Keller-Ross and Gillick and Mr Chantigian) and Division of Physical Therapy (Drs Keller-Ross, Nemanich, and Gillick), Department of Rehabilitation, Medical School, University of Minnesota, Minneapolis, Minnesota
| | | | | | | |
Collapse
|
25
|
Pilloni G, Choi C, Shaw MT, Coghe G, Krupp L, Moffat M, Cocco E, Pau M, Charvet L. Walking in multiple sclerosis improves with tDCS: a randomized, double-blind, sham-controlled study. Ann Clin Transl Neurol 2020; 7:2310-2319. [PMID: 33080122 PMCID: PMC7664269 DOI: 10.1002/acn3.51224] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/21/2020] [Accepted: 09/27/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate whether multiple sessions of transcranial direct current stimulation (tDCS) applied to the primary motor (M1) cortex paired with aerobic exercise can improve walking functions in multiple sclerosis (MS). METHODS MS participants were recruited for a double-blind, parallel-arm, randomized, sham-controlled trial and assigned to 10 sessions (5 d/wk for 2 weeks) of either active or sham tDCS paired with unloaded cycling for 20 minutes. Stimulation was administered over the left M1 cortex (2.5 mA; anode over C3/cathode over FP2). Gait spatiotemporal parameters were assessed using a wearable inertial sensor (10-meter and 2-minute walking tests). Measurements were collected at baseline, end of tDCS intervention, and 4-week postintervention to test for duration of any benefits. RESULTS A total of 15 participants completed the study, nine in the active and six in the sham condition. The active and sham groups were matched according to gender (50% vs. 40% female), neurologic disability (median EDSS 5.5 vs. 5), and age (mean 52.1 ± 12.9 vs. 53.7 ± 9.8 years). The active group had a significantly greater increase in gait speed (0.87 vs. 1.20 m/s, p < 0.001) and distance covered during the 2-minute walking test (118.53 vs. 133.06 m, p < 0.001) at intervention end compared to baseline. At 4-week follow-up, these improvements were maintained (baseline vs. follow-up: gait speed 0.87 vs. 1.18 m/s, p < 0.001; distance traveled 118.53 vs. 143.82 m, p < 0.001). INTERPRETATION Multiple sessions of tDCS paired with aerobic exercise lead to cumulative and persisting improvements in walking and endurance in patients with MS.
Collapse
Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, NYU Langone Health, New York, NY, USA.,Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Claire Choi
- Department of Medicine, SUNY Downstate, New York, NY, USA
| | - Michael T Shaw
- Department of Psychology, Binghamton University, New York, NY, USA
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Lauren Krupp
- Department of Neurology, NYU Langone Health, New York, NY, USA
| | - Marilyn Moffat
- Department of Physical Therapy, New York University, New York, NY, USA
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Leigh Charvet
- Department of Neurology, NYU Langone Health, New York, NY, USA
| |
Collapse
|
26
|
Mencarelli L, Menardi A, Neri F, Monti L, Ruffini G, Salvador R, Pascual-Leone A, Momi D, Sprugnoli G, Rossi A, Rossi S, Santarnecchi E. Impact of network-targeted multichannel transcranial direct current stimulation on intrinsic and network-to-network functional connectivity. J Neurosci Res 2020; 98:1843-1856. [PMID: 32686203 PMCID: PMC9094635 DOI: 10.1002/jnr.24690] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 12/18/2022]
Abstract
Dynamics within and between functional resting-state networks have a crucial role in determining both healthy and pathological brain functioning in humans. The possibility to noninvasively interact and selectively modulate the activity of networks would open to relevant applications in neuroscience. Here we tested a novel approach for multichannel, network-targeted transcranial direct current stimulation (net-tDCS), optimized to increase excitability of the sensorimotor network (SMN) while inducing cathodal inhibitory modulation over prefrontal and parietal brain regions negatively correlated with the SMN. Using an MRI-compatible multichannel transcranial electrical stimulation (tES) device, 20 healthy participants underwent real and sham tDCS while at rest in the MRI scanner. Changes in functional connectivity (FC) during and after stimulation were evaluated, looking at the intrinsic FC of the SMN and the strength of the negative connectivity between SMN and the rest of the brain. Standard, bifocal tDCS targeting left motor cortex (electrode ~C3) and right frontopolar (~Fp2) regions was tested as a control condition in a separate sample of healthy subjects to investigate network specificity of multichannel stimulation effects. Net-tDCS induced greater FC increase over the SMN compared to bifocal tDCS, during and after stimulation. Moreover, exploratory analysis of the impact of net-tDCS on negatively correlated networks showed an increase in the negative connectivity between SMN and prefrontal/parietal areas targeted by cathodal stimulation both during and after real net-tDCS. Results suggest preliminary evidence of the possibility of manipulating distributed network connectivity patterns through net-tDCS, with potential relevance for the development of cognitive enhancement and therapeutic tES solutions.
