Stimulation In People Research Articles

Connectivity as a Predictor of Responsiveness to Transcranial Direct Current Stimulation in People with Stroke: Protocol for a Double-Blind Randomized Controlled Trial.

BackgroundStroke can have devastating consequences for an individual’s quality of life. Interventions capable of enhancing response to therapy would be highly valuable to the field of neurological rehabilitation. One approach is to use noninvasive brain stimulation techniques, such as transcranial direct current stimulation, to induce a neuroplastic response. When delivered in combination with rehabilitation exercises, there is some evidence that transcranial direct current stimulation is beneficial. However, responses to stimulation are highly variable. Therefore biomarkers predictive of response to stimulation would be valuable to help select appropriate people for this potentially beneficial treatment.ObjectiveThe objective of this study is to investigate connectivity of the stimulation target, the ipsilesional motor cortex, as a biomarker predictive of response to anodal transcranial direct current stimulation in people with stroke.MethodsThis study is a double blind, randomized controlled trial (RCT), with two parallel groups. A total of 68 participants with first ever ischemic stroke with motor impairment will undertake a two week (14 session) treatment for upper limb function (Graded Repetitive Arm Supplementary Program; GRASP). Participants will be randomized 2:1 to active:sham treatment groups. Those in the active treatment group will receive anodal transcranial direct current stimulation to the ipsilesional motor cortex at the start of each GRASP session. Those allocated to the sham treatment group will receive sham transcranial direct current stimulation. Behavioural assessments of upper limb function will be performed at baseline, post treatment, 1 month follow-up and 3 months follow-up. Neurophysiological assessments will include magnetic resonance imaging (MRI), electroencephalography (EEG) and transcranial magnetic stimulation (TMS) and will be performed at baseline, post treatment, 1 month follow-up (EEG and TMS only) and 3 months follow-up (EEG and TMS only).ResultsParticipants will be recruited between March 2018 and December 2018, with experimental testing concluding in March 2019.ConclusionsIdentifying a biomarker predictive of response to transcranial direct current stimulation would greatly assist clinical utility of this novel treatment approach.Trial RegistrationAustralia New Zealand Clinical Trials Registry ACTRN12618000443291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618000443291 (Archived by WebCite at http://www.webcitation.org/737QOXXxt)Registered Report IdentifierRR1-10.2196/10848

Effects of Neuromuscular Electrical Stimulation in People with Spinal Cord Injury.

Muscle force production is usually impaired in people with spinal cord injury (SCI). The use of high-intensity neuromuscular electrical stimulation (NMES) strength training can help promote metabolically active lean muscle mass and, thus, increase muscle mass and improve physical health and quality of life (QoL). Nonetheless, NMES is usually used at low-stimulation intensities, and there is limited evidence on the effects of high-intensity NMES strength training into improving muscle force and mass, symptoms of spasticity, or physical health and QoL in people with SCI. Five individuals with chronic SCI completed five 10-repetition sets of high-intensity knee extension NMES strength training sessions for 12 wk in both quadriceps muscles. Quadriceps femoris (QF) knee extensor torque was measured on a dynamometer, and cross-sectional area (CSAQF) was measured with extended field-of-view ultrasonography. Venous blood samples were collected for blood lipid profiling and C-reactive protein analyses. The Spinal Cord Injury Spasticity Evaluation Tool was used to assess symptoms of spasticity, and the QoL index SCI version III was used for QoL measures. QF tetanic knee extensor torque increased on average by 35% (2%-92%), and CSAQF increased by 47% (14%-145%). A significant increase in the HDL/LDL cholesterol ratio (P < 0.001) and a mean significant improvement of 4.8% ± 2.3% (absolute value = 0.26) in the Spinal Cord Injury Spasticity Evaluation Tool score was observed, whereas QoL showed a near-significant improvement in the health and functioning domain (15.0 ± 4.2 and 17.3 ± 5.1; P = 0.07). High-intensity NMES strength training in people with SCI may improve muscle strength, mass, physical health, and QoL. However, replication of these results is necessary before clinical implementation.

What are the effects of multiple-dose transcranial direct current stimulation for people with chronic pain?

What are the effects of multiple-dose transcranial direct current stimulation for people with chronic pain?

What are the effects of high-frequency repetitive transcranial magnetic stimulation for people with chronic pain?

What are the effects of high-frequency repetitive transcranial magnetic stimulation for people with chronic pain?

Kinematic and kinetic benefits of implantable peroneal nerve stimulation in people with post-stroke drop foot using an ankle-foot orthosis.

