Hebbian-Type Stimulation During Robot-Assisted Training in Patients With Stroke

Abstract

Hebbian-type stimulation is feasible in patients poststroke and induces map reorganization and associated decreases in GABAergic inhibition. However, because TMS protocols have a different effect on motor reorganization in the injured brain and may depend on location of the lesion, protocols need to be tailored to the patient's pathology.

Activity-dependent brain stimulation and robot-assisted movements for use-dependent plasticity

“…Unlike classical interventions for paired associative plasticity (Stefan et al, 2000), which combine peripheral sensory stimulation (of the median nerve) with TMS (of the motor cortex) and which follow specific timing rules for long-term potentiation/ depression-like plasticity with opposing effects within a narrow temporal window of 15 ms (Wolters et al, 2003), current movement-related TMS interventions provide more ambiguous findings. Stimulating the motor cortex both 50 ms before (Thabit et al, 2010) and up to 50 ms (Bütefisch et al, 2004(Bütefisch et al, , 2011 after movement initiation of the contralateral thumb or wrist increased corticospinal excitability, while stimulating 100 ms after movement initiation decreased excitability (Thabit et al, 2010). We tend to attribute these heterogeneous findings to different stimulation intensities and stimulated target muscles during motor training, i.e.…”

“…However, the observed timing rules and the effects on specific muscles involved in the movement were unexpected in the light of previous studies. In parallel to the studies of Bütefisch et al (2004, 2011), Massie et al (2015 applied subthreshold stimulation during training a movement opposite to the TMS-evoked direction. Nonetheless, this intervention reduced the excitability of both one movement agonist and two antagonist muscles, when applied in the early phase after movement onset, i.e.…”

“…In addition to traditional rehabilitation training, brain stimulation techniques have been explored to increase the excitability of the stimulated motor cortex and to augment the response to afferent input during motor exercises (Edwardson et al, 2013). Recent approaches examined single-pulse transcranial magnetic stimulation (TMS) applied concurrently with voluntary movements for more specific and efficacious plasticity induction (Bütefisch et al, 2004(Bütefisch et al, , 2011Thabit et al, 2010). Unlike classical interventions for paired associative plasticity (Stefan et al, 2000), which combine peripheral sensory stimulation (of the median nerve) with TMS (of the motor cortex) and which follow specific timing rules for long-term potentiation/ depression-like plasticity with opposing effects within a narrow temporal window of 15 ms (Wolters et al, 2003), current movement-related TMS interventions provide more ambiguous findings.…”

Transcranial magnetic stimulation with electroencephalography: methodology, applications for research and cilinics

“…Безусловно, ЭЭГ -не единствен-ный возможный источник информации для поиска оптимального момента запуска адаптивной стимуля-ции. Например, ЭМГ также может служить для триг-гирования ТМС [73], как и поведенческие показате-ли. Однако именно ТМС-ЭЭГ является одним из универсальных подходов, применимых вне зави-симости от зоны стимуляции и обладающих высоким временным разрешением.…”

Modern Brain Mapping – What Do We Map Nowadays?

“…These closed-loop approaches require the elaboration of protocols for central-peripheral stimulation coupling for the optimal modulation of the recovering brain (41, 42). Such task-dependent closed-loop approaches can be combined with brain-state guided stimulation.…”