The Promising Role of Neuromodulation in Improving Ischemic Stroke Recovery

Abstract

Strokes continue to be a leading cause of death and carries significant morbidity impacting the quality of life for survivors. Although there are preventative measures and growing hyperacute treatments, physical and occupational rehabilitation continue to be the main modalities for recovery of motor abilities, cognitive function, and resolution of pain syndromes post-stroke. Neuromodulation therapies hold great promise for stroke survivors and are beginning to gain traction as the next frontier in regards to post-stroke rehabilitation. It is the aim of this review to explore current beliefs regarding post-acute stroke recovery through neuroplasticity of surviving brain tissue and the impact of neuromodulation through non-invasive and invasive interventions. By understanding the scope of these interventions, the areas in which neuromodulation may be most effective, and the types of recovery they may help constitute, the impact of neuromodulation as a budding area in neurological care and therapy can be better characterized and outlined for future study.

Long-Term Effects of Ischemic Stroke on Autonomic Regulation

“…Finally, the analysis results showcased the limitation of current rehabilitation strategies which failed to restore the autonomic functionality following the ischemic stroke and demand further development of novel rehabilitation schemes to address unmet clinical needs. Novel brain stimulation techniques can serve as a promising therapeutic tool where adaptation of stimulation parameters can be explored to restore baroreflex functionality during rehabilitation to ascertain improved quality of life post rehabilitation [71]- [75].…”

Cortical waves and post‐stroke brain stimulation

“…But controlling dynamics in neural systems via brain stimulation techniques remains challenging because as indicated by Tang and Bassett, “While some understanding has been gained of the control of single neurons, the control of large scale neural systems networks of multiply interacting components remains poorly understood.” As a result, in most cortical stimulation protocols, be they electric or magnetic, parameter values are still adjusted in an empirical fashion. Despite this limitation, cortical stimulation studies clearly produce encouraging results suggesting that these techniques have some potential, but overall, the results remain mixed or limited for example for stroke (see previous studies()), with improvements sometimes limited to 10% to 20%, and for post‐stroke aphasia (see other works()). Aphasia is a complex brain disorder of language and communication caused by damage to the language networks affecting speaking, reading, writing, or understanding language.…”

“…As a result, in most cortical stimulation protocols, be they electric or magnetic, parameter values are still adjusted in an empirical fashion. Despite this limitation, cortical stimulation studies clearly produce encouraging results suggesting that these techniques have some potential, but overall, the results remain mixed or limited for example for stroke (see previous studies [18][19][20][21][22][23], with improvements sometimes limited 24 to 10% to 20%, and for post-stroke aphasia (see other works [25][26][27][28][29][30] ). Aphasia is a complex brain disorder of language and communication caused by damage to the language networks affecting speaking, reading, writing, or understanding language.…”