Study protocol of transcranial electrical stimulation at alpha frequency applied during rehabilitation: A randomized controlled trial in chronic stroke patients with visuospatial neglect (original) (raw)
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American Journal of Physical Medicine & Rehabilitation, 2022
The aim of this study was to evaluate the short-and long-term effects as well as other parameters of repetitive transcranial magnetic stimulation (rTMS) on upper limb motor functional recovery after stroke. Data sources: The databases of PubMed, Medline, Science Direct, Cochrane, and Embase were searched for randomized controlled studies reporting effects of rTMS on upper limb motor recovery published before October 30, 2016. Review methods: The short-and long-term mean effect sizes as well as the effect size of rTMS frequency of pulse, post-stroke onset, and theta burst stimulation patterns were summarized by calculating the standardized mean difference (SMD) and the 95% confidence interval using fixed/random effect models as appropriate. Results: Thirty-four studies with 904 participants were included in this systematic review. Pooled estimates show that rTMS significantly improved short-term (SMD, 0.43; P < 0.001) and long-term (SMD, 0.49; P < 0.001) manual dexterity. More pronounced effects were found for rTMS administered in the acute phase of stroke (SMD, 0.69), subcortical stroke (SMD, 0.66), 5-session rTMS treatment (SMD, 0.67) and intermittent theta burst stimulation (SMD, 0.60). Only three studies reported mild adverse events such as headache and increased anxiety. Conclusions: Five-session rTMS treatment could best improve stroke-induced upper limb dyskinesia acutely and in a long-lasting manner. Intermittent theta burst stimulation is more beneficial than continuous theta burst stimulation. rTMS applied in the acute phase of stroke is more effective than rTMS applied in the chronic phase. Subcortical lesion benefit more from rTMS than other lesion site.
KEYWORDS repetitive transcranial magnetic stimulation; stroke; unilateral neglect Abstract Background: Rehabilitation of the unilateral neglect of acute stroke patients represents a major challenge. Objectives: This study aimed to evaluate the effects of repetitive transcranial magnetic stimulation on the functional recovery of stroke patients with unilateral neglect. Methods: Twenty patients with stroke were randomly assigned to two groups: a repetitive transcranial magnetic stimulation group (experimental) and a control group. The stroke patients in the experimental group underwent repetitive transcranial magnetic stimulation therapy and comprehensive rehabilitation therapy. The stroke patients in the control group underwent sham magnetic stimulation therapy and comprehensive rehabilitation therapy. The patients in both groups received therapy 5 days per week for 4 weeks. The Motor Free Visual Perception Test (MVPT), Line Bisection Test (LBT), Albert Test (AT), and Star Cancellation Test (SCT) were assessed before and after the 4-week therapy period. Results: The experimental group showed a significant increase in the MVPT, LBT, AT, and SCT values compared with the preintervention values (p < 0.05). Furthermore, the control group showed a significant increase in the MVPT, LBT, and AT results compared with the preintervention results (p < 0.05). A significant difference in the post-training gains for the MVPT (8.9 AE 2.5 vs. 4.8 AE 3.0), LBT (À19.3 AE 7.5 vs. À6.5 AE 9.5), AT (13.1 AE 8.0 vs. 4.0 AE 1.9), and SCT (À13.6 AE 6.9 vs. À4.5 AE 6.9) were observed between the experimental group and the control group (p < 0.05). In addition, the effect size for gains in the experimental and control groups was very large in MVPT and AT (effect size Z 3.25 and 2.90), respectively, and the effect size for gains in the experimental and control groups was small in LBT and SCT (effect size Z 0.22 and 0.23, respectively).
Brain Stimulation, 2018
Visuospatial neglect remains a relatively misunderstood complication of stroke. Up to 72% of right hemispheric strokes present neglect symptoms, and up to 75% of those patients still suffer at the 3-month mark [1]. This leads to marked increases in dependency, and lower functional outcomes [2]. Transcranial Direct Current Stimulation is a new rehabilitation tool that has been gaining popularity in the last two decades [3]. Current research focuses on subacute or chronic strokes, while stimulating the posterior parietal cortex (PPC), and seems to have positive effects on visuospatial neglect [4]. Four patients were included in this case report: patient 1, a 74year-old right-handed male patient was admitted at the University hospital's stroke unit with right-sided posterior cerebral artery (PCA) infarction and presented left visuo-spatial neglect. Patient 2: a 69-year-old right-handed male patient with right-sided middle cerebral artery (MCA) infarction and presented left visuo-spatial neglect. Patient 3: a 73-year-old right-handed male patient with right-sided posterior cerebral artery (PCA) infarction and presented left visuo-spatial neglect. Patient 4: a 59-year-old right-handed male patient with right-sided posterior cerebral artery (PCA) infarction and presented left visuo-spatial neglect. The patients understood the study, and gave written and oral consent according to the Declaration of Helsinki (1964). The protocol was approved by the University Hospital's ethics committee. Transcranial direct current stimulation (tDCS) was delivered using standard equipment (Starstim TCS, Barcelona, Spain) following a protocol in which sham and active stimulation sessions were administered in randomized order and double-blind conditions. Treatment began 48h after stroke, following the hospital's protocol to keep patients prone during that time. The patients received 20 minutes of anodal stimulation (anode placed on C4, cathode on FP1 based on the international EEG 10e20 system), using two electrodes covered by saline soaked 25cm 2 sponges, at 2mA daily. For patients 1 and 2, during weeks 1 and 3 patient received 20 minutes of tDCS, whilst during weeks 2 and 4, patient received 20 minutes of placebo (ramping up the current to 2mA over 15 seconds then the device automatically switches off). For patients 3 and 4, during weeks 1 and 3 patient received 20 minutes of placebo, whilst during weeks 2 and 4, patient received 20 minutes of tDCS. During stimulation, the patient was seated in a comfortable position in a calm, quiet and isolated room, and was instructed not perform any activity. In addition to the tDCS or placebo, the patient received 60 minutes of physical therapy (30 minutes of conventional therapy and 30 minutes peddling on a stationary bike), 30 minutes of
2022
Background Non-invasive brain stimulation methods have been widely utilized in research settings to manipulate and understand the functioning of the human brain. In the last two decades, transcranial electrical stimulation (tES) has opened new doors for treating impairments caused by various neurological disorders. However, tES studies have shown inconsistent results in post-stroke cognitive rehabilitation, and there is no consensus on the effectiveness of tES devices in improving cognitive skills after the onset of stroke. Objectives We aim to systematically investigate the efficacy of tES in improving post-stroke global cognition, attention, working memory, executive functions, visual neglect, and verbal fluency. Furthermore, we aim to provide a pathway to an effective use of stimulation paradigms in future studies. Methods Preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were followed. Randomized controlled trials (RCTs) were systematically s...
