Timing-dependent interaction effects of tDCS with mirror therapy on upper extremity motor recovery in patients with chronic stroke: A randomized controlled pilot study

Jin, Minxia; Zhang, Ziwei; Bai, Zhongfei; Fong, Kenneth N. K.

doi:10.1016/j.jns.2019.116436

Cited by 32 publications

(50 citation statements)

References 42 publications

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“…In only 2 studies using tDCS, the stimulation was performed before the VR protocol. The temporal relationship between mirror therapy (for stroke rehabilitation) and anodal tDCS was explored in [ 46 ]; the evidence showed that the simultaneous use of tDCS and mirror therapy resulted in significant improvement in one motor function test, compared to the use of tDCS before mirror therapy. As such, the simultaneous used of tDCS and (VR) therapy seems to be more advantageous and time efficient.…”

Section: Resultsmentioning

confidence: 99%

Virtual reality and non-invasive brain stimulation for rehabilitation applications: a systematic review

Cassani

Novak

Falk

et al. 2020

J NeuroEngineering Rehabil

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The present article reports the results of a systematic review on the potential benefits of the combined use of virtual reality (VR) and non-invasive brain stimulation (NIBS) as a novel approach for rehabilitation. VR and NIBS are two rehabilitation techniques that have been consistently explored by health professionals, and in recent years there is strong evidence of the therapeutic benefits of their combined use. In this work, we reviewed research articles that report the combined use of VR and two common NIBS techniques, namely transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). Relevant queries to six major bibliographic databases were performed to retrieve original research articles that reported the use of the combination VR-NIBS for rehabilitation applications. A total of 16 articles were identified and reviewed. The reviewed studies have significant differences in the goals, materials, methods, and outcomes. These differences are likely caused by the lack of guidelines and best practices on how to combine VR and NIBS techniques. Five therapeutic applications were identified: stroke, neuropathic pain, cerebral palsy, phobia and post-traumatic stress disorder, and multiple sclerosis rehabilitation. The majority of the reviewed studies reported positive effects of the use of VR-NIBS. However, further research is still needed to validate existing results on larger sample sizes and across different clinical conditions. For these reasons, in this review recommendations for future studies exploring the combined use of VR and NIBS are presented to facilitate the comparison among works.

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Section: Resultsmentioning

confidence: 99%

Virtual reality and non-invasive brain stimulation for rehabilitation applications: a systematic review

Cassani

Novak

Falk

et al. 2020

J NeuroEngineering Rehabil

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“…Neurorehabilitation has been proposed and used for the treatment of motor paralysis in stroke, and its effect has been verified (10)(11)(12)(13)(14). One of the treatment methods, the NovEl intervention Using Repetitive transcranial magnetic stimulation and Occupational therapy (NEURO), facilitates peripheral muscle movement by controlling the excitability of the motor cortices by repetitive transcranial magnetic stimulation (rTMS).…”

Section: Introductionmentioning

confidence: 99%

Prediction of Motor Recovery in the Upper Extremity for Repetitive Transcranial Magnetic Stimulation and Occupational Therapy Goal Setting in Patients With Chronic Stroke: A Retrospective Analysis of Prospectively Collected Data

et al. 2020

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Recovery from motor paralysis is facilitated by affected patients' recognition of the need for and practice of their own exercise goals. Neurorehabilitation has been proposed and used for the treatment of motor paralysis in stroke, and its effect has been verified. If an expected score for the neurorehabilitation effect can be calculated using the Fugl-Meyer Motor Assessment (FMA), a global assessment index, before neurorehabilitation, such a score will be useful for optimizing the treatment application criteria and for setting a goal to enhance the treatment effect. Therefore, this study verified whether the responsiveness to a treatment method, the NovEl intervention using repetitive transcranial magnetic stimulation and occupational therapy (NEURO), in patients with post-stroke upper extremity (UE) motor paralysis could be predicted by the pretreatment FMA score. No control group was established in this study for NEURO treatment. To analyze the recovery of the motor function in the UE, delta-FMA was calculated from the pre-and post-FMA scores obtained during NEURO treatment. The probability of three levels of treatment responsiveness was evaluated in association with delta-FMA score (<5, 5≤ delta-FMA <10, and ≥10 as non-responders; responders; and hyper-responders, respectively) according to the reported minimal clinically important difference (MCID). The association of the initial FMA scores with post-FMA scores, from the status of the treatment responsiveness, was determined by multinomial logistic regression analysis. Finally, 1,254 patients with stroke, stratified by FMA scores were analyzed. About 45% of the patients who had FMA scores ranging from 30 to 40 before treatment showed improvement over the MCID by NEURO treatment (odds ratio = 0.93, 95% CI = 0.92-0.95). Furthermore, more than 25% of the patients with more severe initial values, ranging from 26 to 30, improved beyond the MCID calculated in the acute phase Hamaguchi et al. Motor Recovery Predictions in Stroke (odds ratio = 0.87, 95% CI = 0.85-0.89). These results suggest that the evaluated motor function score of the UE before NEURO treatment can be used to estimate the possibility of a patient recovering beyond MCID in the chronic phase. This study provided clinical data to estimate the effect of NEURO treatment by the pretreatment FMA-UE score.

