scholarly journals Rewiring the Lesioned Brain: Electrical Stimulation for Post-Stroke Motor Restoration

2020 ◽  
Vol 22 (1) ◽  
pp. 47-63 ◽  
Author(s):  
Shi-chun Bao ◽  
Ahsan Khan ◽  
Rong Song ◽  
Raymond Kai-yu Tong
Keyword(s):  
Electrical Stimulation ◽  
Functional Improvement ◽  
Stroke Survivors ◽  
Noninvasive Brain Stimulation ◽  
Future Directions ◽  
Post Stroke ◽  
Neuromotor Control ◽  
Peripheral Electrical Stimulation ◽  
Therapeutic Mechanisms ◽  
Multiple Levels

Electrical stimulation has been extensively applied in post-stroke motor restoration, but its treatment mechanisms are not fully understood. Stimulation of neuromotor control system at multiple levels manipulates the corresponding neuronal circuits and results in neuroplasticity changes of stroke survivors. This rewires the lesioned brain and advances functional improvement. This review addresses the therapeutic mechanisms of different stimulation modalities, such as noninvasive brain stimulation, peripheral electrical stimulation, and other emerging techniques. The existing applications, the latest progress, and future directions are discussed. The use of electrical stimulation to facilitate post-stroke motor recovery presents great opportunities in terms of targeted intervention and easy applicability. Further technical improvements and clinical studies are required to reveal the neuromodulatory mechanisms and to enhance rehabilitation therapy efficiency in stroke survivors and people with other movement disorders.

scholarly journals Pathway-specific modulatory effects of neuromuscular electrical stimulation during pedaling in chronic stroke survivors

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Shi-Chun Bao ◽  
Wing-Cheong Leung ◽  
Vincent C. K. Cheung ◽  
Ping Zhou ◽  
Kai-Yu Tong
Keyword(s):  
Electrical Stimulation ◽  
Healthy Subjects ◽  
Neuromuscular Electrical Stimulation ◽  
Neuromuscular Control ◽  
Chronic Stroke ◽  
Sensory Level ◽  
Stroke Survivors ◽  
Potential Contribution ◽  
Descending Pathways ◽  
Post Stroke

Abstract Background Neuromuscular electrical stimulation (NMES) is extensively used in stroke motor rehabilitation. How it promotes motor recovery remains only partially understood. NMES could change muscular properties, produce altered sensory inputs, and modulate fluctuations of cortical activities; but the potential contribution from cortico-muscular couplings during NMES synchronized with dynamic movement has rarely been discussed. Method We investigated cortico-muscular interactions during passive, active, and NMES rhythmic pedaling in healthy subjects and chronic stroke survivors. EEG (128 channels), EMG (4 unilateral lower limb muscles) and movement parameters were measured during 3 sessions of constant-speed pedaling. Sensory-level NMES (20 mA) was applied to the muscles, and cyclic stimulation patterns were synchronized with the EMG during pedaling cycles. Adaptive mixture independent component analysis was utilized to determine the movement-related electro-cortical sources and the source dipole clusters. A directed cortico-muscular coupling analysis was conducted between representative source clusters and the EMGs using generalized partial directed coherence (GPDC). The bidirectional GPDC was compared across muscles and pedaling sessions for post-stroke and healthy subjects. Results Directed cortico-muscular coupling of NMES cycling was more similar to that of active pedaling than to that of passive pedaling for the tested muscles. For healthy subjects, sensory-level NMES could modulate GPDC of both ascending and descending pathways. Whereas for stroke survivors, NMES could modulate GPDC of only the ascending pathways. Conclusions By clarifying how NMES influences neuromuscular control during pedaling in healthy and post-stroke subjects, our results indicate the potential limitation of sensory-level NMES in promoting sensorimotor recovery in chronic stroke survivors.

Evaluating Electrical Activity of Tibialis Anterior Muscle and Balance in Hemiparetic Patients Following Central and Peripheral Electrical Stimulation - Protocol for a Randomized, Double-blinded, Clinical Trial

2019 ◽  
pp. 1-10
Author(s):  
Aline Marina Alves Fruhauf ◽  
Fabiano Politti ◽  
Camila Cardoso da Silva ◽  
David Correa Alves ◽  
João Carlos Ferrari Corrêa ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Motor Cortex ◽  
Electrical Activity ◽  
Tibialis Anterior ◽  
Evaluation System ◽  
Primary Motor Cortex ◽  
Dynamic Balance ◽  
Stroke Survivors ◽  
Median Frequency ◽  
Peripheral Electrical Stimulation

