Transcranial direct current stimulation (tDCS) for improving function and activities of daily living in patients after stroke

Elsner, Bernhard; Kügler, Joachim; Pohl, Marcus; Mehrholz, Jan

doi:10.1002/14651858.cd009645.pub2

Cited by 69 publications

(36 citation statements)

References 62 publications

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“…While the effect of tDCS on manual dexterity of stroke patients and some specific aspects of their motor function appears to be consistent across laboratory studies (Kandel et al, 2012; Butler et al, 2013; Marquez et al, 2013), evidence for the ability of tDCS to improve activities of the daily living is still weak (Elsner et al, 2013), which questions the clinical relevance of tDCS for stroke rehabilitation. Clearly, large clinical trials are needed to settle this question not only for stroke but for any neurological disorders whose symptoms have been claimed to be alleviated by tDCS (PD, dystonia …).…”

Section: Open Questionsmentioning

confidence: 98%

Electrifying the motor engram: effects of tDCS on motor learning and control

Xivry

Shadmehr

2014

Exp Brain Res

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Learning to control our movements accompanies neuroplasticity of motor areas of the brain. The mechanisms of neuroplasticity are diverse and produce what is referred to as the motor engram, i.e. the neural trace of the motor memory. Transcranial direct current stimulation (tDCS) alters the neural and behavioral correlates of motor learning, but its precise influence on the motor engram is unknown. In this review, we summarize the effects of tDCS on neural activity and suggest a few key principles: 1) firing rates are increased by anodal polarization and decreased by cathodal polarization, 2) anodal polarization strengthens newly formed associations, and 3) polarization modulates the memory of new/preferred firing patterns. With these principles in mind, we review the effects of tDCS on motor control, motor learning, and clinical applications. The increased spontaneous and evoked firing rates may account for the modulation of dexterity in non-learning tasks by tDCS. The facilitation of new association may account for the effect of tDCS on learning in sequence tasks while the ability of tDCS to strengthen memories of new firing patterns may underlie the effect of tDCS on consolidation of skills. We then describe the mechanisms of neuroplasticity of motor cortical areas and how they might be influenced by tDCS. We end with current challenges for the fields of brain stimulation and motor learning.

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Section: Open Questionsmentioning

confidence: 98%

Electrifying the motor engram: effects of tDCS on motor learning and control

Xivry

Shadmehr

2014

Exp Brain Res

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“…Stimulation with tDCS has found similar outcomes with improvement after stroke during therapies and for short durations after stimulation (Hummel et al, 2005). Recent Cochrane reviews of rTMS and tDCS both conclude that further studies are required to determine these techniques’ role in stroke recovery (Hao et al, 2013; Elsner et al, 2013). Longer term efficacy is currently being studied with randomized, double-blinded trials to evaluate the utility of these treatment paradigms (Plow et al, 2013).…”

Section: Stroke Therapiesmentioning

confidence: 99%

Novel Stroke Therapeutics: Unraveling Stroke Pathophysiology and Its Impact on Clinical Treatments

George

Steinberg

2015

Neuron

327

217

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Stroke remains a leading cause of death and disability in the world. Over the past few decades our understanding of the pathophysiology of stroke has increased, but greater insight is required to advance the field of stroke recovery. Clinical treatments have improved in the acute time window, but long-term therapeutics remain limited. Complex neural circuits damaged by ischemia make restoration of function after stroke difficult. New therapeutic approaches, including cell transplantation or stimulation, focus on reestablishing these circuits through multiple mechanisms to improve circuit plasticity and remodeling. Other research targets intact networks to compensate for damaged regions. This review highlights several important mechanisms of stroke injury and describes emerging therapies aimed at improving clinical outcomes.

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“…73 However, Cochrane reviews of TMS and tDCS concluded that further investigation is required to determine either technique’s role in stroke recovery. 45,65 A double-blinded pilot RCT to evaluate the long-term efficacy of tDCS found evidence that stimulation of higher motor areas can help recruit adaptation of the contralesional hemisphere in patients with greater ipsilesional injury. 36,125 In sum, the promise of noninvasive neuromodulation for stroke recovery, while demonstrating early promise, 13,74 has not borne out in larger clinical trials (Table 2).…”

Section: Neuromodulationmentioning

confidence: 99%

Neurorestoration after stroke

Azad¹,

Veeravagu²,

Steinberg³

2016

FOC

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Recent advancements in stem cell biology and neuromodulation have ushered in a battery of new neurorestorative therapies for ischemic stroke. While the understanding of stroke pathophysiology has matured, the ability to restore patients' quality of life remains inadequate. New therapeutic approaches, including cell transplantation and neurostimulation, focus on reestablishing the circuits disrupted by ischemia through multidimensional mechanisms to improve neuroplasticity and remodeling. The authors provide a broad overview of stroke pathophysiology and existing therapies to highlight the scientific and clinical implications of neurorestorative therapies for stroke.

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Transcranial direct current stimulation (tDCS) for improving function and activities of daily living in patients after stroke

Cited by 69 publications

References 62 publications

Electrifying the motor engram: effects of tDCS on motor learning and control

Electrifying the motor engram: effects of tDCS on motor learning and control

Novel Stroke Therapeutics: Unraveling Stroke Pathophysiology and Its Impact on Clinical Treatments

Neurorestoration after stroke

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