Collapse
Affiliation(s)
- Lucia Mencarelli
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience of the Siena School of Medicine, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Arianna Menardi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience of the Siena School of Medicine, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Francesco Neri
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience of the Siena School of Medicine, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Lucia Monti
- Unit of Neuroimaging and Neurointervention, “Santa Maria alle Scotte” Medical Center, Siena, Italy
| | - Giulio Ruffini
- Neuroelectrics, Cambridge, MA, USA
- Neuroelectrics, Barcelona, Spain
| | - Ricardo Salvador
- Neuroelectrics, Cambridge, MA, USA
- Neuroelectrics, Barcelona, Spain
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Davide Momi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience of the Siena School of Medicine, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Giulia Sprugnoli
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience of the Siena School of Medicine, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
| | - Alessandro Rossi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience of the Siena School of Medicine, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
- Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Simone Rossi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience of the Siena School of Medicine, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
- Human Physiology Section, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Emiliano Santarnecchi
- Siena Brain Investigation & Neuromodulation Lab (Si-BIN Lab), Department of Medicine, Surgery and Neuroscience of the Siena School of Medicine, Neurology and Clinical Neurophysiology Section, University of Siena, Siena, Italy
- Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
27
|
Sehatpour P, Dondé C, Hoptman MJ, Kreither J, Adair D, Dias E, Vail B, Rohrig S, Silipo G, Lopez-Calderon J, Martinez A, Javitt DC. Network-level mechanisms underlying effects of transcranial direct current stimulation (tDCS) on visuomotor learning. Neuroimage 2020; 223:117311. [PMID: 32889116 PMCID: PMC7778833 DOI: 10.1016/j.neuroimage.2020.117311] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/15/2020] [Accepted: 08/18/2020] [Indexed: 02/02/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation approach in which low level currents are administered over the scalp to influence underlying brain function. Prevailing theories of tDCS focus on modulation of excitation-inhibition balance at the local stimulation location. However, network level effects are reported as well, and appear to depend upon differential underlying mechanisms. Here, we evaluated potential network-level effects of tDCS during the Serial Reaction Time Task (SRTT) using convergent EEG- and fMRI-based connectivity approaches. Motor learning manifested as a significant (p <.0001) shift from slow to fast responses and corresponded to a significant increase in beta-coherence (p <.0001) and fMRI connectivity (p <.01) particularly within the visual-motor pathway. Differential patterns of tDCS effect were observed within different parametric task versions, consistent with network models. Overall, these findings demonstrate objective physiological effects of tDCS at the network level that result in effective behavioral modulation when tDCS parameters are matched to network-level requirements of the underlying task.
Collapse
Affiliation(s)
- Pejman Sehatpour
- Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University/New York State Psychiatric Institute, New York, NY, USA; Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
| | - Clément Dondé
- Université Grenoble Alpes, Inserm U1216, Grenoble Institut des Neurosciences, CHU Grenoble-Alpes, F-38000 Grenoble, France
| | - Matthew J Hoptman
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Johanna Kreither
- PIA Ciencias Cognitivas, Centro de Investigación en Ciencias Cognitivas, Centro de Psicología Aplicada, Facultad de Psicología, Universidad de Talca, Chile
| | - Devin Adair
- Department of Biomedical Engineering, The City College of New York, CUNY, NY, USA
| | - Elisa Dias
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Blair Vail
- Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University/New York State Psychiatric Institute, New York, NY, USA
| | - Stephanie Rohrig
- Department of Psychology, Hofstra University, New Hempstead, NY, USA
| | - Gail Silipo
- Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | | | - Antigona Martinez
- Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University/New York State Psychiatric Institute, New York, NY, USA; Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Daniel C Javitt
- Division of Experimental Therapeutics, College of Physicians and Surgeons, Columbia University/New York State Psychiatric Institute, New York, NY, USA; Schizophrenia Research Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| |
Collapse
|
28
|
Diego APN, Leung AWS. Transcranial direct current stimulation for improving gross motor function in children with cerebral palsy: A systematic review. Br J Occup Ther 2020. [DOI: 10.1177/0308022619897885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The functional abilities of children with cerebral palsy are often compromised because of limited motor function. Transcranial direct current stimulation is a neuromodulation tool used as an adjunct to other therapeutic modalities to improve gross motor function. This review aimed to examine the quality of evidence and the effectiveness of transcranial direct current stimulation for improving gross motor function in children with cerebral palsy. Method A systematic review was conducted, and eligible studies were critically appraised for methodological quality. Randomised controlled trials were selected to undergo meta-analysis for assessing the effectiveness of transcranial direct current stimulation on clinical outcomes. Results Eight studies, including seven randomised controlled trials, fitted the inclusion criteria. All the randomised controlled trials were rated ‘moderate’ quality based on the grading of recommendations assessment, development and evaluation (GRADE) system. Using meta-analysis, only cadence, an outcome measure of gait variables, demonstrated efficacy of intervention, mean difference 16.57 (10.88, 22.25); I2 = 0%, P = 0.83. Other gross motor and functional outcomes had either inconsistent mean difference or high heterogeneity. Conclusion Overall, the effectiveness of transcranial direct current stimulation as a treatment in children with cerebral palsy remains unclear, and the findings should be interpreted with caution. The quality of evidence was mostly moderate, and more vigorous research incorporating functional outcomes should be conducted to guide clinical practice.
