Abstract
Therapies for motor recovery after stroke or traumatic brain injury are still not satisfactory. To date the best approach seems to be the intensive physical therapy. However the results are limited and functional gains are often minimal. The goal of motor training is to minimize functional disability and optimize functional motor recovery. This is thought to be achieved by modulation of plastic changes in the brain. Therefore, adjunct interventions that can augment the response of the motor system to the behavioural training might be useful to enhance the therapy-induced recovery in neurological populations. In this context, noninvasive brain stimulation appears to be an interesting option as an add-on intervention to standard physical therapies. Two non-invasive methods of inducing electrical currents into the brain have proved to be promising for inducing long-lasting plastic changes in motor systems: transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS). These techniques represent powerful methods for priming cortical excitability for a subsequent motor task, demand, or stimulation. Thus, their mutual use can optimize the plastic changes induced by motor practice, leading to more remarkable and outlasting clinical gains in rehabilitation. In this review we discuss how these techniques can enhance the effects of a behavioural intervention and the clinical evidence to date.
Highlights
Motor impairments following stroke or traumatic brain injury (TBI) are the leading cause of disability in adults
The results showed that, regardless of the rTMS intervention, participants demonstrated significant gains on the primary outcome measures and on secondary outcome measures, further supporting the efficacy of constraint-induced movement therapy (CIT)
The uninjured tissue may be receptive to modulation by various external tools including behavioral training and neuromodulatory approaches such as noninvasive brain stimulation
Summary
Motor impairments following stroke or traumatic brain injury (TBI) are the leading cause of disability in adults. The best option in order to optimize the effects of coupling NIBS and motor therapy still needs to be explored but it likely may depend on different factors, as the stages of illness (e.g. acute versus chronic), the type of motor training, the site of stimulation, the timing of stimulation in relation to physical intervention, baseline cortical activity and the technique of NIBS used. This has been reported in clinical trials in stroke patients, in which stimulation with rTMS for 10 days can induce a long-lasting improvement of motor behaviour that lasted for 10 days after the end of stimulation [32,112]; cathodal tDCS applied over 5 consecutive days is associated with a cumulative motor function improvement that lasts up to 2 weeks after the end of stimulation Interesting, this effect is not observed when sessions are applied weekly instead of daily [73].
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