Neural plasticity, 2018
Unilateral spatial neglect (USN) is the most frequent perceptual disorder after stroke. Noninvasive brain stimulation (NIBS) is a tool that has been used in the rehabilitation process to modify cortical excitability and improve perception and functional capacity. To assess the impact of NIBS on USN after stroke. An extensive search was conducted up to July 2016. Studies were selected if they were controlled and noncontrolled trials examining transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and theta burst stimulation (TBS) in USN after stroke, with outcomes measured by standardized USN and functional tests. Twelve RCTs (273 participants) and 4 non-RCTs (94 participants) proved eligible. We observed a benefit in overall USN measured by the line bisection test with NIBS in comparison to sham (SMD -2.35, 95% CI -3.72, -0.98; = 0.0001); the rTMS yielded results that were consistent with the overall meta-analysis (SMD -2.82, 95% CI -3.6...
Trials, 2016
Unilateral spatial neglect (USN) is characterized by the inability to report or respond to people or objects that are presented in the spatial hemisphere that is contralateral to the lesioned hemisphere of the brain. USN has been associated with poor functional outcomes and long stays in hospitals and rehabilitation centers. Noninvasive brain stimulation, such as transcranial direct current stimulation (tDCS), has been used in people who have been affected by USN after stroke. The effects of such treatment could provide new insights for health professionals and policy-makers. The aim of this study will be to evaluate the effectiveness and safety of tDCS for USN after stroke. A prospective randomized controlled trial with two parallel groups will be conducted, which will aim to recruit 60 patients with USN after ischemic or hemorrhagic stroke. Participants will be randomly placed into the following four treatment groups: (1) anodal tDCS over the right parietal lobe (n = 15), (2) cath...
The Effect of Transcranial Direct Current Stimulation on Neglect Syndrome in Stroke Patients
Annals of rehabilitation medicine, 2016
To examine whether transcranial direct current stimulation (tDCS) applied over the posterior parietal cortex (PPC) improves visuospatial attention in stroke patients with left visuospatial neglect. Patients were randomly assigned to 1 of 3 treatment groups: anodal tDCS over the right PPC, cathodal tDCS over the left PPC, or sham tDCS. Each patient underwent 15 sessions of tDCS (5 sessions per week for 3 weeks; 2 mA for 30 minutes in each session). Outcome measures were assessed before treatment and 1 week after completing the treatment. From pre- to post-treatment, there was an improvement in the motor-free visual perception test (MVPT), line bisection test (LBT), star cancellation test (SCT), Catherine Bergego Scale (CBS), Korean version of Modified Barthel Index (K-MBI), and Functional Ambulation Classification in all 3 groups. Improvements in the MVPT, SCT, and LBT were greater in the anodal and cathodal groups than in the sham group. However, improvements in other outcomes were ...
Archives of physical medicine and rehabilitation, 2017
To evaluate the effectiveness of noninvasive brain stimulation (NIBS) - repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) - on hemispatial neglect and performance in activities of daily living (ADL) after stroke. MEDLINE (Pubmed), Embase, Cochrane CENTRAL, SCOPUS, Scielo and Physiotherapy Evidence Database (PEDro) were searched from database inception to December 2016. Randomized controlled trials or crossover trials focused on determining the effects of tDCS or rTMS combined or not combined with other therapies for hemispatial neglect after stroke. Methodological characteristics of the studies, number of participants, comparison groups, interventions and outcomes were extracted. Ten trials comprising 226 participants had data that were suitable for the meta-analysis. Meta-analysis showed that NIBS combined with another therapy significantly improves hemispatial neglect [SMD -1.91 (95% CI, -2.57 to -1.25; I(2) 71%)]. A sensitivity...
Non-invasive cortical stimulation improves post-stroke attention decline
Restorative neurology and neuroscience, 2009
Attention decline after stroke is common and hampers the rehabilitation process, and non-invasive transcranial direct current stimulation (tDCS) has the potential to elicit behavioral changes by modulating cortical excitability. The authors tested the hypothesis that a single session of non-invasive cortical stimulation with excitatory anodal tDCS applied to the left dorsolateral prefrontal cortex (DLPFC) can improve attention in stroke patients. Ten patients with post-stroke cognitive decline (MMSE 25) and 10 age-matched healthy controls participated in this double blind, sham-controlled, crossover study involving the administration of real (2 mA for 20 min) or sham stimulation (2 mA for 1 min) to the left DLPFC. Attention was measured using a computerized Go/No-Go test before and after intervention. Improvements in accuracy and speed after stimulation relative to baseline were compared for real and sham stimulations. In healthy controls, no significant improvement in Go/No-Go test...