scholarly journals Modulating Brain Connectivity by Simultaneous Dual-Mode Stimulation over Bilateral Primary Motor Cortices in Subacute Stroke Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Jungsoo Lee ◽  
Eunhee Park ◽  
Ahee Lee ◽  
Won Hyuk Chang ◽  
Dae-Shik Kim ◽  
...  
Keyword(s):  
Motor Function ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Brain Connectivity ◽  
Resting State Fmri ◽  
Control Group ◽  
Stroke Patients ◽  
Dual Mode ◽  
Subacute Stroke ◽  
Interhemispheric Connectivity ◽  
Stimulation Group

Repetitive transcranial magnetic stimulation (rTMS) or transcranial direct current stimulation (tDCS) has been used for the modulation of stroke patients’ motor function. Recently, more challenging approaches have been studied. In this study, simultaneous stimulation using both rTMS and tDCS (dual-mode stimulation) over bilateral primary motor cortices (M1s) was investigated to compare its modulatory effects with single rTMS stimulation over the ipsilesional M1 in subacute stroke patients. Twenty-four patients participated; 12 participants were assigned to the dual-mode stimulation group while the other 12 participants were assigned to the rTMS-only group. We assessed each patient’s motor function using the Fugl-Meyer assessment score and acquired their resting-state fMRI data at two times: prior to stimulation and 2 months after stimulation. Twelve healthy subjects were also recruited as the control group. The interhemispheric connectivity of the contralesional M1, interhemispheric connectivity between bilateral hemispheres, and global efficiency of the motor network noticeably increased in the dual-mode stimulation group compared to the rTMS-only group. Contrary to the dual-mode stimulation group, there was no significant change in the rTMS-only group. These data suggested that simultaneous dual-mode stimulation contributed to the recovery of interhemispheric interaction than rTMS only in subacute stroke patients. This trial is registered with NCT03279640.

Increased Pinch Strength in Acute and Subacute Stroke Patients After Simultaneous Median and Ulnar Sensory Stimulation

2008 ◽  
Vol 23 (4) ◽  
pp. 351-356 ◽  
Author(s):  
Akkarapol Klaiput ◽  
Wasuwat Kitisomprayoonkul
Keyword(s):  
Sensory Stimulation ◽  
Pinch Strength ◽  
Control Group ◽  
Stroke Patients ◽  
Control Groups ◽  
Sham Control ◽  
Subacute Stroke ◽  
Sham Control Group ◽  
Peripheral Sensory ◽  
Stimulation Group

Background. Peripheral nerve stimulation may induce cortical adaptations as it improves pinch strength in chronic stroke patients immediately after stimulation. Objective. Test the effects of peripheral sensory stimulation on pinch strength in patients with acute and subacute stroke. Methods. Stroke patients (N = 20) who had onset less than 6 months previously and could voluntarily pinch the thumb to the index finger participated in a randomized, single-blinded, controlled study. Ten patients received 2 hours of simultaneous electrical stimulation over the median and ulnar nerves at the wrist to the level of appreciating paresthesias (peripheral sensory stimulation group). Ten control patients received stimulation to the level of perception (sham-control group). Pinch strength of the thumb pad to tip and to lateral side of the index finger of the paretic hand and the Action Research Arm test were tested before and immediately after the stimulation. Results. Lateral and tip pinch strength were significantly increased in both groups ( P < .05). Mean ± SD of increased lateral pinch strength of peripheral sensory stimulation and sham-control groups were 1.24 ± 0.54 pounds and 0.20 ± 0.28 pounds, respectively. Mean ± SD of increased tip pinch strength of peripheral sensory stimulation and sham-control groups were 1.00 ± 0.72 pounds and 0.37 ± 0.36 pounds, respectively. Increase pinch strength of the peripheral sensory stimulation group was greater than the sham-control group, with significant difference ( P < .05). The Action Research Arm test was not significantly changed after stimulation in both groups ( P > .05). Conclusion. Peripheral sensory stimulation of the paretic hand may increase pinch strength of acute and subacute stroke patients immediately after stimulation.

