Transcranial direct current stimulation over the motor and premotor cortex with mirror therapy improves motor control, muscle function, and brain activity in chronic stroke: a double-blind randomized sham-controlled trial

Journal of NeuroEngineering and Rehabilitation, Journal Year: 2025, Volume and Issue: 22(1)

Published: April 26, 2025

Transcranial direct current stimulation (tDCS) is a popular approach to augment the effects of neurorehabilitation. Most studies stimulated ipsilesional primary motor cortex (iM1); nonetheless, success iM1 was variable, suggesting that it may not be optimal for improving recovery. Ipsilesional premotor (iPMC) an alternative candidate based on its likelihood survival post-stroke and contribution functions. This study aimed determine tDCS iPMC with mirror therapy (MT) control, muscle function, brain activity in chronic stroke. Thirty-six participants were randomly distributed into (1) iPMC-tDCS MT (PMC) (2), iM1-tDCS (M1), (3) sham (sham). Motor control assessed using kinematics. Muscle function modified Ashworth Medical Research Council Scales. The M1 PMC recorded electroencephalography (EEG), event-related desynchronization laterality index (LI) examined. Significant within-group differences identified kinematic outcomes. After interventions, group showed reduced paretic upper limb spasticity improved greater movement smoothness peak velocity. trunk compensation fewer displacement flexion. However, relied more compensation, demonstrating increased velocity smoothness. between-group also found displacement. Post-hoc analysis revealed than group. within-and EEG contralesional (cPMC) from pre-to-post intervention In contrast, decreased, LI declined pre- post-intervention activity, having activation Differential treatment benefits between iPMC- MT. uniquely while mitigated during reaching. These findings suggest both could stroke neurorehabilitation considered clinical applications. ClinicalTrials.gov Identifier: NCT04655209. Registered 15th November 2020. https://clinicaltrials.gov/study/NCT04655209 .

Language: Английский

Noninvasive brain stimulation to improve motor outcomes after stroke

Current Opinion in Neurology, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 2, 2024

Purpose of review This highlights recent developments in noninvasive brain stimulation (NIBS) techniques and applications for improving motor outcomes after stroke. Two promising areas development relate to deep neuromodulation the use single-pulse transcranial magnetic (TMS) within a prediction tool predicting upper limb outcome individual patients. Recent findings Systematic reviews highlight inconsistent effect sizes interventional NIBS stroke, as well limited evidence supporting interhemispheric competition model. To improve therapeutic efficacy NIBS, studies have leveraged metaplasticity priming approaches. Transcranial temporal interference (tTIS) low-intensity focused ultrasound (LIFUS) are emerging with potential modulating deeper structures, which may hold promise stroke neurorehabilitation. Additionally, evoked (MEP) status obtained TMS is prognostic biomarker that could be used tailor Summary Trials improved by applying more targeted manner. achieved taking advantage can using biomarkers structural functional reserve stratify patients, recruiting patients homogeneous time windows.

Language: Английский