A Comparison of Primed Low-frequency Repetitive Transcranial Magnetic Stimulation Treatments in Chronic Stroke

Cassidy, Jessica M.; Chu, Haitao; Anderson, David C.; Krach, Linda E.; Snow, LeAnn M.; Kimberley, PT Teresa J; Carey, James R.

doi:10.1016/j.brs.2015.06.007

Cited by 33 publications

(22 citation statements)

References 69 publications

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“…In these patients, it could also be that the facilitation of the affected hemisphere is more effective than inhibition. Also, it might be that different strategies for promoting homeostatic plasticity might produce positive effects (e.g., protocols of so-called primed stimulation in which low-frequency rTMS is preceded by a bout of high-frequency rTMS; Cassidy et al, 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients

et al. 2016

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Previous studies suggested that both robot-assisted rehabilitation and non-invasive brain stimulation can produce a slight improvement in severe chronic stroke patients. It is still unknown whether their combination can produce synergistic and more consistent improvements. Safety and efficacy of this combination has been assessed within a proof-of-principle, double-blinded, semi-randomized, sham-controlled trial. Inhibitory continuous Theta Burst Stimulation (cTBS) was delivered on the affected hemisphere, in order to improve the response to the following robot-assisted therapy via a homeostatic increase of learning capacity. Twenty severe upper limb-impaired chronic stroke patients were randomized to robot-assisted therapy associated with real or sham cTBS, delivered for 10 working days. Eight real and nine sham patients completed the study. Change in Fugl-Meyer was chosen as primary outcome, while changes in several quantitative indicators of motor performance extracted by the robot as secondary outcomes. The treatment was well-tolerated by the patients and there were no adverse events. All patients achieved a small, but significant, Fugl-Meyer improvement (about 5%). The difference between the real and the sham cTBS groups was not significant. Among several secondary end points, only the Success Rate (percentage of targets reached by the patient) improved more in the real than in the sham cTBS group. This study shows that a short intensive robot-assisted rehabilitation produces a slight improvement in severe upper-limb impaired, even years after the stroke. The association with homeostatic metaplasticity-promoting non-invasive brain stimulation does not augment the clinical gain in patients with severe stroke.

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Section: Discussionmentioning

confidence: 99%

Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients

et al. 2016

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“…Participants were recruited as part of a larger investigation examining changes in cortical excitability and paretic hand function following different rTMS treatments delivered to the contralesional hemisphere . In that five‐week crossover study, participants received one session of each of the following treatments in randomized order: 6 Hz primed 1 Hz rTMS, sham 6 Hz primed active 1 Hz rTMS, and 1 Hz primed 1 Hz rTMS.…”

Section: Methodsmentioning

confidence: 99%

Interhemispheric Inhibition Measurement Reliability in Stroke: A Pilot Study

Cassidy

Chu

Chen

et al. 2016

Neuromodulation: Technology at the Neural Interface

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Objective Reliable transcranial magnetic stimulation (TMS) measures for probing corticomotor excitability are important when assessing the physiological effects of non-invasive brain stimulation. The primary objective of this study was to examine test-retest reliability of an interhemispheric inhibition (IHI) index measurement in stroke. Materials and Methods Ten subjects with chronic stroke (≥ 6 months) completed two IHI testing sessions per week for three weeks (six testing sessions total). A single investigator measured IHI in the contra- to-ipsilesional primary motor cortex direction and in the opposite direction using bilateral paired-pulse TMS. Weekly sessions were separated by 24 hours with a 1-week washout period separating testing weeks. To determine if motor-evoked potential (MEP) quantification method affected measurement reliability, IHI indices computed from both MEP amplitude and area responses were found. Reliability was assessed with two-way, mixed intraclass correlation coefficients (ICC(3,k)). Standard error of measurement and minimal detectable difference statistics were also determined. Results With the exception of the initial testing week, IHI indices measured in the contra-to-ipsilesional hemisphere direction demonstrated moderate to excellent reliability (ICC = 0.725 – 0.913). Ipsi-to-contralesional IHI indices depicted poor or invalid reliability estimates throughout the three-week testing duration (ICC= −1.153 – 0.105). The overlap of ICC 95% confidence intervals suggested that IHI indices using MEP amplitude vs. area measures did not differ with respect to reliability. Conclusions IHI indices demonstrated varying magnitudes of reliability irrespective of MEP quantification method. Several strategies for improving IHI index measurement reliability are discussed.

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“…Although many repetitive TMS trials to date have been disappointing, 16 this area of research has taught us that priming the brain for motor learning and recovery is possible. 17 Further work may elucidate the key parameters of stimulation, which, when combined with practice, are optimal for promoting neural reorganization in the developing child. 18,19 Other forms of cortical priming are rapidly gaining attention, including transcranial direct current stimulation, 18,20 and acute bouts of exercise.…”

Section: Plasticitymentioning

confidence: 99%

Stepping Up to Rethink the Future of Rehabilitation: IV STEP Considerations and Inspirations

Kimberley

Novak

Boyd

et al. 2017

Pediatric Physical Therapy

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Background and Purpose The IV STEP conference challenged presenters and participants to consider the state of science in rehabilitation, highlighting key area of progress since the previous STEP conference related to prediction, prevention, plasticity, and participation in rehabilitation. Key Points Emerging from the thought-provoking discussions was recognition of the progress we have made as a profession and a call for future growth. In this summary article, we present a recap of the key points and call for action. We review the information presented and the field at large as it relates to the 4 Ps: prediction, prevention, plasticity, and participation. Recommendations for Practice Given that personalized medicine is an increasingly important approach that was clearly woven throughout the IV STEP presentations, we took the liberty of adding a fifth “P,” Personalized, in our discussion of the future direction of the profession.

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A Comparison of Primed Low-frequency Repetitive Transcranial Magnetic Stimulation Treatments in Chronic Stroke

Cited by 33 publications

References 69 publications

Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients

Combining Robotic Training and Non-Invasive Brain Stimulation in Severe Upper Limb-Impaired Chronic Stroke Patients

Interhemispheric Inhibition Measurement Reliability in Stroke: A Pilot Study

Stepping Up to Rethink the Future of Rehabilitation: IV STEP Considerations and Inspirations

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