No abstract

Background and Purpose-Recent work demonstrated that application of peripheral nerve and cortical stimulation independently can induce modest improvements in motor performance in patients with stroke. The purpose of this study was to test the hypothesis that combining peripheral nerve stimulation (PNS) to the paretic hand with anodal direct current stimulation (tDCS) to the ipsilesional primary motor cortex (M1)

Our results suggest a potentially beneficial effect of noninvasive cortical stimulation during rehabilitative motor training of patients who have suffered from subacute strokes.

The field of transcranial electrical stimulation (tES) has experienced significant growth in the past 15 years. One of the tES techniques leading this increased interest is transcranial direct current stimulation (tDCS). Significant research efforts have been devoted to determining the clinical potential of tDCS in humans. Despite the promising results obtained with tDCS in basic and clinical neuroscience, further progress has been impeded by a lack of clarity on international regulatory pathways. We therefore convened a group of research and clinician experts on tDCS to review the research and clinical use of tDCS. In this report, we review the regulatory status of tDCS, and we summarize the results according to research, off-label and compassionate use of tDCS in the following countries: Australia, Brazil, France, Germany, India, Iran, Italy, Portugal, South Korea, Taiwan and United States. Research use, off label treatment and compassionate use of tDCS are employed in most of the countries reviewed in this study. It is critical that a global or local effort is organized to pursue definite evidence to either approve and regulate or restrict the use of tDCS in clinical practice on the basis of adequate randomized controlled treatment trials.

No abstract

The purpose of this study was to identify the videofluoroscopic prognostic factors that affect the recovery of swallowing function at an early stage after stroke and to make a tool for predicting the long-term prognosis. Eighty-three poststroke patients were selected prospectively. These patients had all undergone videofluoroscopic swallowing studies at an average of 40 days after stroke onset and were followed up for over six months. Prognostic factors were determined by logistic regression analysis between the baseline videofluoroscopic findings and aspiration over six months (p < 0.05). A videofluoroscopic dysphagia scale (VDS) with a sum of 100 was made according to the odds ratios of prognostic factors. The validity of the scale was evaluated by using a receiver operating characteristic curve. The VDS was compiled using the following 14 items: lip closure, bolus formation, mastication, apraxia, tongue-to-palate contact, premature bolus loss, oral transit time, triggering of pharyngeal swallow, vallecular residue, laryngeal elevation, pyriform sinus residue, coating of pharyngeal wall, pharyngeal transit time, and aspiration. At a scale cutoff value of 47, the sensitivity was 0.91 and the specificity was 0.92. The VDS was developed to be used as an objective and quantifiable predictor of long-term persistent dysphagia after stroke.

No abstract

BackgroundThis study was undertaken to test the hypothesis that a combination of excitatory anodal transcranial direct current stimulation (tDCS) to the contralateral motor cortex and inhibitory cathodal tDCS to the ipsilateral motor cortex of the motor performing hand (Bi-tDCS) would elicit more implicit motor sequence learning than anodal tDCS applied to the contralateral motor cortex alone (Uni-tDCS).MethodsEleven healthy right-handed adults underwent a randomized crossover experiment of Uni-tDCS, Bi-tDCS, or sham stimulation. Subjects performed a 12-digit finger sequence serial reaction time task with the right hand at baseline (Pre), at immediately (Post 1), and 24 hours after stimulation (Post 2). The ratios of reaction times of predetermined repeating sequence versus random sequence were subjected to statistical analysis.ResultsThe paired t test showed that reaction time ratios were significant decreased by all stimulation types at Post 1 versus Pre (P < 0.01). However, mean reaction time ratios showed a significant decrease after Uni-tDCS (P < 0.01) and Bi-tDCS (P < 0.01), but only a marginal decreased after Sham (P = 0.05) at Post 2, which suggests that motor sequence learning is consolidated by Uni-tDCS and Bi-tDCS, but only partially consolidated by sham stimulation. No significant differences were observed between Uni-tDCS and Bi-tDCS in terms of in reaction time ratios at Post 1 or 2.ConclusionsNo significant difference was found between Uni-tDCS and Bi-tDCS in terms of induced implicit motor sequence learning, but tDCS led to greater consolidation of the learned motor sequence than sham stimulation. These findings need to be tested in the context of stroke hand motor rehabilitation.