Transcranial Direct Current Stimulation Potentiates Improvements in Functional Ability in Patients With Chronic Stroke Receiving Constraint-Induced Movement Therapy

Figlewski, Krystian; Blicher, Jakob Udby; Mortensen, Jørgen Birk; Severinsen, Kåre Eg; Nielsen, Jørgen Feldbæk; Andersen, Henning

doi:10.1161/strokeaha.116.014988

Cited by 54 publications

(39 citation statements)

References 11 publications

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“…Studies in the area of rehabilitation have indicated that continuous tDCS improved motor function (Costa-Ribeiro et al, 2016; Ilić et al, 2016; Yozbatiran et al, 2016; Figlewski et al, 2017). Thus, continuous tDCS is likely to affect an individual’s AQ score.…”

Section: Discussionmentioning

confidence: 99%

Transcranial Direct Current Stimulation of the Temporoparietal Junction and Inferior Frontal Cortex Improves Imitation-Inhibition and Perspective-Taking with no Effect on the Autism-Spectrum Quotient Score

Nobusako

Nishi

Shuto³

et al. 2017

Front. Behav. Neurosci.

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Lesions to brain regions such as the temporoparietal junction (TPJ) and inferior frontal cortex (IFC) are thought to cause autism-spectrum disorder (ASD). Previous studies indicated that transcranial direct current stimulation (tDCS) of the right TPJ improves social cognitive functions such as imitation-inhibition and perspective-taking. Although previous work shows that tDCS of the right IFC improves imitation-inhibition, its effects on perspective-taking have yet to be determined. In addition, the role of the TPJ and IFC in determining the Autism-Spectrum Quotient (AQ), which is a measure of autism spectrum traits, is still unclear. Thus, the current study performed tDCS on the right TPJ and the right IFC of healthy adults, and examined its effects on imitation-inhibition, perspective-taking and AQ scores. Based on previous studies, we hypothesized that anodal tDCS of the right IFC and right TPJ would improve imitation-inhibition, perspective-taking and the AQ score. Anodal tDCS of the right TPJ or IFC significantly decreased the interference effect in an imitation-inhibition task and the cost of perspective-taking in a perspective-taking task, in comparison to the sham stimulation control. These findings indicated that both the TPJ and the IFC play a role in imitation-inhibition and perspective-taking, i.e., control of self and other representations. However, anodal stimulation of the right TPJ and the right IFC did not alter participants’ AQ. This finding conflicts with results from previous brain imaging studies, which could be attributed to methodological differences such as variation in sex, age and ASD. Therefore, further research is necessary to determine the relationship between the TPJ and IFC, and the AQ.

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Section: Discussionmentioning

confidence: 99%

Transcranial Direct Current Stimulation of the Temporoparietal Junction and Inferior Frontal Cortex Improves Imitation-Inhibition and Perspective-Taking with no Effect on the Autism-Spectrum Quotient Score

Nobusako

Nishi

Shuto³

et al. 2017

Front. Behav. Neurosci.

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“…She was treated with IV thrombolysis and thrombectomy and recanalization was achieved 5 h after symptom onset. One year post-stroke she still suffered from motor impairment (Wolf Motor Function Test [WMFT] score of 30) and was scanned as part of a clinical study investigating the effect of combining Constraint-Induced Movement Therapy and tDCS (Figlewski et al, 2017; Clinical trials NCT01983319, Regional Ethics approval: 1-10-72-268-13). The structural scans showed a cortical lesion in the right parietal lobe (Fig.…”

Section: Methodsmentioning

confidence: 99%

The impact of large structural brain changes in chronic stroke patients on the electric field caused by transcranial brain stimulation

Minjoli

Saturnino

Blicher

et al. 2017

NeuroImage: Clinical

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Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (TDCS) are two types of non-invasive transcranial brain stimulation (TBS). They are useful tools for stroke research and may be potential adjunct therapies for functional recovery. However, stroke often causes large cerebral lesions, which are commonly accompanied by a secondary enlargement of the ventricles and atrophy. These structural alterations substantially change the conductivity distribution inside the head, which may have potentially important consequences for both brain stimulation methods. We therefore aimed to characterize the impact of these changes on the spatial distribution of the electric field generated by both TBS methods. In addition to confirming the safety of TBS in the presence of large stroke-related structural changes, our aim was to clarify whether targeted stimulation is still possible. Realistic head models containing large cortical and subcortical stroke lesions in the right parietal cortex were created using MR images of two patients. For TMS, the electric field of a double coil was simulated using the finite-element method. Systematic variations of the coil position relative to the lesion were tested. For TDCS, the finite-element method was used to simulate a standard approach with two electrode pads, and the position of one electrode was systematically varied. For both TMS and TDCS, the lesion caused electric field “hot spots” in the cortex. However, these maxima were not substantially stronger than those seen in a healthy control. The electric field pattern induced by TMS was not substantially changed by the lesions. However, the average field strength generated by TDCS was substantially decreased. This effect occurred for both head models and even when both electrodes were distant to the lesion, caused by increased current shunting through the lesion and enlarged ventricles. Judging from the similar peak field strengths compared to the healthy control, both TBS methods are safe in patients with large brain lesions (in practice, however, additional factors such as potentially lowered thresholds for seizure-induction have to be considered). Focused stimulation by TMS seems to be possible, but standard tDCS protocols appear to be less efficient than they are in healthy subjects, strongly suggesting that tDCS studies in this population might benefit from individualized treatment planning based on realistic field calculations.

