Robotic Kinematic measures of the arm in chronic Stroke: part 1 – Motor Recovery patterns from tDCS preceding intensive training

Abstract Background Effectiveness of robotic therapy and transcranial direct current stimulation is conventionally assessed with clinical measures. Robotic metrics may be more objective and sensitive for measuring the efficacy of interventions on stroke survivor’s motor recovery. This study investigated if robotic metrics detect a difference in outcomes, not seen in clinical measures, in a study of transcranial direct current stimulation (tDCS) preceding robotic therapy. Impact of impairment severity on intervention response was also analyzed to explore optimization of outcomes by targeting patient sub-groups. Methods This 2020 study analyzed data from a double-blind, sham-controlled, randomized multi-center trial conducted from 2012 to 2016, including a six-month follow-up. 82 volunteers with single chronic ischemic stroke and right hemiparesis received anodal tDCS or sham stimulation, prior to robotic therapy. Robotic therapy involved 1024 repetitions, alternating shoulder-elbow and wrist robots, for a total of 36 sessions. Shoulder-elbow and wrist kinematic and kinetic metrics were collected at admission, discharge, and follow-up. Results No difference was detected between the tDCS or sham stimulation groups in the analysis of robotic shoulder-elbow or wrist metrics. Significant improvements in all metrics were found for the combined group analysis. Novel wrist data showed smoothness significantly improved (P < ·001) while submovement number trended down, overlap increased, and interpeak interval decreased. Post-hoc analysis showed only patients with severe impairment demonstrated a significant difference in kinematics, greater for patients receiving sham stimulation. Conclusions Robotic data confirmed results of clinical measures, showing intensive robotic therapy is beneficial, but no additional gain from tDCS. Patients with severe impairment did not benefit from the combined intervention. Wrist submovement characteristics showed a delayed pattern of motor recovery compared to the shoulder-elbow, relevant to intensive intervention-related recovery of upper extremity function in chronic stroke. Trial registration http://www.clinicaltrials.gov. Actual study start date September 2012. First registered on 15 November 2012. Retrospectively registered. Unique identifiers: NCT01726673 and NCT03562663.

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Effects of anodal and cathodal transcranial direct current stimulation combined with robotic therapy on severely affected arms in chronic stroke patients

Journal of Rehabilitation Medicine ◽

10.2340/16501977-1099 ◽

2013 ◽

Vol 45 (2) ◽

pp. 137-140 ◽

Cited By ~ 38

Author(s):

M Ochi ◽

S Saeki ◽

T Oda ◽

Y Matsushima ◽

K Hachisuka

Keyword(s):

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Chronic Stroke ◽

Stroke Patients ◽

Direct Current Stimulation ◽

Robotic Therapy

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Effect of transcranial direct current stimulation combined with neuromuscular electrical stimulation on upper extremity motor recovery in an individual with chronic stroke

Journal of the Neurological Sciences ◽

10.1016/j.jns.2017.08.2359 ◽

2017 ◽

Vol 381 ◽

pp. 838-839

Author(s):

Y.Y. Wei ◽

M.J. Hsu ◽

J.H. Lin ◽

Z.Y. Yang

Keyword(s):

Electrical Stimulation ◽

Upper Extremity ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Neuromuscular Electrical Stimulation ◽

Chronic Stroke ◽

Motor Recovery ◽

Direct Current Stimulation

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Visual Cortex Transcranial Direct Current Stimulation for Proliferative Diabetic Retinopathy Patients: A Double-Blinded Randomized Exploratory Trial

Brain Sciences ◽

10.3390/brainsci11020270 ◽

2021 ◽

Vol 11 (2) ◽

pp. 270

Author(s):

Angelito Braulio F. de Venecia ◽

Shane M. Fresnoza

Keyword(s):

Diabetic Retinopathy ◽

Visual Cortex ◽

Proliferative Diabetic Retinopathy ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Vision Loss ◽

