A review of combined neuromodulation and physical therapy interventions for enhanced neurorehabilitation

Abstract

Rehabilitation approaches for individuals with neurologic conditions have increasingly shifted toward promoting neuroplasticity for enhanced recovery and restoration of function. This review focuses on exercise strategies and non-invasive neuromodulation techniques that target neuroplasticity, including transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), and peripheral nerve stimulation (PNS). We have chosen to focus on non-invasive neuromodulation techniques due to their greater potential for integration into routine clinical practice. We explore and discuss the application of these interventional strategies in four neurological conditions that are frequently encountered in rehabilitation settings: Parkinson’s Disease (PD), Traumatic Brain Injury (TBI), stroke, and Spinal Cord Injury (SCI). Additionally, we discuss the potential benefits of combining non-invasive neuromodulation with rehabilitation, which has shown promise in accelerating recovery. Our review identifies studies that demonstrate enhanced recovery through combined exercise and non-invasive neuromodulation in the selected patient populations. We primarily focus on the motor aspects of rehabilitation, but also briefly address non-motor impacts of these conditions. Additionally, we identify the gaps in current literature and barriers to implementation of combined approaches into clinical practice. We highlight areas needing further research and suggest avenues for future investigation, aiming to enhance the personalization of the unique neuroplastic responses associated with each condition. This review serves as a resource for rehabilitation professionals and researchers seeking a comprehensive understanding of neuroplastic exercise interventions and non-invasive neuromodulation techniques tailored for specific diseases and diagnoses.

Advances in Neurorehabilitation: Strategies and Outcomes for Traumatic Brain Injury Recovery

“…However, magnetic stimulation is more convenient as it is less painful than electrical stimulation. TMS with high frequency offers an excitatory effect to the neurons where excitation leads to long-term potentiation and low frequency with an inhibitory effect leads to long-term depression [108,114,115].…”

The importance of brain mapping for rehabilitation in birth nonprogressive neuromuscular diseases

“…Preferably, intensive postoperative rehabilitation should follow surgery to establish functional neuronal circuits underlying newly acquired motor skills (Simon et al, 2015 ). Conventional rehabilitation, such as physical therapy, can be empowered with stimulation approaches (Evancho et al, 2023 ), which is of particular relevance for children of early age, as the surgical treatment of birth conditions starts in early childhood. At an early age, children are unlikely to benefit from physical therapy alone, as they are incapable of performing assigned active motor tasks.…”