Noninvasive brain stimulation combined with other therapies improves gait speed after stroke: a systematic review and meta-analysis

Vaz, Patricia Graef; Salazar, Ana Paula; Stein, Cinara; Marchese, Ritchele Redivo; Lukrafka, Janice Luísa; Plentz, Rodrigo Della Méa; Pagnussat, Aline de Souza

doi:10.1080/10749357.2019.1565696

Cited by 43 publications

(45 citation statements)

References 42 publications

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“…Furthermore, NINMs effects seem to have a sustained pain reduction effect even when the intervention session had been finished more than 1 month. However due to the small number of included studies (5 studies, n = 265) our estimates have to be interpreted with caution, similar to other studies in the neuromodulation field where the absence of long term follow up hinders the clinical interpretation of the results 46,47 . No previous systematic review of central NINMs techniques was found.…”

Section: Summary Of Resultssupporting

confidence: 54%

Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Zeng¹,

Pacheco‐Barrios²,

Cao³

et al. 2020

Sci Rep

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Diabetic Peripheral Neuropathy (DPN) typically is accompanied by painful symptoms. Several therapeutic agents have been tried for symptomatic relief, but with varying results. The use of non-invasive neuromodulation (NINM) is a potential treatment option for DPN. The objective of our study is to evaluate NINM effects on pain rating and nerve conduction velocity in DPN patients. The search was carried out in seven databases until Aug 30th, 2019. Finally, twenty studies met the inclusion criteria. We found a significant reduction of pain scores by central NINMs (effect size [ES] = − 0.75, 95% CI = − 1.35 to − 0.14), but not by the overall peripheral techniques (electrical and electromagnetic) (ES = − 0.58, 95% CI = − 1.23 to 0.07). However, the subgroup of peripheral electrical NINMs reported a significant higher effect (ES = − 0.84, 95% CI = − 1.57 to − 0.11) compared to electromagnetic techniques (ES = 0.21; 95% CI = − 1.00 to 1.42, I2 = 95.3%) . Other subgroup analysis results show that NINMs effects are higher with intensive protocols and in populations with resistant symptoms or intolerance to analgesic medications. Besides, NINMs can increase motor nerves velocity (ES = 1.82; 95% CI = 1.47 to 2.17), and there were no effects on sensory nerves velocity (ES = 0.01, 95% CI = − 0.79 to 0.80). The results suggest that central and peripheral electrical NINMs could reduce neuropathic pain among DPN patients, without reported adverse events. Well-powered studies are needed to confirm that NINM techniques as an alternative effective and safe treatment option.

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Section: Summary Of Resultssupporting

confidence: 54%

Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Zeng¹,

Pacheco‐Barrios²,

Cao³

et al. 2020

Sci Rep

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“…[81] NIBS for hemispatial neglect 10/226 NIBS combined with other therapies has positive effect on hemispatial neglect and performance in ADL (moderatequality evidence) Both excitatory and inhibitory stimulations are effective. [82] NIBS for gait speed 10/226 NIBS combined with other therapies are effective to improve gait speed (moderate-quality evidence) [83] NIBS for paretic limb force production 23 Improvements in paretic limb force after tDCS and rTMS Positive effects on force production by increasing cortical activity in the ipsilesional hemisphere and decreasing cortical activity in the contralesional hemisphere.…”

Section: Inosinementioning

confidence: 99%

“…Anodal stimulation performed during tDCS increases the neuronal excitability of the stimulated area, while cathodal stimulation decreases it [85]. In some systematic reviews and meta-analyses have been shown that NIBS combined with other therapies may be effective to improve gait speed [83], hemispatial neglect and performance in ADL [82], and paretic limb force [84] in patients after stroke.…”

Section: Noninvasive Brain Stimulation (Nibs)mentioning

confidence: 99%

Pharmacological Interventions and Rehabilitation Approach for Enhancing Brain Self-repair and Stroke Recovery

