Top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation: a perspective

Fu, Qi; Nitsche, Michael A.; Ren, Xiuyan; Wang, Duanwei; Wang, Limin

doi:10.3389/fneur.2023.1156987

Cited by 7 publications

(2 citation statements)

References 199 publications

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“…These observations not only open new questions for further research but also provide some suggestive insights for motor rehabilitation. It has recently been proposed that topdown and bottom-up stimulation techniques (i.e., peripheral nerve stimulation), combined with AO, could enhance the traditional treatment approaches for stroke rehabilitation [35]. This proposal is based on a review of evidence suggesting that long-term potentiation-like (LTP) plasticity may be the underlying mechanism of acquiring novel motor skills via AO.…”

Section: Discussionmentioning

confidence: 99%

Distinct Effects of Brain Activation Using tDCS and Observational Practice: Implications for Motor Rehabilitation

McLeod,

Chavan,

Lee

et al. 2024

Brain Sciences

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Complex motor skills can be acquired while observing a model without physical practice. Transcranial direct-current stimulation (tDCS) applied to the primary motor cortex (M1) also facilitates motor learning. However, the effectiveness of observational practice for bimanual coordination skills is debated. We compared the behavioural and brain causal connectivity patterns following three interventions: primary motor cortex stimulation (M1-tDCS), action-observation (AO) and a combined group (AO+M1-tDCS) when acquiring a bimanual, two-ball juggling skill. Thirty healthy young adults with no juggling experience were randomly assigned to either video observation of a skilled juggler, anodal M1-tDCS or video observation combined with M1-tDCS. Thirty trials of juggling were performed and scored after the intervention. Resting-state EEG data were collected before and after the intervention. Information flow rate was applied to EEG source data to measure causal connectivity. The two observation groups were more accurate than the tDCS alone group. In the AO condition, there was strong information exchange from (L) parietal to (R) parietal regions, strong bidirectional information exchange between (R) parietal and (R) occipital regions and an extensive network of activity that was (L) lateralized. The M1-tDCS condition was characterized by bilateral long-range connections with the strongest information exchange from the (R) occipital region to the (R) temporal and (L) occipital regions. AO+M1-tDCS induced strong bidirectional information exchange in occipital and temporal regions in both hemispheres. Uniquely, it was the only condition that was characterized by information exchange between the (R) frontal and central regions. This study provides new results about the distinct network dynamics of stimulating the brain for skill acquisition, providing insights for motor rehabilitation.

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Section: Discussionmentioning

confidence: 99%

Distinct Effects of Brain Activation Using tDCS and Observational Practice: Implications for Motor Rehabilitation

McLeod,

Chavan,

Lee

et al. 2024

Brain Sciences

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“…Using TENS ( 34 , 35 ) or tDCS ( 28 , 30 ) alone has been proven effective for post-stroke spastic hemiplegia. A recent review ( 59 ) suggests that the combination of transcranial stimulation and peripheral transcutaneous stimulation techniques may have a synergic effect to optimize neuroplastic changes and improve motor recovery after stroke. Such an effect might be that tDCS depolarizes neuronal membrane potential and modulates GABA, Glutamate levels ( 60 ) and BDNF (brain-derived neurotrophic factor) expression levels in localized brain regions ( 61 ), whereas Acu-TENS activates KCC2-GABA A pathway ( 57 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of acupoints-based TENS combined with tDCS on spasticity and motor function in ischemic stroke with spastic hemiplegia: study protocol for a randomized controlled trial

Qian,

Ma,

et al. 2023

Front. Neurol.