Collapse
Affiliation(s)
| | - Ada WS Leung
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| |
Collapse
|
29
|
Pilloni G, Choi C, Coghe G, Cocco E, Krupp LB, Pau M, Charvet LE. Gait and Functional Mobility in Multiple Sclerosis: Immediate Effects of Transcranial Direct Current Stimulation (tDCS) Paired With Aerobic Exercise. Front Neurol 2020; 11:310. [PMID: 32431658 PMCID: PMC7214839 DOI: 10.3389/fneur.2020.00310] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022] Open
Abstract
Walking impairments are a debilitating feature of multiple sclerosis (MS) because of the direct interference with daily activity. The management of motor symptoms in those with MS remains a therapeutic challenge. Transcranial direct current stimulation (tDCS) is a type of non-invasive brain stimulation that is emerging as a promising rehabilitative tool but requires further characterization to determine its optimal therapeutic use. In this randomized, sham-controlled proof-of-concept study, we tested the immediate effects of a single tDCS session on walking and functional mobility in those with MS. Seventeen participants with MS completed one 20-min session of aerobic exercise, randomly assigned to be paired with either active (2.5 mA, n = 9) or sham (n = 8) tDCS over the primary motor cortex (M1). The groups (active vs. sham) were matched according to gender (50% vs. 60% F), age (52.1 ± 12.85 vs. 54.2 ± 8.5 years), and level of neurological disability (median Expanded Disability Status Scale score 5.5 vs. 5). Gait speed on the 10-m walk test and the Timed Up and Go (TUG) time were measured by a wearable inertial sensor immediately before and following the 20-min session, with changes compared between conditions and time. There were no significant differences in gait speed or TUG time changes following the session in the full sample or between the active vs. sham groups. These findings suggest that a single session of anodal tDCS over M1 is not sufficient to affect walking and functional mobility in those with MS. Instead, behavioral motor response of tDCS is likely to be cumulative, and the effects of multiple tDCS sessions require further study. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03658668.
Collapse
Affiliation(s)
- Giuseppina Pilloni
- NYU Langone Health, Department of Neurology, New York, NY, United States.,Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Claire Choi
- SUNY Downstate, Department of Medicine, New York, NY, United States
| | - Giancarlo Coghe
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Eleonora Cocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Lauren B Krupp
- NYU Langone Health, Department of Neurology, New York, NY, United States
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Leigh E Charvet
- NYU Langone Health, Department of Neurology, New York, NY, United States
| |
Collapse
|
30
|
Imaging Transcranial Direct Current Stimulation (tDCS) with Positron Emission Tomography (PET). Brain Sci 2020; 10:brainsci10040236. [PMID: 32326515 PMCID: PMC7226010 DOI: 10.3390/brainsci10040236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/06/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a form of non-invasive neuromodulation that is increasingly being utilized to examine and modify several cognitive and motor functions. Although tDCS holds great potential, it is difficult to determine optimal treatment procedures to accommodate configurations, the complex shapes, and dramatic conductivity differences among various tissues. Furthermore, recent demonstrations showed that up to 75% of the tDCS current applied to rodents and human cadavers was shunted by the scalp, subcutaneous tissue, and muscle, bringing the effects of tDCS on the cortex into question. Consequently, it is essential to combine tDCS with human neuroimaging to complement animal and cadaver studies and clarify if and how tDCS can affect neural function. One viable approach is positron emission tomography (PET) imaging. PET has unique potential for examining the effects of tDCS within the central nervous system in vivo, including cerebral metabolism, neuroreceptor occupancy, and neurotransmitter activity/binding. The focus of this review is the emerging role of PET and potential PET radiotracers for studying tDCS-induced functional changes in the human brain.
Collapse
|
31
|
Duan JX, Zheng MG, Mu SH, Tian DS, Xu XZ, He ZD, Zhang J. Transcranial direct current stimulation treated by multilead brain reflex instrument accelerates neural functional recovery in a rat model of stroke. Int J Neurosci 2020; 131:571-579. [PMID: 32241216 DOI: 10.1080/00207454.2020.1750391] [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
PURPOSE Clinical research suggests that transcranial direct current stimulation (tDCS) at bilateral supraorbital foramen and inferior orbital rim and nose intersections may facilitate rehabilitation after stroke. However, the underlying neurobiological mechanisms of tDCS remain poorly understood, impeding its clinical application. Here, we investigated the effect of tDCS applied after stroke on neural cells. MATERIALS AND METHODS Middle cerebral arterial occlusion (MCAO) reperfusion was induced in rats. Animals with comparable infarcts were randomly divided into MCAO group and MCAO + tDCS group. Recovery of neurological function was assessed behaviorally by modified neurological severity score (mNSS). Ischemic tissue damage verified histologically by TTC and HE staining. Immunohistochemical staining, real-time qPCR, and western blot were applied to determine the changes of neural cells in ischemic brains. RESULTS The results reveal that tDCS treated by multilead brain reflex instrument can promote the recovery of neurological function, remarkably reduce cerebral infarct volume, promote brain tissue rehabilitation, and can effectively inhibit astrocytosis and enhance neuronal survival and synaptic function in ischemic brains. CONCULSIONS Our study suggests that tDCS treated by multilead brain reflex instrument could be prospectively developed into a clinical treatment modality.
