Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS

Edwards, Dylan; Cortes, Mar; Rykman-Peltz, Avrielle; Chang, Johanna L.; Elder, Jessica; Thickbroom, Gary; Mariman, Juan J.; Gerber, Linda M.; Oromendia, Clara; Krebs, Hermano Igo; Fregni, Felipe; Volpe, Bruce T.; Pascual‐Leone, Álvaro

doi:10.3233/rnn-180869

Cited by 42 publications

(112 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These results indicated that there might be potentially no timing-dependent effects of tDCS with MT, and combination of tDCS with MT either sequentially or concurrently did not yield to additional benefits on motor function than MT alone. Though surprising, these results were similar to the findings of no add-on effects of tDCS with motor-imagery based modality (e.g., brain-computer interface, BCI) or motor training on clinical motor function in several previous studies [ 59 – 61 ]. A recent systematic review of randomized controlled trials of tDCS also did not find additional benefits of tDCS on improving motor function (i.e., FMA scores), but rather benefits of tDCS on enhancing ADL capacity [ 62 ].…”

Section: Discussionsupporting

confidence: 89%

Timing-dependent effects of transcranial direct current stimulation with mirror therapy on daily function and motor control in chronic stroke: a randomized controlled pilot study

Liao

Chiang

Lin

et al. 2020

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

Background: The timing of transcranial direct current stimulation (tDCS) with neurorehabilitation interventions may affect its modulatory effects. Motor function has been reported to be modulated by the timing of tDCS; however, whether the timing of tDCS would also affect restoration of daily function and upper extremity motor control with neurorehabilitation in stroke patients remains largely unexplored. Mirror therapy (MT) is a potentially effective neurorehabilitation approach for improving paretic arm function in stroke patients. This study aimed to determine whether the timing of tDCS with MT would influence treatment effects on daily function, motor function and motor control in individuals with chronic stroke. Methods: This study was a double-blinded randomized controlled trial. Twenty-eight individuals with chronic stroke received one of the following three interventions: (1) sequentially combined tDCS with MT (SEQ), (2) concurrently combined tDCS with MT (CON), and (3) sham tDCS with MT (SHAM). Participants received interventions for 90 min/day, 5 days/week for 4 weeks. Daily function was assessed using the Nottingham Extended Activities of Daily Living Scale. Upper extremity motor function was assessed using the Fugl-Meyer Assessment Scale. Upper extremity motor control was evaluated using movement kinematic assessments. Results: There were significant differences in daily function between the three groups. The SEQ group had greater improvement in daily function than the CON and SHAM groups. Kinematic analyses showed that movement time of the paretic hand significantly reduced in the SEQ group after interventions. All three groups had significant improvement in motor function from pre-intervention to post-intervention.

show abstract

Section: Discussionsupporting

confidence: 89%

Timing-dependent effects of transcranial direct current stimulation with mirror therapy on daily function and motor control in chronic stroke: a randomized controlled pilot study

Liao

Chiang

Lin

et al. 2020

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

show abstract

“…A consideration for use of the MEP as an outcome predictor is the influence of amplitude and probability criteria for MEP presence determination, which requires further exploration. 59 The postintervention UE-FMA of the patients was tracked at 1, 3, and 6 months of the therapy. The UE-FMA at 1, 3, and 6 months of the intervention was significantly correlated with the postintervention UE-FMA just after the intervention (Pearson correlation coefficient > 0.90 for all).…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Methods Predict Individual Upper-Limb Motor Impairment Following Therapy in Chronic Stroke