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BackgroundSpastic hemiplegia following ischemic strokes seriously impedes the recovery of motor function posing a vast rehabilitation challenge. As the uncertain effects of recommended conventional treatments such as botulinum toxin injections on active functional improvement and potential adverse effects cannot be bypassed, there is an increasing need in alternative, more effective and safer modalities. Acupoints-based transcutaneous electrical nerve stimulation (Acu-TENS) and transcranial direct current stimulation (tDCS) are effective non-invasive modalities for stroke rehabilitation, particularly showing anti-spastic effect and functional improvements as well. However, the optimal stimulation frequency of Acu-TENS and whether combination of Acu-TENS and tDCS exert synergistic effect remain to be investigated.ObjectiveTo evaluate the effects of Acu-TENS combined with tDCS on spasticity and motor function in ischemic stroke patients with spastic hemiplegia and screen the optimal frequency of Acu-TENS.MethodsA total of 90 post-ischemic stroke patients with spastic hemiplegia will be intervened for 4 weeks and followed up for 4 weeks. They will be randomly assigned to three groups including two observation groups and a standard care control group in a 1:1:1 ratio. All patients will receive standard care and regular rehabilitation accordingly. In addition, the two observation groups will receive 12 sessions of Acu-TENS at 20 Hz or 100 Hz for 30 min combined with 1 mA tDCS for 20 min, three times a week, for 4 weeks. The primary outcome is the change in total modified Ashworth scale (MAS) score from baseline to week 4. Secondary outcomes include changes in surface electromyography (SEMG), Fugl-Meyer Motor Function Scale, Modified Barthel Index (MBI), and 10-meter walk test from baseline to week 4. MAS score will also be measured after 4 weeks of follow-up. Adverse events throughout the study will be recorded.DiscussionThis trial will evaluate, for the first time, the therapeutic potentials and safety of Acu-TENS combined with tDCS on spasticity and motor function in stroke patients. It will provide evidence for frequency-dependent anti-spastic effect of Acu-TENS, and a reference for rated parameter setting of new mixed transcutaneous and transcranial stimulation system for stroke rehabilitation, thereby promoting proactive healthcare consequently.Trial registration:Chinese Clinical Trials Register ChiCTR2200067186.

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Balance of power: The choice between trial and participant numbers to optimise the detection of phase-dependent effects

Geffen,

Bland,

Sale

2024

Imaging Neuroscience

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The fields of neuroscience and psychology are currently in the midst of a so-called “reproducibility crisis”, with growing concerns regarding a history of weak effect sizes and low statistical power in much of the research published in these fields over the last few decades. Whilst the traditional approach for addressing this criticism has been to increase participant sample sizes, there are many research contexts in which the number of trials per participant may be of equal importance. The present study aimed to compare the relative importance of participants and trials in the detection of phase-dependent phenomena, which are measured across a range of neuroscientific contexts (e.g., neural oscillations, non-invasive brain stimulation). This was achievable within a simulated environment where one can manipulate the strength of this phase-dependency in two types of outcome variables: one with normally distributed residuals (idealistic) and one comparable to motor-evoked potentials (an MEP-like variable). We compared the statistical power across thousands of experiments with the same number of sessions per experiment but with different proportions of participants and number of sessions per participant (30 participants ⨉ 1 session, 15 participants ⨉ 2 sessions, and 10 participants ⨉ 3 sessions), with the trials being pooled across sessions for each participant. These simulations were performed for both outcome variables (idealistic and MEP-like) and four different effect sizes (0.075— ‘weak’, 0.1— ‘moderate’, 0.125— ‘strong’, 0.15— ‘very strong’), as well as separate control scenarios with no true effect. Across all scenarios with (true) discoverable effects, and for both outcome types, there was a statistical benefit for experiments maximising the number of trials rather than the number of participants (i.e., it was always beneficial to recruit fewer participants but have them complete more trials). These findings emphasise the importance of obtaining sufficient individual-level data rather than simply increasing participant numbers.

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Top-down and bottom-up stimulation techniques combined with action observation treatment in stroke rehabilitation: a perspective

Cited by 7 publications

References 199 publications

Distinct Effects of Brain Activation Using tDCS and Observational Practice: Implications for Motor Rehabilitation

Distinct Effects of Brain Activation Using tDCS and Observational Practice: Implications for Motor Rehabilitation

Effects of acupoints-based TENS combined with tDCS on spasticity and motor function in ischemic stroke with spastic hemiplegia: study protocol for a randomized controlled trial

Balance of power: The choice between trial and participant numbers to optimise the detection of phase-dependent effects

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