Abstract
BackgroundThere is growing evidence that the combination of non-invasive brain stimulation and motor skill training is an effective new treatment option in neurorehabilitation. We investigated the beneficial effects of the application of transcranial direct current stimulation (tDCS) combined with virtual reality (VR) motor training.MethodsIn total, 15 healthy, right-handed volunteers and 15 patients with stroke in the subacute stage participated. Four different conditions (A: active wrist exercise, B: VR wrist exercise, C: VR wrist exercise following anodal tDCS (1 mV, 20 min) on the left (healthy volunteer) or affected (stroke patient) primary motor cortex, and D: anodal tDCS without exercise) were provided in random order on separate days. We compared during and post-exercise corticospinal excitability under different conditions in healthy volunteers (A, B, C, D) and stroke patients (B, C, D) by measuring the changes in amplitudes of motor evoked potentials in the extensor carpi radialis muscle, elicited with single-pulse transcranial magnetic stimulation. For statistical analyses, a linear mixed model for a repeated-measures covariance pattern model with unstructured covariance within groups (healthy or stroke groups) was used.ResultsThe VR wrist exercise (B) facilitated post-exercise corticospinal excitability more than the active wrist exercise (A) or anodal tDCS without exercise (D) in healthy volunteers. Moreover, the post-exercise corticospinal facilitation after tDCS and VR exercise (C) was greater and was sustained for 20 min after exercise versus the other conditions in healthy volunteers (A, B, D) and in subacute stroke patients (B, D).ConclusionsThe combined effect of VR motor training following tDCS was synergistic and short-term corticospinal facilitation was superior to the application of VR training, active motor training, or tDCS without exercise condition. These results support the concept of combining brain stimulation with VR motor training to promote recovery after a stroke.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-124) contains supplementary material, which is available to authorized users.
Highlights
There is growing evidence that the combination of non-invasive brain stimulation and motor skill training is an effective new treatment option in neurorehabilitation
The mean baseline resting motor threshold (RMT) in each experiment showed no major differences among conditions (F3,56 = 0.027, P = 0.99 in healthy volunteers; F2,42 = 0.394, P = 0.67 in stroke patients; Table 2)
After 20 min, the motor evoked potential (MEP) amplitude was decreased and there was no difference between the virtual reality (VR) wrist exercise and active wrist exercise (A) or transcranial direct current stimulation (tDCS) without exercise conditions (D) (A: P = 0.41, D: P = 4.9; Table 4)
Summary
There is growing evidence that the combination of non-invasive brain stimulation and motor skill training is an effective new treatment option in neurorehabilitation. There is growing evidence that a combination of non-invasive brain stimulation and motor skill training is a new treatment option in the field of neurorehabilitation [5,6]. These newer combinations and training approaches are based on an increased understanding of the plasticity of the nervous system and how this plasticity facilitates motor learning, as influenced by frequency of use, skill development, and practice parameters [7,8]. Recent experimental evidence suggests that corticospinal excitability is enhanced after VR-induced visuomotor learning conditions, and that VR technologies have great potential for the development of novel strategies for sensorimotor training in neurorehabilitation [15,16]
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