Tozlu

Edwards

Boes

et al. 2020

Neurorehabil Neural Repair

View full text Add to dashboard Cite

Background. Accurate prediction of clinical impairment in upper-extremity motor function following therapy in chronic stroke patients is a difficult task for clinicians but is key in prescribing appropriate therapeutic strategies. Machine learning is a highly promising avenue with which to improve prediction accuracy in clinical practice. Objectives. The objective was to evaluate the performance of 5 machine learning methods in predicting postintervention upper-extremity motor impairment in chronic stroke patients using demographic, clinical, neurophysiological, and imaging input variables. Methods. A total of 102 patients (female: 31%, age 61 ± 11 years) were included. The upper-extremity Fugl-Meyer Assessment (UE-FMA) was used to assess motor impairment of the upper limb before and after intervention. Elastic net (EN), support vector machines, artificial neural networks, classification and regression trees, and random forest were used to predict postintervention UE-FMA. The performances of methods were compared using cross-validated R2. Results. EN performed significantly better than other methods in predicting postintervention UE-FMA using demographic and baseline clinical data (median [Formula: see text] P < .05). Preintervention UE-FMA and the difference in motor threshold (MT) between the affected and unaffected hemispheres were the strongest predictors. The difference in MT had greater importance than the absence or presence of a motor-evoked potential (MEP) in the affected hemisphere. Conclusion. Machine learning methods may enable clinicians to accurately predict a chronic stroke patient’s postintervention UE-FMA. Interhemispheric difference in the MT is an important predictor of chronic stroke patients’ response to therapy and, therefore, could be included in prospective studies.

show abstract

“…Alternatively, the association of NIBS and RT may have effects on retention of improved motor performance rather than on immediate effects of motor training. Results of a trial that randomized 164 patients to active or sham atDCS of the motor cortex of the affected hemisphere prior to RT, 34 included in this review, contradict this hypothesis. After 36 sessions of treatment, the benefits of RT were unchanged by add-on atDCS.…”

Section: Discussionmentioning

confidence: 99%

“…Body structure/body function: 7 of the included studies [31][32][33][34][35][36][37] chose the FMA as an outcome measure of body structure/function. Overall, a nonsignificant homogeneous SES (MD = 0.15; 95% CI = −3.10 to 3.40; P = .93; I 2 = 0%) was found ( Figure 1).…”

Section: Main Analysismentioning

confidence: 99%

Effects of Robotic Therapy Associated With Noninvasive Brain Stimulation on Upper-Limb Rehabilitation After Stroke: Systematic Review and Meta-analysis of Randomized Clinical Trials

Reis

Bernardo

Oshiro

et al. 2021

Neurorehabil Neural Repair

View full text Add to dashboard Cite

Background Robot-assisted therapy and noninvasive brain stimulation (NIBS) are promising strategies for stroke rehabilitation. Objective This systematic review and meta-analysis aims to evaluate the evidence of NIBS as an add-on intervention to robotic therapy in order to improve outcomes of upper-limb motor impairment or activity in individuals with stroke. Methods This study was performed according to the PRISMA Protocol and was previously registered on the PROSPERO Platform (CRD42017054563). Seven databases and gray literature were systematically searched by 2 reviewers, and 1176 registers were accessed. Eight randomized clinical trials with upper-limb body structure/function or activity limitation outcome measures were included. Subgroup analyses were performed according to phase poststroke, device characteristics (ie, arm support, joints involved, unimanual or bimanual training), NIBS paradigm, timing of stimulation, and number of sessions. The Grade-Pro Software was used to assess quality of the evidence. Results A nonsignificant homogeneous summary effect size was found both for body structure function domain (mean difference [MD] = 0.15; 95% CI = −3.10 to 3.40; P = 0.93; I2 = 0%) and activity limitation domain (standard MD = 0.03; 95% CI = −0.28 to 0.33; P = 0.87; I2 = 0%). Conclusions According to this systematic review and meta-analysis, at the moment, there are not enough data about the benefits of NIBS as an add-on intervention to robot-assisted therapy on upper-limb motor function or activity in individuals with stroke.

show abstract

Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS

Cited by 42 publications

References 40 publications

Timing-dependent effects of transcranial direct current stimulation with mirror therapy on daily function and motor control in chronic stroke: a randomized controlled pilot study

Timing-dependent effects of transcranial direct current stimulation with mirror therapy on daily function and motor control in chronic stroke: a randomized controlled pilot study

Machine Learning Methods Predict Individual Upper-Limb Motor Impairment Following Therapy in Chronic Stroke

Effects of Robotic Therapy Associated With Noninvasive Brain Stimulation on Upper-Limb Rehabilitation After Stroke: Systematic Review and Meta-analysis of Randomized Clinical Trials

Contact Info

Product

Resources

About