Concomitant transcranial direct current stimulation (tDCS) is suggested to enhance the functional effects of other physical rehabilitation methods in individuals with motor impairment stemming from a chronic cerebrovascular disease. Thus, the primary aim of the proposed study is to analyze the electrical activity of the tibialis anterior (TA) muscle of the paretic limb in stroke survivors following an intervention involving the combination of tDCS over the motor cortex and peripheral electrical stimulation (PES) administered over the paretic TA. The secondary objective is to analyze the effect on dynamic balance. Methods: Thirty-six adult stroke survivors will be randomized into three groups: 1) Active tDCS + active PES; 2) Sham tDCS + active PES and 3) Active tDCS + sham PES. TDCS active will be positioned bilateral over the primary motor cortex of the damaged hemisphere (C1 or C2) and the cathode will be positioned over the primary motor cortex of the undamaged hemisphere (C1 or C2) with a current of 2 mA for 20 minutes. For sham tDCS, will follow the same standarts, however, the equipment will be switched on for only 20 seconds. PES will be administered to the paretic TA at 50 Hz for 30 minutes. Evaluations: the median frequency and root mean square (RMS) of the paretic TA will be analyzed using electromyography (EMG) and dynamic balance will be evaluated using the Mini-Balance Evaluation System (Mini-BESTest) at baseline (pre-intervention), after 10 treatment sessions at a frequency of five times a week for two weeks (post-intervention) and 30 days after the end of the interventions (follow up). Discussion: PES has proven to facilitate the conduction of sensory-motor afferences to the cerebral cortex in stroke survivors. Combining PES with tDCS, which has a direct effect on increasing cortical excitability, could favor motor acquisition and neuronal plasticity in this population.

Transcranial Electrical Stimulation in Post-Stroke Cognitive Rehabilitation

2016 ◽  
Vol 21 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Silvia Convento ◽  
Cristina Russo ◽  
Luca Zigiotto ◽  
Nadia Bolognini
Keyword(s):  
Electrical Stimulation ◽  
Cognitive Rehabilitation ◽  
Cognitive Disorders ◽  
Spatial Neglect ◽  
Transcranial Electrical Stimulation ◽  
Clinical Settings ◽  
Post Stroke ◽  
Neuropsychological Disorders ◽  
Current State ◽  
Stimulation Technique

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.

scholarly journals Post-stroke fatigue: an exploratory study with patients and health professionals to develop a patient-reported outcome measure

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Ingrid Johansen Skogestad ◽  
Marit Kirkevold ◽  
Petra Larsson ◽  
Christine Råheim Borge ◽  
Bent Indredavik ◽  
...  
Keyword(s):  
Future Development ◽  
Health Professionals ◽  
Outcome Measure ◽  
Patient Reported Outcome ◽  
Stroke Survivors ◽  
Structured Interviews ◽  
Post Stroke ◽  
Patient Reported Outcome Measure ◽  
Patient Reported ◽  
Initial Hospital

Abstract Background Post-stroke fatigue (PSF) is commonly reported and described as disabling by patients recovering from stroke. However, a major challenge is how to accurately diagnose and assess PSF. Therefore, the aim of this study was to explore PSF as it is experienced by stroke survivors and described by health professionals to guide future development of a PSF-specific PROM. Methods Individual semi-structured interviews were conducted with stroke survivors experiencing PSF (n = 9) and three focus groups were conducted with health professionals (n = 16). Data were analyzed through inductive content analysis. Results The analysis revealed four themes illustrating the experience and descriptions of PSF: 1) PSF characteristics, 2) interfering and aggravating factors, 3) management, and 4) PSF awareness, which refers to stroke survivors first becoming aware of PSF after their initial hospital admission. Conclusion This study highlights the complexity and multidimensionality of PSF. The results from this study will guide future development of a PSF-PROM and support its content validity.

scholarly journals ‘Somebody stuck me in a bag of sand’: Lived experiences of the altered and uncomfortable body after stroke

2021 ◽  
pp. 026921552110007
Author(s):  
Hannah Stott ◽  
Mary Cramp ◽  
Stuart McClean ◽  
Ailie Turton
Keyword(s):  
Support Groups ◽  
Phenomenological Study ◽  
Community Support ◽  
Phenomenological Approach ◽  
The Body ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Personal Perceptions ◽  
Psychological Sense ◽  
Qualitative Phenomenological

Objective: This study explored stroke survivors’ experiences of altered body perception, whether these perceptions cause discomfort, and the need for clinical interventions to improve comfort. Design: A qualitative phenomenological study. Setting: Participants’ homes. Participants: A purposive sample of 16 stroke survivors were recruited from community support groups. Participants (median: age 59; time post stroke >2 years), were at least six-months post-stroke, experiencing motor or sensory impairments and able to communicate verbally. Interventions: Semi-structured, face-to-face interviews were analysed using an interpretive phenomenological approach and presented thematically. Results: Four themes or experiences were identified: Participants described (1) a body that did not exist; (2) a body hindered by strange sensations and distorted perceptions; (3) an uncontrollable body; and (4) a body isolated from social and clinical support. Discomfort was apparent in a physical and psychological sense and body experiences were difficult to comprehend and communicate to healthcare staff. Participants wished for interventions to improve their comfort but were doubtful that such treatments existed. Conclusion: Indications are that altered body perceptions cause multifaceted physical and psychosocial discomfort for stroke survivors. Discussions with patients about their personal perceptions and experiences of the body may facilitate better understanding and management to improve comfort after stroke.

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