Transcranial Electrical Stimulation in Post-Stroke Cognitive 					Rehabilitation

Abstract. Cognitive rehabilitation is an important area of neurological rehabilitation, which aims at the treatment of cognitive disorders due to acquired brain damage of different etiology, including stroke. Although the importance of cognitive rehabilitation for stroke survivors is well recognized, available cognitive treatments for neuropsychological disorders, such as spatial neglect, hemianopia, apraxia, and working memory, are overall still unsatisfactory. The growing body of evidence supporting the potential of the transcranial Electrical Stimulation (tES) as tool for interacting with neuroplasticity in the human brain, in turn for enhancing perceptual and cognitive functions, has obvious implications for the translation of this noninvasive brain stimulation technique into clinical settings, in particular for the development of tES as adjuvant tool for cognitive rehabilitation. The present review aims at presenting the current state of art concerning the use of tES for the improvement of post-stroke visual and cognitive deficits (except for aphasia and memory disorders), showing the therapeutic promises of this technique and offering some suggestions for the design of future clinical trials. Although this line of research is still in infancy, as compared to the progresses made in the last years in other neurorehabilitation domains, current findings appear very encouraging, supporting the development of tES for the treatment of post-stroke cognitive impairments.

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Cognitive Rehabilitation Interventions for Neglect and Related Disorders: Moving from Bench to Bedside in Stroke Patients

Journal of Cognitive Neuroscience ◽

10.1162/jocn.2006.18.7.1223 ◽

2006 ◽

Vol 18 (7) ◽

pp. 1223-1236 ◽

Cited By ~ 76

Author(s):

Anna M. Barrett ◽

Laurel J. Buxbaum ◽

H. Branch Coslett ◽

Emmeline Edwards ◽

Kenneth M. Heilman ◽

...

Keyword(s):

Cognitive Rehabilitation ◽

Functional Disability ◽

Spatial Neglect ◽

Rational Approach ◽

Future Research ◽

Stroke Patients ◽

Current Opinion ◽

Post Stroke ◽

Sensory Dysfunction ◽

Review Current

The spatial neglect syndrome, defined by asymmetric attention and action not attributed to primary motor or sensory dysfunction and accompanied by functional disability, is a major cause of post-stroke morbidity. In this review, we consider the challenges and obstacles facing scientific researches wishing to evaluate the mechanisms and effectiveness of rehabilitation interventions. Spatial neglect is a heterogeneous disorder, for which consensus research definitions are not currently available, and it is unclear which of the deficits associated with the syndrome causes subsequent disability. We review current opinion about methods of assessment, suggest a rational approach to selecting therapies which requires further study, and make systems-level and theoretical recommendations for building theory. We lastly review some creative questions for consideration in future research.

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A future of current flow modelling for transcranial electrical stimulation?

10.31219/osf.io/u45gf ◽

2021 ◽

Author(s):

Jenny lee ◽

Sven Bestmann ◽

Carys Evans

Keyword(s):

Electrical Stimulation ◽

Current Flow ◽

Brain Activity ◽

Cost Effective ◽

Electrical Current ◽

Transcranial Electrical Stimulation ◽

Clinical Settings ◽

Dose Control ◽

Health And Disease ◽

The Brain

Transcranial electrical stimulation (tES) is used to non-invasively modulate brain activity in health and disease. Current flow modeling (CFM) provides estimates of where, and how much electrical current is delivered to the brain during tES. It therefore holds promise as a method to reduce commonplace variability in tES delivery and, in turn, the outcomes of stimulation. However, the adoption of CFM has not yet been widespread and its impact on tES outcome variability is unclear. Here we discuss the potential barriers to effective, practical CFM-informed tES use. We first consider the multi-dimensional challenge of optimising stimulation dose. CFMs estimate the intensity of electrical fields (E-fields), their spatial extent, and the direction of current flow in a target brain region during tES. Researchers must make informed decisions to prioritise E-field characteristics most likely to result in desired stimulation outcomes, though the physiological consequences of the modelled current flow are often unknown. Second, we address the issue of a disconnect between predictions of E-field characteristics provided by CFMs, and predictions of the physiological consequences of stimulation which CFMs are not designed to address. Third, we discuss how ongoing development of CFM in conjunction with other modelling approaches could overcome these challenges while maintaining accessibility for widespread use. The increasing complexity and sophistication of CFM is a mandatory step towards dose control and precise, individualised delivery of tES, but also risks counteracting the appeal of tES as a straight-forward, cost effective tool for neuromodulation, particularly in clinical settings.

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Therapeutic synergism: How can psychopharmacology improve cognitive rehabilitation?

Dementia & Neuropsychologia ◽

10.1590/1980-57642018dn13-040009 ◽

2019 ◽

Vol 13 (4) ◽

pp. 422-426

Author(s):

Leonardo Caixeta ◽

Victor Melo Caixeta

Keyword(s):

Psychotropic Drugs ◽

Cognitive Rehabilitation ◽

Cognitive Disorders ◽

Rehabilitation Program ◽

Treatment Modalities ◽

Clinical Settings ◽

Cognitive Symptoms ◽

Therapeutic Approaches ◽

Neuropsychological Rehabilitation ◽

Concurrent Use

ABSTRACT Despite recent advances in cognitive rehabilitation of patients with cognitive disorders, there are many major obstacles to the optimized global use of this therapeutic resource. Objective: The authors outline the concept of ‘therapeutic synergism’, i.e. the concurrent use of pharmacological and cognitive rehabilitation therapies to maximize functional benefits, addressing the optimization of therapeutic approaches for cognitive disorders. Methods: Three psychopharmacological and rehabilitation interrelationship paradigms are presented in three different clinical settings. Results: Paradigm 1: Behavioral and cognitive symptoms that hinder a cognitive rehabilitation program, but can be improved with psychopharmacology. Paradigm 2: Cognitive symptoms that hinder cognitive rehabilitation, but can be improved with anticholinesterases. Paradigm 3: Behavioral symptoms that hamper the use of cognitive rehabilitation, but can be improved by psychotropic drugs. Conclusion: Judicious use of psychotropic drugs in cognitive disorders can benefit, directly or indirectly, cognitive functions, thereby favoring other treatment modalities for cognitive impairment, such as neuropsychological rehabilitation.

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