Neuromodulatory Interventions for Traumatic Brain Injury

Pape, Theresa; Herrold, Amy A.; Guernon, Ann; Aaronson, Alexandra; Rosenow, Joshua M.

doi:10.1097/htr.0000000000000643

Cited by 15 publications

(10 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Transcranial direct current stimulation is a neuromodulation method and occupational therapy practitioners may consider advanced training to deliver this intervention. Although these interventions are not widely available clinically and may require additional training to perform, non-invasive brain stimulation interventions could prime the brain to engage with a subsequent sensory stimulation intervention using emotionally relevant and salient stimuli warranting future research (Pape et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

Interventions Facilitating Recovery of Consciousness Following Traumatic Brain Injury: A Systematic Review

Weaver

Watters

Cogan

2022

OTJR: Occupational Therapy Journal of Research

View full text Add to dashboard Cite

People who experience disorders of consciousness (DoC) following a severe traumatic brain injury (TBI) have complex rehabilitation needs addressed by occupational therapy. To examine the effectiveness of interventions to improve arousal and awareness of people with DoC following a TBI. For this systematic review, we followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched six databases in collaboration with a research librarian. Twenty-seven studies were included and grouped thematically. Multimodal sensory stimulation, familiar voices telling structured stories, and transcranial direct current stimulation had a moderate level of evidence. Multimodal sensory stimulation had the strongest evidence in support of its use in clinical practice. Occupational therapy practitioners should administer multimodal stimuli frequently as studies reported administering these interventions at least twice daily. Occupational therapy practitioners should incorporate personally relevant, meaningful, salient stimuli into interventions when treating patients with DoC.

show abstract

Section: Discussionmentioning

confidence: 99%

Interventions Facilitating Recovery of Consciousness Following Traumatic Brain Injury: A Systematic Review

Weaver

Watters

Cogan

2022

OTJR: Occupational Therapy Journal of Research

View full text Add to dashboard Cite

show abstract

“…Transcranial magnetic stimulation (TMS) techniques have received increased attention in recent years as potential treatments for neurological disorders via manipulating cortical excitability, such as traumatic brain injury, stroke, spinal cord injury, and movement disorders (Bender Pape et al, 2020 ; Korzhova et al, 2019 ; Pink et al, 2021 ; Spagnolo et al, 2021 ). Intermittent theta burst stimulation (iTBS) is a form of repetitive transcranial magnetic stimulation (rTMS) that can facilitate corticomotor excitability (Butts et al, 2014 ; Hinder et al, 2014 ; Huang et al, 2005 ; Klomjai et al, 2015 ; Suppa et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

“…iTBS has been evaluated in individuals with spinal cord injury (SCI), showing variable effects (Fassett et al, 2017 ). Other work has noted that although TMS techniques are therapeutically promising, considerable work remains to be done in determining the driving factors behind treatment response variability (Bender Pape et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of neuroanatomy on corticomotor excitability during and after transcranial magnetic stimulation and intermittent theta burst stimulation

Mittal

Thakkar

Hodges

et al. 2022

Human Brain Mapping

View full text Add to dashboard Cite

Individual neuroanatomy can influence motor responses to transcranial magnetic stimulation (TMS) and corticomotor excitability after intermittent theta burst stimulation (iTBS). The purpose of this study was to examine the relationship between individual neuroanatomy and both TMS response measured using resting motor threshold (RMT) and iTBS measured using motor evoked potentials (MEPs) targeting the biceps brachii and first dorsal interosseus (FDI). Ten nonimpaired individuals completed sham‐controlled iTBS sessions and underwent MRI, from which anatomically accurate head models were generated. Neuroanatomical parameters established through fiber tractography were fiber tract surface area (FTSA), tract fiber count (TFC), and brain scalp distance (BSD) at the point of stimulation. Cortical magnetic field induced electric field strength (EFS) was obtained using finite element simulations. A linear mixed effects model was used to assess effects of these parameters on RMT and iTBS (post‐iTBS MEPs). FDI RMT was dependent on interactions between EFS and both FTSA and TFC. Biceps RMT was dependent on interactions between EFS and and both FTSA and BSD. There was no groupwide effect of iTBS on the FDI but individual changes in corticomotor excitability scaled with RMT, EFS, BSD, and FTSA. iTBS targeting the biceps was facilitatory, and dependent on FTSA and TFC. MRI‐based measures of neuroanatomy highlight how individual anatomy affects motor system responses to different TMS paradigms and may be useful for selecting appropriate motor targets when designing TMS based therapies.

