It Takes Two: Noninvasive Brain Stimulation Combined With Neurorehabilitation

Abstract

The goal of post-acute neurorehabilitation is to maximize patients' function, ideally by using surviving brain and central nervous system tissue when possible. Yet the structures incorporated into neurorehabilitative approaches often differ from this target, which may explain why efficacy of conventional clinical treatments targeting neurological impairments varies widely. Non-invasive brain stimulation such as with Transcranial Magnetic Stimulation (TMS) and transcranial direct current stimulation (tDCS) offers the possibility of directly targeting brain structures to facilitate or inhibit their activity so as to steer neural plasticity in recovery, and measure neuronal output and interactions for evaluating progress. Latest advances as stereotactic navigation and electric field modeling are enabling more precise targeting of patient's residual structures in diagnosis and therapy. Given its promise, this supplement illustrates the wide-ranging significance of TMS and tDCS in neurorehabilitation, including in stroke, pediatrics, traumatic brain injury, focal hand dystonia, neuropathic pain and spinal cord injury. TMS and tDCS are still not widely used and remain poorly understood in neurorehabilitation. Thus, the present supplement includes articles that highlight ready clinical application of these technologies, including their comparative diagnostic capabilities relative to neuroimaging, their therapeutic benefit, their optimal delivery, the stratification of likely responders, and the variable benefits associated with their clinical use due to interactions between pathophysiology and the innate reorganization of the patient's brain. Overall, the supplement concludes that whether provided in isolation or in combination, non-invasive brain stimulation with neuro-rehabilitation are synergistic in the potential to transform clinical practice.

Electrical Stimulation Elicits Neural Stem Cells Activation: New Perspectives in CNS Repair

“…Additionally, tDCS and TMS are proven to be well-tolerated, inexpensive, and safe with few adverse effects. Moreover, tDCS, a portable device with simplicity of its mode of action, offers the possibility of use as a home-based treatment (Page et al, 2015 ). Last but not the least, EA is minimally invasive and shares safe, efficacious, and inexpensive similarities with TMS and tDCS.…”

Multifractality, Interactivity, and the Adaptive Capacity of the Human Movement System: A Perspective for Advancing the Conceptual Basis of Neurologic Physical Therapy

“…49 Very recently, non-invasive brain stimulation also has been added to the array of stimulation-based tools that might augment neurorehabilitation practices. 50 Generally speaking, these devices are designed to deliver predictable, linear patterns of stimulation for the purpose of facilitating movement (e.g., muscle activation, kinematics, etc). In the future, such devices potentially could be designed to deliver stimulation containing multifractal features, with the specific intent of enhancing and diversifying the adaptive capacity of a patient’s movement system.…”

Usefulness of robotic gait training plus neuromodulation in chronic spinal cord injury: a case report

“…stem cell induction), remyelination (oligodendrocyte function), and spinal plasticity modulation (reduced inhibition). 13 We may hypothesize that our rTMS paradigm could have strengthened the RAGT's effects thanks to either direct cortico-spinal or trans-synaptic spinal effects. 14 Indeed, it has been shown that rTMS could decrease intracortical inhibition phenomena and shape I-waves, allowing the recruitment of the spared corticospinal tract fibers, and thus improving the motor functions.…”