Rewiring the Lesioned Brain: Electrical Stimulation for Post-Stroke Motor Restoration

Abstract

Electrical stimulation has been extensively applied in post-stroke motor restoration, but its treatment mechanisms are not fully understood. Stimulation of neuromotor control system at multiple levels manipulates the corresponding neuronal circuits and results in neuroplasticity changes of stroke survivors. This rewires the lesioned brain and advances functional improvement. This review addresses the therapeutic mechanisms of different stimulation modalities, such as noninvasive brain stimulation, peripheral electrical stimulation, and other emerging techniques. The existing applications, the latest progress, and future directions are discussed. The use of electrical stimulation to facilitate post-stroke motor recovery presents great opportunities in terms of targeted intervention and easy applicability. Further technical improvements and clinical studies are required to reveal the neuromodulatory mechanisms and to enhance rehabilitation therapy efficiency in stroke survivors and people with other movement disorders.

Anodal Transcranial Direct Current Stimulation of Anterior Cingulate Cortex Modulates Subcortical Brain Regions Resulting in Cognitive Enhancement

“…Recent evidence suggests that we can manipulate the brain activity through external stimulation and transcranial direct current stimulation (tDCS), a non-invasive brain stimulation method, has emerged as a prime tool for manipulating brain activity (Nitsche et al, 2008 ). The last decade has seen a sharp increase in the use of stimulation methodologies not just in understanding cognition but also in treating Parkinson's disease (Biagioni et al, 2018 ), motor rehabilitation following stroke (Bao et al, 2020 ), chronic pain (O'Connell et al, 2018 ), and other anxiety disorders (Kuo et al, 2014 ). Stimulation at the target region provides a causal inference on how the directly induced neural alterations influence behavioral changes, establishing a better understanding of the brain-behavior relationship.…”

Neuroimmune System as a Driving Force for Plasticity Following CNS Injury

“…Interestingly, increased BDNF levels are also observed following numerous exercise paradigm interventions for CNS injuries and are directly linked to cellular, synaptic, and anatomical plasticity as well as functional recovery after injury (Vaynman and Gomez-Pinilla, 2005 ; Houle and Côté, 2013 ). Upregulated BDNF is also observed in other rehabilitative strategies, including epidural spinal cord stimulation and cortical stimulation, which are used to promote motor recovery and pain control following SCI (Lynskey et al, 2008 ) or stroke (Bao et al, 2020 ). These findings, therefore, indicate that such rehabilitative strategies exert an immunomodulatory effect at the neurotrophic-neuroimmune axis and modify plasticity in spinal and cortical circuits.…”

The Effects of 10 Hz and 20 Hz tACS in Network Integration and Segregation in Chronic Stroke: A Graph Theoretical fMRI Study

“…Meanwhile, there have been various rehabilitation strategies proposed, including conventional physical therapies as well as advanced robot-assisted methods [ 3 , 4 ]. Except for these therapies that influence brain reorganization in a round-about way, the transcranial current stimulation (tCS), which non-invasively modulates the activity of the brain, has attracted increasing attention [ 5 ].…”