Transcranial Direct Current Stimulation (tDCS) has recently gained a lot of attention as a tool to modulate neuronal plasticity influencing motor learning processes and functional recovery after stroke (Schlaug & Renga 2008; Chisari et al., 2014). The main conceptual target is to use tDCS for normalizing imbalanced inter-hemispheric inhibition, increasing excitability of perilesional intact regions of the affected hemisphere with anodal stimulation and/or decreasing excitability of the contralesional hemisphere with cathodal stimulation (Celnik et al., 2009; Fregni et al., 2005; Hummel et al., 2005; Hummel & Cohen 2005; Hummel et al., 2006). First evidences demonstrated transient improvement of upper limb motor function after a single session of tDCS and some studies have suggested potentially cumulative effect of multiple sessions of tDCS in improving motor learning in healthy subjects and hand motor recovery in patients with stroke (Boggio et al., 2007; Reis et al., 2009). These findings allow to support the hypothesis that combining multi-sessions tDCS protocol with other upper limb rehabilitative techniques which use improve upper limb motor recovery after stroke (Wessel et al., 2015; Nair et al., 2008). At this purpose we overviewed studies in which a combined upper limb rehabilitative therapy including tDCS was administered to subacute or chronic stroke patients. Different treatments were associated with tDCS such as virtual reality-based therapy (VRT), robot assisted arm training (AT), constraint induced therapy (CIMT), or occupational therapy (OT). First evidences revealed that tDCS sessions can be administered simultaneously to conventional therapy sessions, and the mean tDCS treatment duration was about 10-15 sessions for 2-3 weeks. Most of these studies showed significant effects for experimental treatment groups versus control groups, evaluated with different clinical scales for upper limb motor function. All studies used functional scales to explore upper limb motor improvement, but e.g., Bolognini et al., (2011) also showed a neurophysiological correlate to identify reduction in interhemispheric inhibition probably mostly due of tDCS effects. Particularly effective was the association between tDCS and OT or CIMT (Nair et al., 2008; Lindberg et al., 2012; Bolognini et al., 2011). Conversely the other types of combined trails showed no significant or only preliminary results in upper limb outcome measures, probably due to a very small sample size. In this overview we conclude that tDCS can be considered an important tool to maximize the effects of traditional therapies for upper limb motor recovery, modulating the plasticity-dependent processes after stroke (Wessel et al., 2010). However it will be useful to clarify the timing and duration of tDCS administration protocols and how these parameters influence other therapies effects, in order to identify a useful combined upper limb rehabilitation strategy for stroke patients.
The combined use of tDCS and other rehabilitation techniques to improve upper limb motor function after stroke
Chisari, C.;Sgherri, G.;Lamola, G.;Rossi, B.
2016-01-01
Abstract
Transcranial Direct Current Stimulation (tDCS) has recently gained a lot of attention as a tool to modulate neuronal plasticity influencing motor learning processes and functional recovery after stroke (Schlaug & Renga 2008; Chisari et al., 2014). The main conceptual target is to use tDCS for normalizing imbalanced inter-hemispheric inhibition, increasing excitability of perilesional intact regions of the affected hemisphere with anodal stimulation and/or decreasing excitability of the contralesional hemisphere with cathodal stimulation (Celnik et al., 2009; Fregni et al., 2005; Hummel et al., 2005; Hummel & Cohen 2005; Hummel et al., 2006). First evidences demonstrated transient improvement of upper limb motor function after a single session of tDCS and some studies have suggested potentially cumulative effect of multiple sessions of tDCS in improving motor learning in healthy subjects and hand motor recovery in patients with stroke (Boggio et al., 2007; Reis et al., 2009). These findings allow to support the hypothesis that combining multi-sessions tDCS protocol with other upper limb rehabilitative techniques which use improve upper limb motor recovery after stroke (Wessel et al., 2015; Nair et al., 2008). At this purpose we overviewed studies in which a combined upper limb rehabilitative therapy including tDCS was administered to subacute or chronic stroke patients. Different treatments were associated with tDCS such as virtual reality-based therapy (VRT), robot assisted arm training (AT), constraint induced therapy (CIMT), or occupational therapy (OT). First evidences revealed that tDCS sessions can be administered simultaneously to conventional therapy sessions, and the mean tDCS treatment duration was about 10-15 sessions for 2-3 weeks. Most of these studies showed significant effects for experimental treatment groups versus control groups, evaluated with different clinical scales for upper limb motor function. All studies used functional scales to explore upper limb motor improvement, but e.g., Bolognini et al., (2011) also showed a neurophysiological correlate to identify reduction in interhemispheric inhibition probably mostly due of tDCS effects. Particularly effective was the association between tDCS and OT or CIMT (Nair et al., 2008; Lindberg et al., 2012; Bolognini et al., 2011). Conversely the other types of combined trails showed no significant or only preliminary results in upper limb outcome measures, probably due to a very small sample size. In this overview we conclude that tDCS can be considered an important tool to maximize the effects of traditional therapies for upper limb motor recovery, modulating the plasticity-dependent processes after stroke (Wessel et al., 2010). However it will be useful to clarify the timing and duration of tDCS administration protocols and how these parameters influence other therapies effects, in order to identify a useful combined upper limb rehabilitation strategy for stroke patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