Sham Stimulation ◽

Direct Current Stimulation ◽

Residual Vision ◽

Cathodal Tdcs

Proliferative diabetic retinopathy (PDR) is a severe complication of diabetes. PDR-related retinal hemorrhages often lead to severe vision loss. The main goals of management are to prevent visual impairment progression and improve residual vision. We explored the potential of transcranial direct current stimulation (tDCS) to enhance residual vision. tDCS applied to the primary visual cortex (V1) may improve visual input processing from PDR patients’ retinas. Eleven PDR patients received cathodal tDCS stimulation of V1 (1 mA for 10 min), and another eleven patients received sham stimulation (1 mA for 30 s). Visual acuity (logarithm of the minimum angle of resolution (LogMAR) scores) and number acuity (reaction times (RTs) and accuracy rates (ARs)) were measured before and immediately after stimulation. The LogMAR scores and the RTs of patients who received cathodal tDCS decreased significantly after stimulation. Cathodal tDCS has no significant effect on ARs. There were no significant changes in the LogMAR scores, RTs, and ARs of PDR patients who received sham stimulation. The results are compatible with our proposal that neuronal noise aggravates impaired visual function in PDR. The therapeutic effect indicates the potential of tDCS as a safe and effective vision rehabilitation tool for PDR patients.

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Can Transcranial Direct Current Stimulation Enhance Functionality in Older Adults? A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10132981 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2981

Author(s):

Andrés Pino-Esteban ◽

Álvaro Megía-García ◽

David Martín-Caro Álvarez ◽

Hector Beltran-Alacreu ◽

Juan Avendaño-Coy ◽

...

Keyword(s):

Systematic Review ◽

Older Adults ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Randomized Clinical Trials ◽

Scientific Evidence ◽

Healthy Older Adults ◽

Sham Stimulation ◽

Direct Current Stimulation ◽

Potential Benefits

Transcranial direct current stimulation (tDCS) is a non-invasive, easy to administer, well-tolerated, and safe technique capable of affecting brain excitability, both at the cortical and cerebellum levels. However, its effectiveness has not been sufficiently assessed in all population segments or clinical applications. This systematic review aimed at compiling and summarizing the currently available scientific evidence about the effect of tDCS on functionality in older adults over 60 years of age. A search of databases was conducted to find randomized clinical trials that applied tDCS versus sham stimulation in the above-mentioned population. No limits were established in terms of date of publication. A total of 237 trials were found, of which 24 met the inclusion criteria. Finally, nine studies were analyzed, including 260 healthy subjects with average age between 61.0 and 85.8 years. Seven of the nine included studies reported superior improvements in functionality variables following the application of tDCS compared to sham stimulation. Anodal tDCS applied over the motor cortex may be an effective technique for improving balance and posture control in healthy older adults. However, further high-quality randomized controlled trials are required to determine the most effective protocols and to clarify potential benefits for older adults.

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Does transcranial direct current stimulation affect selective visual attention in children with left-sided infantile hemiplegia? A randomized, controlled pilot study

Brain Impairment ◽

10.1017/brimp.2020.20 ◽

2020 ◽

pp. 1-13

Author(s):

Raed A. Alharbi ◽

Saleh A. Aloyuni ◽

Faizan Kashoo ◽

Mohamed I. Waly ◽

Harpreet Singh ◽

...

Keyword(s):

Pilot Study ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Repeated Measures ◽

Sham Group ◽

Time Points ◽

Selective Visual Attention ◽

Subject Factor ◽

And Control

Abstract Objective: Infantile hemiplegia due to brain injury is associated with poor attention span, which critically affects the learning and acquisition of new skills, especially among children with left-sided infantile hemiplegia (LSIH). This study aimed to improve the selective visual attention (SVA) of children with LSIH through transcranial direct current stimulation (tDCS). Methods: A total of 15 children participated in this randomized, double-blinded, pilot study; of them, 10 experienced LSIH, and the remaining 5 were healthy age-matched controls. All the children performed the Computerized Stroop Color-Word Test (CSCWT) at baseline, during the 5th and 10th treatment sessions, and at follow-up. The experimental (n = 5) and control groups (n = 5) received tDCS, while the sham group (n = 5) received placebo tDCS. All three groups received cognitive training on alternate days, for 3 weeks, with the aim to improve SVA. Results: Two-way repeated measures analysis of variance (ANOVA) showed a statistically significant change in the mean scores of CSCWT between time points (baseline, 5th and 10th sessions, and follow-up) within-subject factor, group (experimental, sham) between-subject factor and interaction (time points X group) (p < 0.005). Furthermore, a one-way repeated measures ANOVA showed significant differences between time point (p < 0.005) for the experimental and control group but not the sham group. Conclusion: These pilot results suggest that future research should be conducted with adequate samples to enable conclusions to be drawn.

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