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“…Participants must meet all of the following criteria: (1) have a diagnosis of a unilateral ischaemic or haemorrhagic first-ever stroke; (2) time after stroke onset ≥6 months36; (3) between 18 and 64 years old; (4) reside in community dwellings; (5) with residual upper limb impairment ≥second level in the Functional Test for the Hemiplegic Upper Extremity (FTHUE) 37. FTHUE is a fast screening tool for upper limb functional movement, which has been used as a screening in our previous RCTs 38 39. FTHUE levels two to four are defined as low upper limb functioning poststroke, and levels five and seven are defined as high upper limb functioning poststroke38; (6) able to understand simple verbal instruction and follow one-step commands; (7) able to give informed written consent to participate in the study.…”

Section: Methodsmentioning

confidence: 99%

Effects of priming intermittent theta burst stimulation on upper limb motor recovery after stroke: study protocol for a proof-of-concept randomised controlled trial

Zhang

Fong

2020

BMJ Open

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IntroductionIntermittent theta burst stimulation (iTBS), a form of repetitive transcranial magnetic stimulation (rTMS), delivered to the ipsilesional primary motor cortex (M1), appears to enhance the brain’s response to rehabilitative training in patients with stroke. However, its clinical utility is highly subject to variability in different protocols. New evidence has reported that preceding iTBS, with continuous theta burst stimulation (cTBS) may stabilise and even boost the facilitatory effect of iTBS on the stimulated M1, via metaplasticity. The aim of this study is to investigate the effects of iTBS primed with cTBS (ie, priming iTBS), in addition to robot-assisted training (RAT), on the improvement of the hemiparetic upper limb functions of stroke patients and to explore potential sensorimotor neuroplasticity using electroencephalography (EEG).Methods and analysisA three-arm, subjects and assessors-blinded, randomised controlled trial will be performed with patients with chronic stroke. An estimated sample of 36 patients will be needed based on the prior sample size calculation. All participants will be randomly allocated to receive 10 sessions of rTMS with different TBS protocols (cTBS+iTBS, sham cTBS+iTBS and sham cTBS+sham iTBS), three to five sessions per week, for 2–3 weeks. All participants will receive 60 min of RAT after each stimulation session. Primary outcomes will be assessed using Fugl-Meyer Assessment-Upper Extremity scores and Action Research Arm Test. Secondary outcomes will be assessed using kinematic outcomes generated during RAT and EEG.Ethics and disseminationEthical approval has been obtained from The Human Subjects Ethics Sub-committee, University Research Committee of The Hong Kong Polytechnic University (reference number: HSEARS20190718003). The results yielded from this study will be presented at international conferences and sent to a peer-review journal to be considered for publication.Trial registration numberNCT04034069.

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Timing-dependent interaction effects of tDCS with mirror therapy on upper extremity motor recovery in patients with chronic stroke: A randomized controlled pilot study

Cited by 32 publications

References 42 publications

Virtual reality and non-invasive brain stimulation for rehabilitation applications: a systematic review

Virtual reality and non-invasive brain stimulation for rehabilitation applications: a systematic review

Prediction of Motor Recovery in the Upper Extremity for Repetitive Transcranial Magnetic Stimulation and Occupational Therapy Goal Setting in Patients With Chronic Stroke: A Retrospective Analysis of Prospectively Collected Data

Effects of priming intermittent theta burst stimulation on upper limb motor recovery after stroke: study protocol for a proof-of-concept randomised controlled trial

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