Collapse
Affiliation(s)
- Jun-Xiu Duan
- School of Medicine, Shenzhen University, Shenzhen, China
| | - Mei-Ge Zheng
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shu-Hua Mu
- Psychology & Social College, Shenzhen University, Shenzhen, China
| | - Da-Sheng Tian
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Xin-Zhong Xu
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Zhen-Dan He
- School of Medicine, Shenzhen University, Shenzhen, China
| | - Jian Zhang
- School of Medicine, Shenzhen University, Shenzhen, China
| |
Collapse
|
32
|
Workman CD, Ponto LLB, Kamholz J, Rudroff T. No Immediate Effects of Transcranial Direct Current Stimulation at Various Intensities on Cerebral Blood Flow in People with Multiple Sclerosis. Brain Sci 2020; 10:brainsci10020082. [PMID: 32033094 PMCID: PMC7071720 DOI: 10.3390/brainsci10020082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 01/29/2020] [Accepted: 02/02/2020] [Indexed: 12/03/2022] Open
Abstract
Animal and transcranial magnetic stimulation motors have evoked potential studies suggesting that the currently used transcranial direct current stimulation (tDCS) intensities produce measurable physiological changes. However, the validity, mechanisms, and general efficacy of this stimulation modality are currently being scrutinized. The purpose of this pilot study was to investigate the effects of dorsolateral prefrontal cortex tDCS on cerebral blood flow. A sample of three people with multiple sclerosis underwent two blocks of five randomly assigned tDCS intensities (1, 2, 3, 4 mA, and sham; 5 min each) and [15O]water positron emission tomography imaging. The relative regional (i.e., areas under the electrodes) and global cerebral blood flow were calculated. The results revealed no notable differences in regional or global cerebral blood flow from the different tDCS intensities. Thus, 5 min of tDCS at 1, 2, 3, and 4 mA did not result in immediate changes in cerebral blood flow. To achieve sufficient magnitudes of intracranial electrical fields without direct peripheral side effects, novel methods may be required.
Collapse
Affiliation(s)
- Craig D. Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
| | - Laura L. Boles Ponto
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
| | - John Kamholz
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
| | - Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA;
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA;
- Correspondence: ; Tel.: +1-319-467-0363
| |
Collapse
|
33
|
Abstract
Cerebral palsy (CP) is a disorder characterized by abnormal tone, posture and movement and clinically classified based on the predominant motor syndrome-spastic hemiplegia, spastic diplegia, spastic quadriplegia, and extrapyramidal or dyskinetic. The incidence of CP is 2-3 per 1,000 live births. Prematurity and low birthweight are important risk factors for CP; however, multiple other factors have been associated with an increased risk for CP, including maternal infections, and multiple gestation. In most cases of CP the initial injury to the brain occurs during early fetal brain development; intracerebral hemorrhage and periventricular leukomalacia are the main pathologic findings found in preterm infants who develop CP. The diagnosis of CP is primarily based on clinical findings. Early diagnosis is possible based on a combination of clinical history, use of standardized neuromotor assessment and findings on magnetic resonance imaging (MRI); however, in most clinical settings CP is more reliably recognized by 2 years of age. MRI scan is indicated to delineate the extent of brain lesions and to identify congenital brain malformations. Genetic tests and tests for inborn errors of metabolism are indicated based on clinical findings to identify specific disorders. Because CP is associated with multiple associated and secondary medical conditions, its management requires a multidisciplinary team approach. Most children with CP grow up to be productive adults.
Collapse
Affiliation(s)
- Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kamalazoo, MI, USA
| | - Mekala Neelakantan
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kamalazoo, MI, USA
| | - Karan Pandher
- Chicago Medical School at Rosalind Franklin University, Chicago, IL, USA
| | - Joav Merrick
- Hadassah Hebrew University Medical Center, Jarusalem, Israel.,University of Kentucky, Lexington, KY, USA.,School of Public Health, Georgia State University, Atlanta, GA, USA
| |
Collapse
|
34
|
Workman CD, Kamholz J, Rudroff T. Increased leg muscle fatigability during 2 mA and 4 mA transcranial direct current stimulation over the left motor cortex. Exp Brain Res 2020; 238:333-343. [PMID: 31919540 DOI: 10.1007/s00221-019-05721-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/30/2019] [Indexed: 12/21/2022]
Abstract
Transcranial direct current stimulation (tDCS) using intensities ≤ 2 mA on physical and cognitive outcomes has been extensively investigated. Studies comparing the effects of different intensities of tDCS have yielded mixed results and little is known about how higher intensities (> 2 mA) affect outcomes. This study examined the effects of tDCS at 2 mA and 4 mA on leg muscle fatigability. This was a double-blind, randomized, sham-controlled study. Sixteen healthy young adults underwent tDCS at three randomly ordered intensities (sham, 2 mA, 4 mA). Leg muscle fatigability of both legs was assessed via isokinetic fatigue testing (40 maximal reps, 120°/s). Torque- and work-derived fatigue indices (FI-T and FI-W, respectively), as well as total work performed (TW), were calculated. FI-T of the right knee extensors indicated increased fatigability in 2 mA and 4 mA compared with sham (p = 0.01, d = 0.73 and p < 0.001, d = 1.61, respectively). FI-W of the right knee extensors also indicated increased fatigability in 2 mA and 4 mA compared to sham (p = 0.01, d = 0.57 and p < 0.001, d = 1.12, respectively) and 4 mA compared with 2 mA (p = 0.034, d = 0.37). tDCS intensity did not affect TW performed. The 2 mA and 4 mA tDCS intensities increased the fatigability of the right knee extensors in young, healthy participants, potentially from altered motor unit recruitment/discharge rate or cortical hyperexcitability. Despite this increase in fatigability, the TW performed in both these conditions was not different from sham.