Effects of repetitive transcranial magnetic stimulation combined with transcranial direct current stimulation on motor function and cortex excitability in subacute stroke patients: A randomized controlled trial

2020 ◽  
pp. 026921552097294
Author(s):  
Yan Gong ◽  
Xian-Ming Long ◽  
Ying Xu ◽  
Xiu-Ying Cai ◽  
Ming Ye
Keyword(s):  
Evoked Potentials ◽  
Motor Function ◽  
Lower Limb ◽  
Motor Evoked Potentials ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Change Score ◽  
Stroke Patients ◽  
Subacute Stroke ◽  
Motion Threshold

Objective: To explore effects of repetitive transcranial magnetic stimulation (rTMS) combined with transcranial direct current stimulation (tDCS) on motor function and cortex excitability in subacute stroke patients. Design: Randomized controlled trial. Setting: Inpatient hospitals. Subjects: Sixty-five participants were randomly assigned to four groups: sham, 1Hz rTMS, cathodic tDCS combined with 1Hz rTMS (tDCS-/rTMS-) and anodic tDCS combined with 1Hz rTMS (tDCS+/rTMS-). Interventions: Four interventions were used, including sham, 1Hz rTMS, and cathodal or anodal tDCS, followed by 1Hz rTMS over contralesional motor cortex, which continued for four weeks. Main measures: Outcome measures were motor function and cortical excitability, evaluated by Fugl-Meyer Assessment, National Institutes of Health Stroke Scale and Barthel Index, resting Motion Threshold, Motor Evoked Potentials and Central Motor Conduction Time, assessed at baseline, four weeks and eight weeks. Results: At four weeks after interventions, Fugl-Meyer Assessment lower limb change score in tDCS+/rTMS- group was significantly larger than other three groups ( P < 0.001). There were significant differences in bilateral Motor Evoked Potentials changes between tDCS+/rTMS- group and sham group ( P < 0.05). At eight weeks, compared to other groups, National Institutes of Health Stroke Scale ( P = 0.003), Barthel Index ( P = 0.002), FMA lower limb score ( P < 0.001), and bilateral resting Motion Threshold, Motor Evoked Potentials ( P < 0.05) showed significant changes in tDCS+/rTMS- group. Furthermore, Fugl-Meyer Assessment lower limb change score was associated with increased ipsilesional Motor Evoked Potentials ( r = 0.703 P < 0.001) in tDCS+/rTMS- group. Conclusion: 1Hz rTMS combined with anode tDCS stimulation protocol could be a preferable rehabilitative strategy for motor recovery in subacute stroke patients.

scholarly journals Therapeutic Effects of a Newly Developed 3D Magnetic Finger Rehabilitation Device in Subacute Stroke Patients: A Pilot Study

2022 ◽  
Vol 12 (1) ◽  
pp. 113
Author(s):  
Sung-Hoon Kim ◽  
Dong-Min Ji ◽  
Chan-Yong Kim ◽  
Sung-Bok Choi ◽  
Min-Cheol Joo ◽  
...  
Keyword(s):  
Pilot Study ◽  
Motor Function ◽  
Magnetic Force ◽  
Intervention Group ◽  
Control Group ◽  
Therapeutic Effects ◽  
Stroke Patients ◽  
Rehabilitation Treatment ◽  
Subacute Stroke ◽  
Function Test

We developed a magnetic-force-based three-dimensional (3D) rehabilitation device that can perform motor rehabilitation treatment for paralyzed fingers, regardless of upper extremity movement and position, and investigated the therapeutic effects of the device. An end-effector type rehabilitation device that can generate magnetic fields in three directions was developed using electromagnets and permanent magnetics. A double-blinded randomized controlled pilot study was conducted with a total of 12 patients. The intervention group had rehabilitation treatment using the developed magnetic finger rehabilitation device for 30 min a day for four weeks. The control group underwent exercise rehabilitation treatment. The control group received conventional occupational therapy on the upper limbs, including hands, from an occupational therapist, for the same amount of time. Adverse effects were monitored, and the patient’s sensory or proprioceptive deficits were examined before the intervention. No participants reported safety concerns while the intervention was conducted. The Wolf Motor Function Test (WMFT) scores were significantly improved in the intervention group (from 13.4 ± 3.6 to 20.9 ± 4.0 points) compared to the control group (from 13.1 ± 4.0 to 15.2 ± 3.8 points) (p = 0.016). The patients in the intervention group (from 88 ± 12 to 67 ± 13 s) showed greater improvement of WMFT times compared to the control group (from 89 ± 10 to 73 ± 11 s) (p = 0.042). The Manual Function Test and the upper limb score of the Fugl-Meyer Assessment were significantly improved in the intervention group compared with the control group (p = 0.038 and p = 0.042). The patients in the intervention group also showed significantly greater enhancement of the Korean version of the modified Barthel Index than the control group (p = 0.042). Rehabilitation treatment using the 3D magnetic-force-driven finger rehabilitation device helped improve finger motor function and activities of daily living in subacute stroke patients.