Szelenberger

Kostka

Saluk‐Bijak

et al. 2019

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Neuroplasticity is a natural process occurring in the brain for the entire life. Stroke is the leading cause of long term disability and a huge medical and financial problem throughout the world. Research conducted over the past decade focused mainly on neuroprotection in the acute phase of stroke while very little studies target the chronic stage. Recovery after stroke depends on the ability of our brain to reestablish the structural and functional organization of neurovascular networks. Combining adjuvant therapies and drugs may enhance the repair processes and restore impaired brain functions. Currently, there are some drugs and rehabilitative strategies that can facilitate brain repair and improve clinical effect even years after stroke onset. Moreover, some of the compounds such as citicoline, fluoxetine, niacin, levodopa, etc. are already in clinical use or are being trialed in clinical issues. Many studies are also testing cell therapies; in our review, we focused on studies where cells have been implemented at the early stage of stroke. Next, we discuss pharmaceutical interventions. In this section, we selected methods of cognitive, behavioral, and physical rehabilitation as well as adjuvant interventions for neuroprotection including noninvasive brain stimulation and extremely low-frequency electromagnetic field. The modern rehabilitation represents a new model of physical interventions with the limited therapeutic window up to six months after stroke. However, previous studies suggest that the time window for stroke recovery is much longer than previously thought. This review attempts to present the progress in neuroprotective strategies, both pharmacological and non-pharmacological that can stimulate the endogenous neuroplasticity in post-stroke patients.

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“…During such gait training, neuroplasticity can be facilitated with adjuvant treatment with non-invasive brain stimulation (NIBS) techniques to the lower limb motor cortex of stroke survivors [6]. Here, moderate-quality evidence has been found on NIBS combined with various therapies to improve gait speed after stroke [7], [8]. Importantly, NIBS treatment effects were found signi cant only in the care of transcranial magnetic stimulation (TMS), while transcranial direct current stimulation (tDCS) did not show any signi cant therapeutic effects [8].…”

Section: Introductionmentioning

confidence: 99%

Investigating the Effects of Cerebellar Transcranial Direct Current Stimulation on Post-Stroke Overground Gait Performance: a partial least-squares regression approach

Solanki

Rezaee

Dutta

et al. 2020

Preprint

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Abstract Background Stroke often results in impaired gait, which can limit community ambulation and the quality of life. Recent works have shown the feasibility of transcranial Direct Current Stimulation (tDCS) as an adjuvant treatment to facilitate gait rehabilitation. Since the cerebellum plays an essential role in balance and movement coordination, which is crucial for independent overground ambulation, so, we investigated the effects of cerebellar tDCS (ctDCS) on the post-stroke overground gait performance in chronic stroke survivors. Methods Fourteen chronic post-stroke male subjects were recruited based on convenience sampling at the collaborating hospitals where ten subjects finally participated in the ctDCS gait study. We evaluated the effects of two ctDCS montages with 2 mA direct current, a) optimized configuration for dentate stimulation with 3.14 cm2 disc anode at PO10h (10/5 EEG system) and 3.14 cm2 disc cathode at PO9h (10/5 EEG system), and b) optimized configuration for leg lobules VII-IX stimulation with 3.14 cm2 disc anode at Exx8 (electrodes defined by ROAST) and 3.14 cm2 disc cathode at Exx7. Two-sided Wilcoxon rank-sum test was performed at the 5% significance level on the percent normalized change measures in the overground gait performance. Results We found ctDCS to be acceptable by all the exposed subjects. The ctDCS intervention had an effect on the 'Normalised Step length Affected side' (p = 0.1) and 'Gait Stability Ratio' (p = 0.0569), which was found using Wilcoxon signed-rank test at 10% significance level. Also, ctDCS montage specific effect was found using a two-sided Wilcoxon rank-sum test at a 5% significance level for 'Step Time Affected Leg' (p = 0.0257) and '%Stance Time Unaffected Leg' (p = 0.0376). Moreover, the changes in the quantitative gait parameters across both the montages were found to be correlated to the mean electric field strength in the lobules based on partial least squares regression analysis (R2 statistic = 0.6574) where the mean electric field strength at the cerebellar lobules, Vermis VIIIb, Ipsilesional IX, Vermis IX, Ipsilesional X, had the most loading. Conclusion Our feasibility study indicated the potential of a single session of ctDCS to contribute to the immediate improvement in the balance and gait performance in terms of gait-related indices and clinical gait measures.

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Noninvasive brain stimulation combined with other therapies improves gait speed after stroke: a systematic review and meta-analysis

Cited by 43 publications

References 42 publications

Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

Pharmacological Interventions and Rehabilitation Approach for Enhancing Brain Self-repair and Stroke Recovery

Investigating the Effects of Cerebellar Transcranial Direct Current Stimulation on Post-Stroke Overground Gait Performance: a partial least-squares regression approach

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