Collapse
Affiliation(s)
- Craig D Workman
- Department of Health and Human Physiology, University of Iowa, E432 Field House, Iowa City, IA, 52242, USA
| | - John Kamholz
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, E432 Field House, Iowa City, IA, 52242, USA.
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
| |
Collapse
|
35
|
The Tolerability and Efficacy of 4 mA Transcranial Direct Current Stimulation on Leg Muscle Fatigability. Brain Sci 2019; 10:brainsci10010012. [PMID: 31878058 PMCID: PMC7017217 DOI: 10.3390/brainsci10010012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 12/12/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) modulates cortical excitability and affects a variety of outcomes. tDCS at intensities ≤2 mA is well-tolerated, but the tolerability and efficacy of tDCS at intensities >2 mA merits systematic investigation. The study objective was to determine the tolerability and effects of 4 mA tDCS on leg muscle fatigability. Thirty-one young, healthy adults underwent two randomly ordered tDCS conditions (sham, 4 mA) applied before and during an isokinetic fatigue test of the knee extensors and flexors. Subjects reported the severity of the sensations felt from tDCS. Primary outcomes were sensation tolerability and the fatigue index of the knee extensors and flexors. A repeated-measures ANOVA determined statistical significance (p < 0.05). Sensation severity at 4 mA tDCS was not substantially different than sham. However, two subjects reported a moderate–severe headache, which dissipated soon after the stimulation ended. The left knee flexors had significantly greater fatigability with 4 mA tDCS compared with sham (p = 0.018). tDCS at 4 mA was well-tolerated by young, healthy subjects and increased left knee flexor fatigability. Exploration of higher intensity tDCS (>2 mA) to determine the potential benefits of increasing intensity, especially in clinical populations with decreased brain activity/excitability, is warranted.
Collapse
|
36
|
Lee J, Jin Y, Yoon B. Bilateral Transcranial Direct Stimulation Over the Primary Motor Cortex Alters Motor Modularity of Multiple Muscles. J Mot Behav 2019; 52:474-488. [PMID: 31795875 DOI: 10.1080/00222895.2019.1646206] [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] [Indexed: 10/25/2022]
Abstract
Transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) has been demonstrated to modulate the motor performance of both healthy individuals and patients with neuromuscular disorders. However, the effect of tDCS on motor control of multiple muscles, which is a prerequisite to change in motor performance, is currently unknown. Using dimensionality reduction analysis, we investigated whether bilateral tDCS over M1 modulates the coordinated activity of 12 muscles. Fifteen healthy men participated in this randomized, double-blind crossover study. Each participant received a 20-min sham and 2-mA stimulation bilaterally over M1 (anode on the right M1 and cathode on the left M1), with a minimum washout period of 4 days. Muscle activation and end-point kinematics were evaluated during a task where participants reached out to a marked target with non-dominant hand as fast as possible, before and immediately after tDCS application. We found decreased similarity in motor modularity and significant changes in muscle activation in a specific motor module, particularly when reaching out to a target placed within arm's length and improved smoothness index of movement only following 2-mA stimulation. These findings indicate that clinicians and researchers need to consider the simultaneous effect of bilateral tDCS over M1 on multiple muscles when they establish tDCS protocol to change in motor performance of patients with neuromuscular deficits.
Collapse
Affiliation(s)
- JaeHyuk Lee
- Major in Rehabilitation Science, Graduate School, Korea University, Seoul, Korea
| | - Yan Jin
- Major in Rehabilitation Science, Graduate School, Korea University, Seoul, Korea
| | - BumChul Yoon
- Major in Rehabilitation Science, Graduate School, Korea University, Seoul, Korea.,Department of Physical Therapy, College of Health Science, Korea University, Seoul, Korea
| |
Collapse
|
37
|
Wang H, Zhou X, Cui D, Liu R, Tan R, Wang X, Liu Z, Yin T. Comparative Study of Transcranial Magneto-Acoustic Stimulation and Transcranial Ultrasound Stimulation of Motor Cortex. Front Behav Neurosci 2019; 13:241. [PMID: 31680896 PMCID: PMC6798265 DOI: 10.3389/fnbeh.2019.00241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/24/2019] [Indexed: 11/13/2022] Open
Abstract
Transcranial ultrasound stimulation (TUS; f < 1 MHz) is a promising approach to non-invasive brain stimulation. Transcranial magneto-acoustic stimulation (TMAS) is a technique of neuromodulation for regulating neuroelectric-activity utilizing a magnetic-acoustic coupling electric field generated by low-intensity ultrasound and magnetic fields. However, both techniques use the physical means of low-intensity ultrasound and can induce the response of the motor cortex. Therefore, it is necessary to distinguish the difference between the two techniques in the regulation of neural activity. This study is the first to quantify the amplitude and response latency of motor cortical electromyography (EMG) in mice induced by TMAS and TUS. The amplitude of EMG (2.73 ± 0.32 mV) induced by TMAS was significantly greater than that induced by TUS (2.22 ± 0.33 mV), and the EMG response latency induced by TMAS (101.25 ± 88.4 ms) was significantly lower than that induced by TUS (181.25 ± 158.4 ms). This shows that TMAS can shorten the response time of nerve activity and enhance the neuromodulation effect of TUS on the motor cortex. This provides a theoretical basis for revealing the physiological mechanisms of TMAS and the treatment of neuropsychiatric diseases using it.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Zhipeng Liu