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“…Six studies involving eight used a bilateral montage, including the anodal stimulation of M1 of the ipsilesional hemisphere (C3 and C4 EEG 10/20 system), cathodal stimulation of M1 of the controlesional hemisphere or cathodal stimulation of the contralateral supraorbital area to the lesion [12][13][14][15][16][17][18][19]. Bilateral montage is often used based on the assumption that the movements of the impaired limbs are often associated with a high level of transcallosal inhibition by the hemisphere not affected by the hemisphere being injured [10,20]; some studies conducted with multimodal imaging techniques and mapping, such as fMRIs and TMSs, confirmed the existence of this imbalance of the hemisphere not affected, also called a hemispheric competition model, particularly during the preparation and execution of upperlimb motor acts [21,22], some authors hypothesize that the amount of this imbalance in inter-hemispheric excitability may be positively correlated with the degree of severity of motor disability [10,6].…”

Section: Discussionmentioning

confidence: 99%

“…Five out of eight studies contributed to the administration of tDCS to the rehabilitation treatment, reporting a significant increase compared to the control groups [12,13,16,17]; Straudi et al using Upper Extremity Robot-Assisted Training however showed a general improvement in motor function in both groups, and the lack of significant superiority between the experimental group and the control group. It has been hypothesized that peripheral training, meant as functional motor tasks designed to promote sensorimotor integration, coordination of movements and goal-directed activities of practical relevance [12], in combination with tDCS could improve the acquisition of motor skills and the respective consolidation of the same through a mechanism LTD due to the increase in inputs versus the cortex while its intrinsic excitability is modified by tDCS [23].…”

Section: Discussionmentioning

confidence: 99%

“…Eight studies were considered for a total of 178 subjects included [6,[12][13][14][15][16][17][18]. Computer literacy research has been focused on post-stroke motor recovery studies by administering non-invasive brain stimulation (NIBS) including transcranial direct current stimulation (tDCS); the research period of the literature is between January 2005 and May 2016.…”

Section: Literature Research and Selection Of Studiesmentioning

confidence: 99%

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Efficacy of Transcranial Direct Current Stimulation as Support for Neurorehabilitation Therapy: A Meta-analysis of Available Studies

Pa¹,

Marini²

2017

Int J Phys Med Rehabil

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Transcranial direct current stimulation (tDCS) is a non-invasive, well-tolerated, brain stimulation technique, using a weak current applied on the scalp. Rational of tDCS use has been based on the assumption of the post-stroke inter-hemispheric competition model, resulting in a hypo-excitability hemispheric lesion and a hyper-excitability healthy hemisphere, to improve the recovery of motor function. Several small studies have been published but the efficacy of tDCS is not established. We performed a systematic review of published studies to assess efficacy of tDCS on motor function of patients with stroke. A thorough search of main databases has been performed to identify randomized, controlled studies on efficacy of tDCS in patients with stroke. The values derived from the primary outcome measures of these studies have been standardized to make them comparable; eight comparisons were planned: degree of dependence, improvement of upper limb, improvement of global motor function, improvement of lower limb and visual perception; comparison between anode stimulation and sham, anode stimulation and followup. 8 studies have been included in the meta-analysis. 3 studies have been excluded because of lack of statistical data, non-randomized assignment and lack of a control group; 178 participants have been included altogether. Most of comparisons did not produce significant results; however a significant improvement of dependence scores (p=0.02), of lower limb index (p=0.02), and of visual perception (p=0.02) have been found. Despite the encouraging results by neurophysiological and instrumental investigations, in some heterogeneous cases, our study shows that there is a need to conduct studies with larger sample sizes.

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Transcranial Direct Current Stimulation Potentiates Improvements in Functional Ability in Patients With Chronic Stroke Receiving Constraint-Induced Movement Therapy

Abstract: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01983319.

Cited by 54 publications

References 11 publications

Transcranial Direct Current Stimulation of the Temporoparietal Junction and Inferior Frontal Cortex Improves Imitation-Inhibition and Perspective-Taking with no Effect on the Autism-Spectrum Quotient Score

Transcranial Direct Current Stimulation of the Temporoparietal Junction and Inferior Frontal Cortex Improves Imitation-Inhibition and Perspective-Taking with no Effect on the Autism-Spectrum Quotient Score

The impact of large structural brain changes in chronic stroke patients on the electric field caused by transcranial brain stimulation

Efficacy of Transcranial Direct Current Stimulation as Support for Neurorehabilitation Therapy: A Meta-analysis of Available Studies

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