show abstract

“…8 One interesting study showed good results from use of NIBS among patients with acute stroke and, although each condition has its specific characteristic, that study highlights the potential for use of NIBS among patients with acute brain injury in general. 1 One of the great challenges in proposing clinical trials to test use of NIBS among patients with acute TBI concerns safety, considering that these are patients with great clinical instability.Thus, neurological stability needs to be ensured, given that patients with acute brain injury have high incidence of epilepsy, for example. 2 Another great challenge for researchers in preparing the study design is to fit the protocols to the sample homogeneity, considering that TBI cases are complex and have different characteristics.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Neuromodulation in acute traumatic brain injury: a tool in the rehabilitation process that needs to be investigated

2022

View full text Add to dashboard Cite

In 2014, while one of us (FZSA) was working towards his doctorate, he had the opportunity to follow about 200 patients who had suffered severe head trauma (traumatic brain injury, TBI), from the first day after the trauma until one year later. In relation to these cases, a variety of hypothetical questions arose: Could noninvasive brain stimulation (NIBS) help to contain the advancement of neurotoxicity, help with reorganization after brain injury and optimize brain neuroplasticity? In addition to the question of whether it was effective, would it be safe? What would be the barriers?At that time, studies investigating the effects of NIBS in patients suffering from TBI had been conducted, 1-3 but none of them related to acute patients. So far, little progress has been made in neuromodulation studies on this type of patient. 4 In fact, neuromodulation is a consolidated form of treatment for various neurological problems consequent to diseases such as depression, stroke, pain and others. 5 Neurophysiological effects are known in the literature, although some questions about mechanisms exist in relation to some diseases. 6 However, various questions remain to be addressed in relation to TBI. This condition is a major public health problem worldwide and there is a need to move forward regarding its treatment. Neuromodulation may therefore form an important tool in the rehabilitation process for this disease condition. 7 Many barriers exist in relation to how NIBS is performed in critically ill patients, especially with regard to transcranial direct current stimulation (TDCS) and transcranial magnetic stimulation (TMS). The issues involved include safety, clinical instability, extent of the injury, unfavorable hospital environment, heterogeneity of the injuries of TBI patients and treatment adherence after hospital discharge. 8 One interesting study showed good results from use of NIBS among patients with acute stroke and, although each condition has its specific characteristic, that study highlights the potential for use of NIBS among patients with acute brain injury in general. 1 One of the great challenges in proposing clinical trials to test use of NIBS among patients with acute TBI concerns safety, considering that these are patients with great clinical instability.Thus, neurological stability needs to be ensured, given that patients with acute brain injury have high incidence of epilepsy, for example. 2 Another great challenge for researchers in preparing the study design is to fit the protocols to the sample homogeneity, considering that TBI cases are complex and have different characteristics. These complexities and differences form a great barrier to applying pre-established protocols such patients. Hence, patients' individuality needs to be respected and application of protocols and assemblies of equipment close to the target have to be guided by very careful evaluation. Use of tools such as functional magnetic resonance imaging, electroencephalograms, positron emission tomography (PET) scans and neuronavigat...

show abstract

Neuromodulatory Interventions for Traumatic Brain Injury

Cited by 15 publications

References 47 publications

Interventions Facilitating Recovery of Consciousness Following Traumatic Brain Injury: A Systematic Review

Interventions Facilitating Recovery of Consciousness Following Traumatic Brain Injury: A Systematic Review

Effect of neuroanatomy on corticomotor excitability during and after transcranial magnetic stimulation and intermittent theta burst stimulation

Neuromodulation in acute traumatic brain injury: a tool in the rehabilitation process that needs to be investigated

Contact Info

Product

Resources

About