- Peking Union Medical College, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences, Tianjin, China
| | - Tao Yin
- Peking Union Medical College, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences, Tianjin, China
| |
Collapse
|
38
|
Maldonado T, Goen JRM, Imburgio MJ, Eakin SM, Bernard JA. Single session high definition transcranial direct current stimulation to the cerebellum does not impact higher cognitive function. PLoS One 2019; 14:e0222995. [PMID: 31600223 PMCID: PMC6786549 DOI: 10.1371/journal.pone.0222995] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 09/11/2019] [Indexed: 11/18/2022] Open
Abstract
The prefrontal cortex is central to higher order cognitive function. However, the cerebellum, generally thought to be involved in motor control and learning, has also been implicated in higher order cognition. Recent work using transcranial direct current stimulation (tDCS) provides some support for right cerebellar involvement in higher order cognition, though the results are mixed, and often contradictory. Here, we used cathodal high definition tDCS (HD-tDCS) over the right cerebellum to assess the impact of HD-tDCS on modulating cognitive performance. We predicted that stimulation would result in performance decreases, which would suggest that optimal cerebellar function is necessary for cognitive performance, much like the prefrontal cortex. That is, it is not simply a structure that lends support to complete difficult tasks. While the expected cognitive behavioral effects were present, we did not find effects of stimulation. This has broad implications for cerebellar tDCS research, particularly for those who are interested in using HD-tDCS as a way of examining cerebellar function. Further implications, limitations, and future directions are discussed with particular emphasis on why null findings might be critical in developing a clear picture of the effects of tDCS on the cerebellum.
Collapse
Affiliation(s)
- Ted Maldonado
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, United States of America
| | - James R. M. Goen
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Michael J. Imburgio
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Sydney M. Eakin
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, United States of America
| | - Jessica A. Bernard
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas, United States of America
- Texas A&M Institute for Neuroscience, Texas A&M University, College Station, Texas, United States of America
| |
Collapse
|
39
|
Rosenthal O, Wing AM, Wyatt JL, Punt D, Brownless B, Ko-Ko C, Miall RC. Boosting robot-assisted rehabilitation of stroke hemiparesis by individualized selection of upper limb movements - a pilot study. J Neuroeng Rehabil 2019; 16:42. [PMID: 30894192 PMCID: PMC6425657 DOI: 10.1186/s12984-019-0513-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 03/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Intensive robot-assisted training of the upper limb after stroke can reduce motor impairment, even at the chronic stage. However, the effectiveness of practice for recovery depends on the selection of the practised movements. We hypothesized that rehabilitation can be optimized by selecting the movements to be practiced based on the trainee’s performance profile. Methods We present a novel principle (‘steepest gradients’) for performance-based selection of movements. The principle is based on mapping motor performance across a workspace and then selecting movements located at regions of the steepest transition between better and worse performance. To assess the benefit of this principle we compared the effect of 15 sessions of robot-assisted reaching training on upper-limb motor impairment, between two groups of people who have moderate-to-severe chronic upper-limb hemiparesis due to stroke. The test group (N = 7) received steepest gradients-based training, iteratively selected according to the steepest gradients principle with weekly remapping, whereas the control group (N = 9) received a standard “centre-out” reaching training. Training intensity was identical. Results Both groups showed improvement in Fugl-Meyer upper-extremity scores (the primary outcome measure). Moreover, the test group showed significantly greater improvement (twofold) compared to control. The score remained elevated, on average, for at least 4 weeks although the additional benefit of the steepest-gradients -based training diminished relative to control. Conclusions This study provides a proof of concept for the superior benefit of performance-based selection of practiced movements in reducing upper-limb motor impairment due to stroke. This added benefit was most evident in the short term, suggesting that performance-based steepest-gradients training may be effective in increasing the rate of initial phase of practice-based recovery; we discuss how long-term retention may also be improved. Trial registration ISRCTN, ISRCTN65226825, registered 12 June 2018 - Retrospectively registered, Electronic supplementary material The online version of this article (10.1186/s12984-019-0513-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Orna Rosenthal
- School of Psychology, University of Birmingham, B15 2TT, Birmingham, UK.