Abstract T P123: Non-invasive Brain Stimulation for Motor Function of Chronic Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Eunhee Park ◽  
Tae Gun Kwon ◽  
Won Hyuk Chang ◽  
Yun-Hee Kim
Keyword(s):  
Motor Function ◽  
Brain Stimulation ◽  
Movement Time ◽  
Motor Task ◽  
Chronic Stroke ◽  
Stroke Patients ◽  
Dual Mode ◽  
Simultaneous Application ◽  
Corticomotor Excitability ◽  
Cathodal Tdcs

Objective: The purpose of this study was to investigate the effect of dual-mode noninvasive brain stimulation (NBS) by combining transcranial direct current stimulation (tDCS) over the unaffected primary motor cortex (uM1) and high-frequency repetitive transcranial magnetic stimulation (rTMS) over the affected M1 (aM1) on motor functions and corticomotor excitability in chronic stroke patients. Methods: Seventeen chronic stroke patients (12 men; mean age 58.7 years; 12 infarctions and 5 hemorrhages) participated in this double blinded random-order crossover study. All participants received three randomly arranged, dual-mode stimulations with 24 hours of washout period; Condition 1, simultaneous application of 10 Hz rTMS over the aM1 and cathodal tDCS over the uM1; Condition 2, simultaneous application of 10 Hz rTMS over the M1a and anodal tDCS over the uM1; Condition 3, 10 Hz rTMS over the aM1 and sham tDCS over the uM1. Corticomotor excitability using motor evoked potential (MEP) amplitude and hand motor functions using the sequential motor task were assessed before and after stimulation. Results: MEP amplitude was significantly increased after condition 1 and 3, respectively (p<0.05). The changes of MEP amplitude were significantly higher in condition 1 than condition 2 (p<0.05). In sequential motor task, the movement time was significantly decreased after condition 1 and 3, respectively (p<0.05). The change of movement time was significantly larger in condition 1 than the other conditions (p<0.05). Conclusions: Simultaneous stimulation of cathodal tDCS over the uM1 produced enhancement of 10 Hz rTMS effect over the aM1 in patients with stroke. These results suggest the dual-mode NBS as a method of enhancing motor function probably by inducing interhemispheric interaction of bilateral primary motor cortices in chronic stroke patients (Supported by the National Research Foundation of Korea grant (No.2011-0016960) and a KOSEF grant (M10644000022-06N4400-02210)).

scholarly journals Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016566
Author(s):  
Eline C C van Lieshout ◽  
Johanna M A Visser-Meily ◽  
Sebastiaan F W Neggers ◽  
H Bart van der Worp ◽  
Rick M Dijkhuizen
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Primary Outcome ◽  
Primary Motor Cortex ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

scholarly journals Concurrent Validity of Physiological Cost Index in Walking over Ground and during Robotic Training in Subacute Stroke Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Anna Sofia Delussu ◽  
Giovanni Morone ◽  
Marco Iosa ◽  
Maura Bragoni ◽  
Stefano Paolucci ◽  
...  
Keyword(s):  
Random Sequence ◽  
Pearson Correlation ◽  
Control Group ◽  
Stroke Patients ◽  
Robotic Training ◽  
Cost Index ◽  
Physiological Cost ◽  
Subacute Stroke ◽  
Weight Support ◽  
Walking Tests

Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (p<0.001); in CG Pearson correlation was 0.852 (p<0.001). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients.

