Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke

Elsner, Bernhard; Kügler, Joachim; Pohl, Marcus; Mehrholz, Jan

doi:10.1002/14651858.cd009645.pub4

Cited by 61 publications

(42 citation statements)

References 185 publications

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“…Regarding brain plasticity, previous BCI studies have reported cortical reorganization alongside the clinical motor improvement ( 19 , 20 , 63 ). These results are thought to be partly due to the brain engagement needed for the BCI to work ( 64 ) and we hypothesize that the underlying plastic changes can further be enhanced with tDCS, which was reported to have a positive effect on the strength of event related desynchronizations ( 65 – 67 ) and motor outcome ( 68 , 69 ). We assume that behavioral restitution of function, induced by the combined neurotechnology approach will go alongside with cortical reorganization processes, which we plan to capture by a multimodal evaluation by means of (f)MRI, DTI and TMS-EEG related outcome measures.…”

Section: Discussionmentioning

confidence: 86%

A Novel Patient-Tailored, Cumulative Neurotechnology-Based Therapy for Upper-Limb Rehabilitation in Severely Impaired Chronic Stroke Patients: The AVANCER Study Protocol

et al. 2022

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Effective, patient-tailored rehabilitation to restore upper-limb motor function in severely impaired stroke patients is still missing. If suitably combined and administered in a personalized fashion, neurotechnologies offer a large potential to assist rehabilitative therapies to enhance individual treatment effects. AVANCER (clinicaltrials.gov NCT04448483) is a two-center proof-of-concept trial with an individual based cumulative longitudinal intervention design aiming at reducing upper-limb motor impairment in severely affected stroke patients with the help of multiple neurotechnologies. AVANCER will determine feasibility, safety, and effectivity of this innovative intervention. Thirty chronic stroke patients with a Fugl-Meyer assessment of the upper limb (FM-UE) <20 will be recruited at two centers. All patients will undergo the cumulative personalized intervention within two phases: the first uses an EEG-based brain-computer interface to trigger a variety of patient-tailored movements supported by multi-channel functional electrical stimulation in combination with a hand exoskeleton. This phase will be continued until patients do not improve anymore according to a quantitative threshold based on the FM-UE. The second interventional phase will add non-invasive brain stimulation by means of anodal transcranial direct current stimulation to the motor cortex to the initial approach. Each phase will last for a minimum of 11 sessions. Clinical and multimodal assessments are longitudinally acquired, before the first interventional phase, at the switch to the second interventional phase and at the end of the second interventional phase. The primary outcome measure is the 66-point FM-UE, a significant improvement of at least four points is hypothesized and considered clinically relevant. Several clinical and system neuroscience secondary outcome measures are additionally evaluated. AVANCER aims to provide evidence for a safe, effective, personalized, adjuvant treatment for patients with severe upper-extremity impairment for whom to date there is no efficient treatment available.

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Section: Discussionmentioning

confidence: 86%

A Novel Patient-Tailored, Cumulative Neurotechnology-Based Therapy for Upper-Limb Rehabilitation in Severely Impaired Chronic Stroke Patients: The AVANCER Study Protocol

et al. 2022

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“…From the past three decades, tDCS has become an increasingly popular technique in rehabilitation treatment (84). The use of tDCS in stroke research has gained particular interest, because both online and offline effects of tDCS can improve functional outcomes (85,86).…”

Section: Transcranial Direct Current Stimulationmentioning

confidence: 99%

The Application of Technological Intervention for Stroke Rehabilitation in Southeast Asia: A Scoping Review With Stakeholders' Consultation

Selamat

Ainuddin

et al. 2022

Front. Public Health

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BackgroundThe technological intervention is considered as an adjunct to the conventional therapies applied in the rehabilitation session. In most high-income countries, technology has been widely used in assisting stroke survivors to undergo their treatments. However, technology use is still lacking in Southeast Asia, especially in middle- and low-income countries. This scoping review identifies and summarizes the technologies and related gaps available in Southeast Asia pertaining to stroke rehabilitation.MethodsThe JBI manual for evidence synthesis was used to conduct a scoping study. Until September 2021, an electronic search was performed using four databases (Medline, CINAHL, Scopus, ASEAN Citation Index). Only the studies that were carried out in Southeast Asia were chosen.ResultsForty-one articles were chosen in the final review from 6,873 articles found during the initial search. Most of the studies reported the implementation of technological intervention combined with conventional therapies in stroke rehabilitation. Advanced and simple technologies were found such as robotics, virtual reality, telerehabilitation, motion capture, assistive devices, and mobility training from Singapore, Thailand, Malaysia, and Indonesia. The majority of the studies show that technological interventions can enhance the recovery period of stroke survivors. The consultation session suggested that the technological interventions should facilitate the needs of the survivors, caregivers, and practitioners during the rehabilitation.ConclusionsThe integration of technology into conventional therapies has shown a positive outcome and show significant improvement during stroke recovery. Future studies are recommended to investigate the potential of home-based technological intervention and lower extremities.

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“…[28][29][30] tDCS has gradually increased applicability in the neurorehabilitation field. [31][32][33][34]…”

Section: Clinical Application Of Tms and Tdcsmentioning

confidence: 99%

Clinical applications and consideration of interventions of electrotherapy for orthopedic and neurological rehabilitation

Chen

Cheen

Jheng

et al. 2022

Journal of the Chinese Medical Association

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Electrotherapy or electrical stimulation (ES) is a part of clinical intervention in the rehabilitation field. With rehabilitation intervention, electrotherapy may be provided as a treatment for pain relief, strengthening, muscle education, wound recovery, or functional training. Although these interventions may not be considered as the primary therapy for patients, the advantages of the ease of operation, lower costs, and lower risks render ES to be applied frequently in clinics. There have also been emerging ES tools for brain modulation in the past decade. ES interventions are not only considered analgesics but also as an important assistive therapy for motor improvement in orthopedic and neurological rehabilitation. In addition, during the coronavirus disease pandemic, lockdowns and self-quarantine policies have led to the discontinuation of orthopedic and neurological rehabilitation interventions. Therefore, the feasibility and effectiveness of home-based electrotherapy may provide opportunities for the prevention of deterioration or extension of the original therapy. The most common at-home applications in previous studies showed positive effects on pain relief, functional ES, muscle establishment, and motor training. Currently, there is a lack of certain products for at-home brain modulation; however, transcranial direct current stimulation has shown the potential of future home-based rehabilitation due to its relatively small and simple design. We have organized the features and applications of ES tools and expect the future potential of remote therapy during the viral pandemic.

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Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke

Abstract: Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people a er stroke (Review)

Cited by 61 publications

References 185 publications

A Novel Patient-Tailored, Cumulative Neurotechnology-Based Therapy for Upper-Limb Rehabilitation in Severely Impaired Chronic Stroke Patients: The AVANCER Study Protocol

A Novel Patient-Tailored, Cumulative Neurotechnology-Based Therapy for Upper-Limb Rehabilitation in Severely Impaired Chronic Stroke Patients: The AVANCER Study Protocol

The Application of Technological Intervention for Stroke Rehabilitation in Southeast Asia: A Scoping Review With Stakeholders' Consultation

Clinical applications and consideration of interventions of electrotherapy for orthopedic and neurological rehabilitation

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