The effect of transcranial direct current stimulation combined with functional task training on motor recovery in stroke patients

Abstract

Background: Motor deficits are common after stroke and are a major contributor to stroke-related disability and the potential for long-lasting neurobiological consequences of stroke remains unresolved. There are only a few treatments available for the improvement of motor function in stroke patients. However, the mechanisms underlying stroke recovery remain poorly understood, and effective neurorehabilitation interventions remain insufficiently proven for widespread implementation. Methods: Herein, we propose to enhance the effects of brain plasticity using a powerful noninvasive technique for brain modulation consisting of navigated transcranial magnetic stimulation (TMS) priming with transcranial direct current stimulation (tDCS) in combination with motor-training-like constraint-induced movement therapy (CIMT). Our hypothesis is that navigated low-frequency rTMS stimulus priming with precise location provided by neuronavigation on the healthy side of the brain and with anodal tDCS on the affected side combined with CIMT will induce a greater motor function improvement than that obtained with sham tDCS combined with CIMT alone. We predict that the application of this technique will result in a large reduction in cortical excitability and dis-inhibition in the affected hemisphere and lead to improvements in behavioral measures of hand function in stroke patients. Discussion: The proposed study, therefore, is important for several reasons. The results could potentially lead to improved stroke therapeutics, and the approach makes use of 2 potential pathways to modulate brain function. Trial registration: This study protocol was registered in Clinical Trials Registry (https://clinicaltrials.gov/ct2/show/NCT04646577). Ethics and dissemination: The study has been reviewed and approved by the Human Research Ethics Committee of the King Fahad Specialist Hospital Dammam. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, broadcast media, print media, the internet and various community/stakeholder engagement activities.

Knowledge and attitude toward transcranial magnetic stimulation among rehabilitation specialists in Saudi Arabia

“…This could be because most of our participants did not have TMS equipment in their workplaces and were not post-professional degree holders, which might be attributed to the lack of post-professional rehabilitation and residency programs in Saudi Arabia ( Bindawas, 2014 ; Alghadir et al, 2015 ). In addition, limited TMS research has been conducted among rehabilitation specialists in Saudi Arabia ( Al-Hussain et al, 2021 ; Bashir et al, 2021 ). TMS is still considered a new concept to be addressed in rehabilitation in Saudi Arabia, and brain stimulation is not covered in the curriculum of bachelor’s degree programs in rehabilitation science.…”

“…Enhancing motor performance is a core goal for physical therapy interventions; therefore, in the past few decades, there has been vigorous growth in the range of rehabilitation technologies, such as noninvasive brain stimulation (NIBS), that can improve the recovery of patients with motor impairments ( Winstein et al, 2016 ; Palmer et al, 2018 ; Winstein and Varghese, 2018 ; Al-Hussain et al, 2021 ; Bashir et al, 2021 ; Braun and Wittenberg, 2021 ). Specifically, combining TMS with different rehabilitation techniques to improve motor recovery has been widely investigated.…”