| | - Alan M Wing
- School of Psychology, University of Birmingham, B15 2TT, Birmingham, UK
| | - Jeremy L Wyatt
- School of Computer Science, University of Birmingham, B15 2TT, Birmingham, UK
| | - David Punt
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, B15 2TT, Birmingham, UK
| | - Briony Brownless
- School of Psychology, University of Birmingham, B15 2TT, Birmingham, UK
| | - Chit Ko-Ko
- West Midlands Rehabilitation Centre, Birmingham, B29 6JA, UK
| | | |
Collapse
|
40
|
Pilloni G, Shaw M, Feinberg C, Clayton A, Palmeri M, Datta A, Charvet LE. Long term at-home treatment with transcranial direct current stimulation (tDCS) improves symptoms of cerebellar ataxia: a case report. J Neuroeng Rehabil 2019; 16:41. [PMID: 30890162 PMCID: PMC6425598 DOI: 10.1186/s12984-019-0514-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Progressive cerebellar ataxia is a neurodegenerative disorder without effective treatment options that seriously hinders quality of life. Previously, transcranial direct current stimulation (tDCS) has been demonstrated to benefit cerebellar functions (including improved motor control, learning and emotional processing) in healthy individuals and patients with neurological disorders. While tDCS is an emerging therapy, multiple daily sessions are needed for optimal clinical benefit. This case study tests the symptomatic benefit of remotely supervised tDCS (RS-tDCS) for a patient with cerebellar ataxia. METHODS We report a case of a 71-year-old female patient with progressive cerebellar ataxia, who presented with unsteady gait and balance impairment, treated with tDCS. tDCS was administered using our RS-tDCS protocol and was completed daily in the patient's home (Monday - Friday) with the help of a trained study technician. tDCS was paired with 20 min of simultaneous cognitive training, followed by 20 min of physical exercises directed by a physical therapist. Stimulation consisted of 20 min of 2.5 mA direct current targeting the cerebellum via an anodal electrode and a cathodal electrode placed over the right shoulder. The patient completed baseline and treatment end visits with neurological, cognitive, and motor (Lafayette Grooved Pegboard Test, 25 ft walk test and Timed Up and Go Test) assessments. RESULTS The patient successfully completed sixty tDCS sessions, 59 of which were administered remotely at the patient's home with the use of real time supervision as enabled by video conferencing. Mild improvement was observed in the patient's gait with a 7% improvement in walking speed, which she completed without a walking-aid at treatment end, which was in stark contrast to her baseline assessment. Improvements were also achieved in manual dexterity, with an increase in pegboard scores bilaterally compared to baseline. CONCLUSIONS Results from this case report suggest that consecutively administered tDCS treatments paired with cognitive and physical exercise hold promise for improving balance, gait, and manual dexterity in patients with progressive ataxia. Remotely supervised tDCS provides home access to enable the administration over an extended period. Further controlled study in a large group of those with cerebellar ataxia is needed to replicate these findings. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03049969 . Registered 10 February 2017- Retrospectively registered.
Collapse
Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, New York University Langone Health, 10th floor, 222 East 41st Street, New York, NY, 10017, USA.,Department of Mechanical Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Michael Shaw
- Department of Neurology, New York University Langone Health, 10th floor, 222 East 41st Street, New York, NY, 10017, USA
| | - Charles Feinberg
- Department of Neurology, New York University Langone Health, 10th floor, 222 East 41st Street, New York, NY, 10017, USA
| | - Ashley Clayton
- Department of Neurology, New York University Langone Health, 10th floor, 222 East 41st Street, New York, NY, 10017, USA
| | - Maria Palmeri
- Department of Neurology, New York University Langone Health, 10th floor, 222 East 41st Street, New York, NY, 10017, USA
| | | | - Leigh E Charvet
- Department of Neurology, New York University Langone Health, 10th floor, 222 East 41st Street, New York, NY, 10017, USA.
| |
Collapse
|
41
|
Bueno MEB, do Nascimento Neto LI, Terra MB, Barboza NM, Okano AH, Smaili SM. Effectiveness of acute transcranial direct current stimulation on non-motor and motor symptoms in Parkinson's disease. Neurosci Lett 2018; 696:46-51. [PMID: 30553865 DOI: 10.1016/j.neulet.2018.12.017] [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] [Received: 08/03/2018] [Revised: 11/29/2018] [Accepted: 12/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is an appropriate treatment for Parkinson's disease (PD). It offers promising results and is known to improve symptoms. Nevertheless, consistent parameters need to be established for research purposes. OBJECTIVE To verify the effectiveness of acute tDCS on non-motor and motor symptoms in PD. METHODS A double-blind, randomized and sham-controlled study, in which twenty individuals randomly underwent two (one real, one sham) stimulation sessions. The current was applied to the dorsolateral prefrontal cortex (DLPFC) for 20 min at 2 mA. Participants were assessed before and after the stimulation using the Trail Making Test (TMT), Verbal Fluency test, Stroop test, Timed Up and Go test and video gait analysis. In the statistical analysis, a two-way variance analysis of repeated measures was applied to the variables time, group and time vs. group interaction, using Sidak's post-hoc test. RESULTS Statistically significant differences were found for TMT part B in both groups. For the Verbal Fluency test differences were found only within the group that received real stimulation. Additionally, both groups revealed improved reaction time in the congruent, incongruent and total phases of the Stroop test, but a significant difference in the Stroop effect was found only within the group that received real stimulation. CONCLUSION The results confirm that improvements on cognitive tests are possible after a single session of DLPFC stimulation.