scholarly journals The Role of Continuous Theta Burst TMS in the Neurorehabilitation of Subacute Stroke Patients: A Placebo-Controlled Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Ana Dionísio ◽  
Rita Gouveia ◽  
João Castelhano ◽  
Isabel Catarina Duarte ◽  
Gustavo C. Santo ◽  
...  
Keyword(s):  
Motor Function ◽  
Primary Motor Cortex ◽  
Phase Iii ◽  
Repeated Measure ◽  
Controlled Study ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke ◽  
Theta Burst

Objectives: Transcranial magnetic stimulation, in particular continuous theta burst (cTBS), has been proposed for stroke rehabilitation, based on the concept that inhibition of the healthy hemisphere helps promote the recovery of the lesioned one. We aimed to study its effects on cortical excitability, oscillatory patterns, and motor function, the main aim being to identify potentially beneficial neurophysiological effects.Materials and Methods: We applied randomized real or placebo stimulation over the unaffected primary motor cortex of 10 subacute (7 ± 3 days) post-stroke patients. Neurophysiological measurements were performed using electroencephalography and electromyography. Motor function was assessed with the Wolf Motor Function Test. We performed a repeated measure study with the recordings taken pre-, post-cTBS, and at 3 months' follow-up.Results: We investigated changes in motor rhythms during arm elevation and thumb opposition tasks and found significant changes in beta power of the affected thumb's opposition, specifically after real cTBS. Our results are consistent with an excitatory response (increase in event-related desynchronization) in the sensorimotor cortical areas of the affected hemisphere, after stimulation. Neither peak-to-peak amplitude of motor-evoked potentials nor motor performance were significantly altered.Conclusions: Consistently with the theoretical prediction, this contralateral inhibitory stimulation paradigm changes neurophysiology, leading to a significant excitatory impact on the cortical oscillatory patterns of the contralateral hemisphere. These proof-of-concept results provide evidence for the potential role of continuous TBS in the neurorehabilitation of post-stroke patients. We suggest that these changes in ERS/ERD patterns should be further explored in future phase IIb/phase III clinical trials, in larger samples of poststroke patients.

Combining inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) treatment improves motor function by modulating GABA in acute ischemic stroke patients

2021 ◽  
pp. 1-16
Author(s):  
Qing-Mei Chen ◽  
Fei-Rong Yao ◽  
Hai-Wei Sun ◽  
Zhi-Guo Chen ◽  
Jun Ke ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Motor Function ◽  
Magnetic Stimulation ◽  
Sham Group ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Motor Dysfunction ◽  
Gaba Level ◽  
Stroke Patients ◽  
Before And After

Background: The combination of inhibitory and facilitatory repetitive transcranial magnetic stimulation (rTMS) can improve motor function of stroke patients with undefined mechanism. It has been demonstrated that rTMS exhibits a neuro-modulatory effect by regulating the major inhibitory neurotransmitter γ-aminobutyric acid (GABA) in other diseases. Objectives: To evaluate the effect of combined inhibitory and facilitatory rTMS on GABA in the primary motor cortex (M1) for treating motor dysfunction after acute ischemic stroke. Methods: 44 ischemic stroke patients with motor dysfunction were randomly divided into two groups. The treatment group was stimulated with 10 Hz rTMS at the ipsilesional M1 and 1 Hz rTMS at the contralesional M1. The sham group received bilateral sham stimulation at the motor cortices. The GABA level in the bilateral M1 was measured by proton magnetic resonance spectroscopy (1H-MRS) at 24 hours before and after rTMS stimulation. Motor function was measured using the Fugl-Meyer Assessment (FMA). The clinical assessments were performed before and after rTMS and after 3 months. Results: The treatment group exhibited a greater improvement in motor function 24 hours after rTMS compared to the sham group. The increased improvement in motor function lasted for at least 3 months after treatment. Following 4 weeks of rTMS, the GABA level in the ipsilesional M1 of the treatment group was significantly decreased compared to the sham group. Furthermore, the change of FMA score for motor function was negatively correlated to the change of the GABA:Cr ratio. Finally, the effect of rTMS on motor function outcome was partially mediated by GABA level change in response to the treatment (27.7%). Conclusions: Combining inhibitory and facilitatory rTMS can decrease the GABA level in M1, which is correlated to the improvement of motor function. Thus, the GABA level in M1 may be a potential biomarker for treatment strategy decisions regarding rTMS neuromodulatory interventions.

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