Efficacy of Coupling Inhibitory and Facilitatory Repetitive Transcranial Magnetic Stimulation to Enhance Motor Recovery in Hemiplegic Stroke Patients

Sung, Wen-Hsu; Wang, Chih Pin; Chou, Chien‐Chen; Chen, Yi Cheng; Chang, Yue Cune; Tsai, Po Yi

doi:10.1161/strokeaha.111.000522

Cited by 114 publications

(94 citation statements)

References 38 publications

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“…One of the prevailing models of motor recovery in ischaemic stroke is compensatory excitation of the contralesional hemisphere that is causing pathological disinhibition of transcallosal pathways 135 . Consequently, concurrent stimulation of the lesioned hemisphere and inhibition of the non-lesioned hemisphere (that is, through the use of TMS) may have beneficial effects on recovery 136 . Active patient participation in the therapy is another guiding principle of rehabilitation that is derived from studies employing forced use of the affected limb 137 and robotic therapy that minimizes assistance to encourage greater patient effort 138 .…”

Section: Rehabilitation In Strokementioning

confidence: 99%

Closed-loop brain training: the science of neurofeedback

et al. 2016

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Section: Rehabilitation In Strokementioning

confidence: 99%

Closed-loop brain training: the science of neurofeedback

et al. 2016

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“…When applied over the ipsilesional motor cortex of chronic stroke patients, reaction time and pinch force of the affected hand improved (Hummel et al, 2006). Similarly, facilitatory repetitive TMS (rTMS) applied to the ipsilesional hemisphere (Khedr et al, 2010) and inhibitory rTMS targeting the contralesional hemisphere (Takeuchi et al, 2005) or their combination (Sung et al, 2013) showed effects on motor functions in stroke, but more studies with larger sample sizes are needed (Hao et al, 2013).…”

Section: Combination Of Bmis and Brain Stimulation In Neurorehabilitamentioning

confidence: 99%

Brain–machine interfaces in neurorehabilitation of stroke

Soekadar

Birbaumer

Slutzky

et al. 2015

Neurobiology of Disease

278

180

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Stroke is among the leading causes of long-term disabilities leaving an increasing number of people with cognitive, affective and motor impairments depending on assistance in their daily life. While function after stroke can significantly improve in the first weeks and months, further recovery is often slow or non-existent in the more severe cases encompassing 30-50% of all stroke victims. The neurobiological mechanisms underlying recovery in those patients are incompletely understood. However, recent studies demonstrated the brain's remarkable capacity for functional and structural plasticity and recovery even in severe chronic stroke. As all established rehabilitation strategies require some remaining motor function, there is currently no standardized and accepted treatment for patients with complete chronic muscle paralysis. The development of brain-machine interfaces (BMIs) that translate brain activity into control signals of computers or external devices provides two new strategies to overcome stroke-related motor paralysis. First, BMIs can establish continuous high-dimensional brain-control of robotic devices or functional electric stimulation (FES) to assist in daily life activities (assistive BMI). Second, BMIs could facilitate neuroplasticity, thus enhancing motor learning and motor recovery (rehabilitative BMI). Advances in sensor technology, development of non-invasive and implantable wireless BMI-systems and their combination with brain stimulation, along with evidence for BMI systems' clinical efficacy suggest that BMI-related strategies will play an increasing role in neurorehabilitation of stroke.

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“…This was demonstrated to be both safe and effective in boosting motor facilitating efficacy compared with traditional 10-session rTMS. 29 However, a safe, optimal repetition number, and appropriate rest interval for aphasic patients remains uncertain. With regard to this combined therapy, establishment of an optimal conditioning protocol is important, and further dosage studies should be conducted.…”

mentioning

confidence: 99%

Efficacy of Synchronous Verbal Training During Repetitive Transcranial Magnetic Stimulation in Patients With Chronic Aphasia

Wang

Hsieh

Tsai

et al. 2014

Stroke

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Background and Purpose-Although multiple studies have suggested that repetitive transcranial magnetic stimulation (rTMS) may facilitate recovery after stroke, the efficacy of synchronous speech therapy integrated with an rTMS protocol has yet to be determined. We investigated language responses to this strategy and determined the longevity of the resulting therapeutic outcomes. Methods-Forty-five patients with stroke who presented with nonfluent aphasia were randomly assigned to the TMS syn group and underwent synchronous picture-naming training together with contralesional 1 Hz-rTMS for 10 daily sessions. The TMS sub group underwent subsequent picture-naming activity after the primed 1 Hz-rTMS, and the TMS sham group received concurrent naming task along with the sham 1 Hz-rTMS. The Concise Chinese Aphasia test and the picturenaming test were performed before, immediately, and after 3 months of the intervention. Results-TMS syn showed significantly superior results in Concise Chinese Aphasia test score (P<0.001), expression and description subtests (P<0.001), and action (P=0.02) and object naming activity (P=0.008); the superior results lasted for 3 months (P=0.005), in comparison with the TMS sub and TMS sham groups. Conclusions-We established a real-time model that involved implementing verbal tasks together with the rTMS protocol.Our results confirmed that the strategy yielded favorable outcomes that were of considerable longevity. The results also indicated that the rTMS protocol and language training can be combined to achieve outcomes superior to those obtained when used separately. we hypothesized that temporal synchronous modulation (online model) in the Broca area through rTMS modulation and concurrent language system activation can result in greater synaptic strength than the separate application of these interventions (offline model).We investigated the efficacy of low-frequency rTMS coupled with a simultaneous picture-naming activity for treating chronic nonfluent aphasic patients and evaluated the resulting effects for a 3-month period. Methods ParticipantsSeventy-six patients with stroke who were admitted to the stroke unit of a tertiary medical center or who attended follow-up visits at outpatient clinics were evaluated consecutively for participation in this study. Three patients approached declined to participate ( Figure 1); and 45 right-handed patients met the inclusion criteria: (1) a diagnosis of nonfluent aphasia resulting from a first-ever left middle cerebral artery infarction that had been confirmed by MRI; (2) >6 months of poststroke duration with a plateau in aphasic condition; (3) no current depression as evaluated using the Aphasic Depression Rating Scale 12 ; (4) an absence of spatial neglect or visual field deficits; and (5) an absence of TMS contraindications. Forty-three patients completed the 3-month assessment. The study was approved by the local institutional review board, and all patients gave their written informed consent before participating.The biographical data of the e...

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Efficacy of Coupling Inhibitory and Facilitatory Repetitive Transcranial Magnetic Stimulation to Enhance Motor Recovery in Hemiplegic Stroke Patients

Abstract: the potential for a consecutive suppressive-facilitatory TMS protocol to improve motor outcomes after chronic stroke. Methods-Fifty-four chronic hemiplegic stroke patients were allocated across 4 groups to undergo 20 daily sessions of (1)

Cited by 114 publications

References 38 publications

Closed-loop brain training: the science of neurofeedback

Closed-loop brain training: the science of neurofeedback

Brain–machine interfaces in neurorehabilitation of stroke

Efficacy of Synchronous Verbal Training During Repetitive Transcranial Magnetic Stimulation in Patients With Chronic Aphasia

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