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Non-invasive brain stimulation in early rehabilitation after stroke.

ABSTRACT: The new tendency in rehabilitation involves non-invasive tools that, if applied early after stroke, promote neurorecovery. Repetitive transcranial magnetic stimulation and transcranial direct current stimulation may correct the disruption of cortical excitability and effectively contribute to the restoration of movement and speech. The present paper analyses the results of non-invasive brain stimulation (NIBS) trials, highlighting different aspects related to the repetitive transcranial magnetic stimulation frequency, transcranial direct current stimulation polarity, the period and stimulation places in acute and subacute ischemic strokes. The risk of adverse events, the association with motor or language recovery specific training, and the cumulative positive effect evaluation are also discussed.

SUBMITTER: Blesneag AV

PROVIDER: S-EPMC4564042 | biostudies-other | 2015

REPOSITORIES: biostudies-other

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Non-invasive brain stimulation in early rehabilitation after stroke.

Blesneag A V AV Popa L L Stan A D AD

Journal of medicine and life 20150101

The new tendency in rehabilitation involves non-invasive tools that, if applied early after stroke, promote neurorecovery. Repetitive transcranial magnetic stimulation and transcranial direct current stimulation may correct the disruption of cortical excitability and effectively contribute to the restoration of movement and speech. The present paper analyses the results of non-invasive brain stimulation (NIBS) trials, highlighting different aspects related to the repetitive transcranial magnetic ...[more]

PMID: 26361512

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Project description:BackgroundNon-invasive brain stimulation (NIBS) techniques and mirror therapy (MT) are promising rehabilitation measures for stroke. While the combination of MT and NIBS has been employed for post-stroke upper limb motor functional rehabilitation, its effectiveness has not been examined.ObjectiveThis study aimed to evaluate the effectiveness of combined MT and NIBS in the recovery of upper limb motor function in stroke patients.MethodsThe search was carried out in PubMed, EMBASE, Cochrane Library, Web of Science, Science Direct, CNKI, WANFANG and VIP until December 2021. Randomized clinical trials (RCTs) comparing MT or NIBS alone with the combination of NIBS and MT in improving upper extremity motor recovery after stroke were selected. A meta-analysis was performed to calculate the mean differences (MD) or the standard mean differences (SMD) and 95% confidence intervals (CI) with random-effect models. Subgroup analyses were also conducted according to the types of control group, the types of NIBS, stimulation timing and phase poststroke.ResultsA total of 12 articles, including 17 studies with 628 patients, were reviewed in the meta-analysis. In comparison with MT or NIBS alone, the combined group significantly improved body structure and function (MD = 5.97; 95% CI: 5.01-6.93; P < 0.05), activity levels (SMD = 0.82; 95% CI 0.61-1.02; P < 0.05). For cortical excitability, the motor evoked potential cortical latency (SMD = -1.05; 95% CI:-1.57--0.52; P < 0.05) and the central motor conduction time (SMD=-1.31 95% CI:-2.02--0.61; P < 0.05) of the combined group were significantly shortened. A non-significant homogeneous summary effect size was found for MEP amplitude (SMD = 0.47; 95%CI = -0.29 to 1.23; P = 0.23). Subgroup analysis showed that there is an interaction between the stimulation sequence and the combined treatment effect.ConclusionIn this meta-analysis of randomized clinical trials, in comparison to the control groups, MT combined with NIBS promoted the recovery of upper extremity motor function after stroke, which was reflected in the analysis of body structure and function, activity levels, and cortical excitability.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022304455.

Project description:In recent years, the potential of non-invasive brain stimulation (NIBS) for therapeutic effects on cognitive functions has been explored for populations with stroke. There are various NIBS methods depending on the stimulation site and stimulation parameters. However, there is no systematic NIBS review of post-stroke cognitive impairment with a focus on stimulation sites and stimulation parameters. The purpose of this study is to conduct a systematic review and meta-analysis on effectiveness and safety of NIBS for cognitive impairment after a stroke to obtain new insights. This study was prospectively registered with the PROSPERO database of systematic reviews (CRD42020183298). All English articles from MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and CENTRAL were searched from inception up to 31 December 2020. Randomized and prospective controlled trials were included for the analysis. Studies with at least five individuals post-stroke, whereby at least five sessions of NIBS were provided and using standardized neuropsychological measurement of cognition, were included. We assessed the methodological quality of selected studies as described in the Physiotherapy Evidence Database (PEDro) scoring system. A total of 10 studies met eligibility criteria. Six studies used repetitive transcranial magnetic stimulation (rTMS) and four studies used transcranial direct current stimulation (tDCS). The pooled sample size was 221 and 196 individuals who received rTMS and tDCS respectively. Eight studies combined general rehabilitation, cognitive training, or additional therapy with NIBS. In rTMS studies, target symptoms included global cognition (n = 4), attention (n = 3), memory (n = 4), working memory (WM) (n = 3), and executive function (n = 2). Five studies selected the left dorsolateral prefrontal cortex (DPLFC) as the stimulation target. One rTMS study selected the right DLPFC as the inhibitory stimulation target. Four of six studies showed significant improvement. In tDCS studies, target symptoms included global cognition (n = 2), attention (n = 4), memory (n = 2) and WM (n = 2). Three studies selected the frontal area as the stimulation target. All studies showed significant improvement. In the meta-analysis, rTMS showed a significant effect on attention, memory, WM and global cognition classified by neuropsychological tests. On the other hand, tDCS had no significant effect. In post-stroke patients with deficits in cognitive function, including attention, memory, and WM, NIBS shows promising positive effects. However, this effect is limited, suggesting that further studies are needed with more precision in stimulation sites and stimulation parameters. Future studies using advanced neurophysiological and neuroimaging tools to allow for a network-based approach to treat cognitive symptoms post-stroke with NIBS are warranted.

Project description:Background Stroke is one of the most frequent causes of death in Germany and the developed countries. After a stroke, those affected often suffer particularly from functional motor restrictions of the upper extremities. Newer techniques such as the BCI-FES systems aim to establish a communication channel between the brain and external devices with a neuromuscular intervention. The electrical activity of the brain is measured, processed, translated into control signals and can then be used to control an application. Methods As a mixed-methods design (exploratory design), eight guideline-based expert interviews were conducted first. For the quantitative expert survey, 95 chief physicians from the field of neuromedicine in rehabilitation facilities nationwide were subsequently invited to participate in an online survey. Results In our data analysis, we found that doctors are largely open-minded towards new technical rehabilitation systems. In addition to the proper functioning of the system, they consider the understanding of the functionality and the meaningfulness of the system to be particularly important. In addition, the system should be motivating for individuals, generate meaningful movements, be easy to use, evidence-based and quick to set up. Concerns were expressed regarding the understanding of the system’s processes, especially in the acute phase after a stroke, as well as the excessive expectation of results from the system on the part of the persons. The experts named stroke patients in rehabilitation phase C, which is about mobilization and recovery, as well as all persons who can understand the language requirements as benefiting groups of people. Conclusion The present study shows that more research should and must be done in the field of BCI-FES interfaces, and various development trends have been identified. The system has the potential to play a leading role in the rehabilitation of stroke patients in the future. Nevertheless, more work should be done on the improvement and implementation as well as the system’s susceptibility to interference in everyday patient life. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02716-z.

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Non-invasive brain stimulation in early rehabilitation after stroke.

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Non-invasive brain stimulation in early rehabilitation after stroke.

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