Collapse
|
42
|
Dalong G, Jiyuan L, Ying Z, Lei Z, Yanhong H, Yongcong S. Transcranial direct current stimulation reconstructs diminished thalamocortical connectivity during prolonged resting wakefulness: a resting-state fMRI pilot study. Brain Imaging Behav 2018; 14:278-288. [DOI: 10.1007/s11682-018-9979-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
43
|
Sánchez-Kuhn A, Pérez-Fernández C, Moreno M, Flores P, Sánchez-Santed F. Differential Effects of Transcranial Direct Current Stimulation (tDCS) Depending on Previous Musical Training. Front Psychol 2018; 9:1465. [PMID: 30250439 PMCID: PMC6139306 DOI: 10.3389/fpsyg.2018.01465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/25/2018] [Indexed: 12/23/2022] Open
Abstract
Previous studies have shown that transcranial direct current stimulation (tDCS) facilitates motor performance, but individual differences such as baseline performance seem to influence this effect. Accordingly, musicians offer an inter-individual differences model due to anatomical and functional variances displayed among the motor cortex regions. The aim of the present work was to study if the baseline motor skill predicts whether tDCS can enhance motor learning. For that objective, we administered anodal (n = 20) or sham (n = 20) tDCS on the right primary motor cortex region of 40 right-handed healthy participants, who were divided into four groups: musicians (tDCS/sham) and non-musicians (tDCS/sham). We measured the skill index (SI) presented in the sequential finger-tapping task (SEQTAP) at baseline, during three 20 min/2 mA stimulation sessions, and in follow-up tests after 20 min and 8 days. Depending on the normality of the data distribution, statistical differences were estimated by ANOVA and Bonferroni post hoc test or Kruskal-Wallis and U Mann-Whitney. Results showed that musicians scored higher in baseline performance than non-musicians. The non-musicians who received tDCS scored higher than the sham group in the first and second stimulation session. This effect was extended to the 20 min and 8 days follow-up test. In musicians, there was no effect of tDCS. The present method seems to be suitable for the achievement of positive and consolidated tDCS effects on motor learning in inexperienced participants, but not in musicians. These data may have an implication for the rehabilitation of motor impairments, contributing to more individualized stimulation protocols.
Collapse
Affiliation(s)
- Ana Sánchez-Kuhn
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
| | | | - Margarita Moreno
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
| | - Pilar Flores
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
- Instituto de Neurorehabilitación Infantil InPaula, Almería, Spain
| | - Fernando Sánchez-Santed
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
- Instituto de Neurorehabilitación Infantil InPaula, Almería, Spain
| |
Collapse
|
44
|
Bashir S, Al-Hussain F, Wasay M, Yoo WK. The Effect of Repetitive Arm Cycling Training Priming with Transcranial Direct Current Stimulation on Post-Stroke: Pilot Study. BRAIN & NEUROREHABILITATION 2018. [DOI: 10.12786/bn.2018.11.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Shahid Bashir
- Neurophysiology department, Neuroscience Center, King Fahad Specialist Hospital Dammam, Dammam, Saudi Arabia
- Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fawaz Al-Hussain
- Department of Neurology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Wasay
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | - Woo-Kyoung Yoo
- Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| |
Collapse
|
45
|
Esmaeilpour Z, Marangolo P, Hampstead BM, Bestmann S, Galletta E, Knotkova H, Bikson M. Incomplete evidence that increasing current intensity of tDCS boosts outcomes. Brain Stimul 2017; 11:310-321. [PMID: 29258808 DOI: 10.1016/j.brs.2017.12.002] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is investigated to modulate neuronal function by applying a fixed low-intensity direct current to scalp. OBJECTIVES We critically discuss evidence for a monotonic response in effect size with increasing current intensity, with a specific focus on a question if increasing applied current enhance the efficacy of tDCS. METHODS We analyzed tDCS intensity does-response from different perspectives including biophysical modeling, animal modeling, human neurophysiology, neuroimaging and behavioral/clinical measures. Further, we discuss approaches to design dose-response trials. RESULTS Physical models predict electric field in the brain increases with applied tDCS intensity. Data from animal studies are lacking since a range of relevant low-intensities is rarely tested. Results from imaging studies are ambiguous while human neurophysiology, including using transcranial magnetic stimulation (TMS) as a probe, suggests a complex state-dependent non-monotonic dose response. The diffusivity of brain current flow produced by conventional tDCS montages complicates this analysis, with relatively few studies on focal High Definition (HD)-tDCS. In behavioral and clinical trials, only a limited range of intensities (1-2 mA), and typically just one intensity, are conventionally tested; moreover, outcomes are subject brain-state dependent. Measurements and models of current flow show that for the same applied current, substantial differences in brain current occur across individuals. Trials are thus subject to inter-individual differences that complicate consideration of population-level dose response. CONCLUSION The presence or absence of simple dose response does not impact how efficacious a given tDCS dose is for a given indication. Understanding dose-response in human applications of tDCS is needed for protocol optimization including individualized dose to reduce outcome variability, which requires intelligent design of dose-response studies.
Collapse
Affiliation(s)
- Zeinab Esmaeilpour
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY 10031, USA; Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran.
| | - Paola Marangolo
- Dipartimento di Studi Umanistici, University Federico II, Naples and IRCCS Fondazione Santa Lucia, Rome Italy
| | - Benjamin M Hampstead
- VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48105, USA
| | - Sven Bestmann
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, University College London, UK
| | - Elisabeth Galletta
- Rusk Rehabilitation Medicine, New York University Langone Medical Center, USA
| | - Helena Knotkova
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Department of Family and Social Medicine, Albert Einstein College of Medicine, The Bronx, NY, USA
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York of CUNY, New York, NY 10031, USA
| |
Collapse
|