Contralesional 'drop foot' after stroke is usually treated with an ankle-foot orthosis (AFO). However, AFOs may hamper ankle motion during stance. Peroneal functional electrical stimulation (FES) is an alternative treatment that provides active dorsiflexion and allows normal ankle motion. Despite this theoretical advantage of FES, the kinematic and kinetic differences between AFO and FES have been scarcely investigated. To test whether walking with implanted FES leads to improvements in stance stability, propulsion, and swing initiation compared to AFO. A 4-channel peroneal nerve stimulator (ActiGait®) was implanted in 22 chronic patients after stroke. Instrumented gait analyses were performed during comfortable walking up to 26 weeks (n = 10) or 52 weeks (n = 12) after FES-system activation. Kinematics of knee and ankle (stance and swing phase) and kinetics (stance phase) of gait were determined, besides spatiotemporal parameters. Finally, we determined whether differences between devices regarding late stance kine(ma)tics correlated with those regarding the swing phase. In mid-stance, knee stability improved as the peak knee extension velocity was lower with FES (β = 18.1°/s, p = 0.007), while peak ankle plantarflexion velocity (β = -29.2°/s, p = 0.006) and peak ankle plantarflexion power (β = -0.2 W/kg, p = 0.018) were higher with FES compared to AFO. With FES, the ground reaction force (GRF) vector at peak ankle power (i.e., 'propulsion') was oriented more anteriorly (β = -1.1°, p = 0.001). Similarly, the horizontal GRF (β = -0.8% body mass, p = 0.003) and gait speed (β = 0.03 m/s, p = 0.015) were higher. An increase in peak ankle plantarflexion velocity and a more forward oriented GRF angle during late stance were moderately associated with an increase in hip flexion velocity during initial swing (rs = 0.502, p = 0.029 and rs = 0.504, p = 0.028, respectively). This study substantiates the evidence that implantable peroneal FES as a treatment for post-stroke drop foot may be superior over AFO in terms of knee stability, ankle plantarflexion power, and propulsion.

Effectiveness of Activity-Based Therapy in Comparison with Surface Spinal Stimulation in People with Traumatic Incomplete Spinal Cord Injury for Activation of Central Pattern Generator for Locomotion: Study Protocol for a 24-Week Randomized Controlled Trial.

Study DesignA multi-centric randomized controlled trial to be conducted at two sites, department of phyhysiotherapypy, Punjabi University, Patiala and rehabilitation department, Indian Spinal Injury Centre, New Delhi, India.PurposeTo determine the effectiveness of activity-based therapy in comparison with surface spinal stimulation (SSS) in traumatic incomplete spinal cord injury (SCI) with special reference to locomotion—a central pattern generator controlled function.Overview of LiteratureA major goal for many patients after SCI is to regain the function of locomotion. It is crucial that rehabilitation strives to maximize locomotor ability and functional recovery after SCI. Experimental evidence of improvement in stepping and motor control after activity-based training in animal models and human SCI has been translated into clinical neuro-rehabilitation.MethodsControl group participants will undertake an intensive 24-week duration thrice weekly program of activity-based therapy. In addition to this the participants in experimental group will also receive a session of 45 minutes of SSS on thrice weekly basis. The primary analysis for our study will be at 24 weeks. Linear regression will be used to determine the mean between-group differences and 95% confidence interval for all continuous outcomes using baseline scores and group allocation as covariates.Results The primary outcome measure is improvement in the level of walking index for SCI-II. The secondary outcome measures are modified Ashworth scale, Penn spasm frequency score, spinal cord independence measure-III, SCI functional ambulation inventory, Hoffman’s reflex, somatosensory evoked potential, and American Spinal Injury Association Impairment Scale scores.ConclusionsAn insight into training-induced mechanisms will be of great importance to fine tune such combined treatments and vindicate their efficacy in restoration of locomotion and functional activities in individuals with SCI.

Deep brain stimulation for people with Alzheimer's disease: Anticipating potential effects on the tripartite self.

Memory dysfunction and cognitive impairments due to Alzheimer’s disease can affect the selfhood and identity of afflicted individuals, causing distress to both people with Alzheimer’s disease and their caregivers. Recently, a number of case studies and clinical trials have been conducted to determine the potential of deep brain stimulation as a therapeutic modality for people with Alzheimer’s disease. Some of these studies have shown that deep brain stimulation could induce flashbacks and stabilize or even improve memory. However, deep brain stimulation itself has also been attributed as a potential threat to identity and selfhood, especially when procedure-related adverse events arise. We anticipate potential effects of deep brain stimulation for people with Alzheimer’s disease on selfhood, reconciling information from medical reports, psychological, and sociological investigations on the impacts of deep brain stimulation or Alzheimer’s disease on selfhood. A tripartite model of the self that extends the scope of Rom Harré’s and Steve Sabat’s social constructionist framework was used. In this model, potential effects of deep brain stimulation for Alzheimer’s disease on Self 1 or singularity through use of first-person indexicals, and gestures of self-reference, attribution, and recognition; Self 2 or past and present attributes, knowledge of these characteristics, and continuity of narrative identity; and Self 3 or the relational and social self are explored. The ethical implications of potential effects of deep brain stimulation for Alzheimer’s disease on the tripartite self are then highlighted, focusing on adapting informed consent procedures and care provided throughout the trial to account for both positive and negative plausible effects on Self 1, Self 2, and Self 3.

Pulse Width Does Not Influence the Gains Achieved With Neuromuscular Electrical Stimulation in People With Multiple Sclerosis: Double-Blind, Randomized Trial

Background. Multiple sclerosis (MS) eventually compromises the walking ability of most individuals burdened with the disease. Treatment with neuromuscular electrical stimulation (NMES) can restore some functional abilities in persons with MS, but its effectiveness may depend on stimulus-pulse duration. Objective. To compare the effects of a 6-week intervention with narrow- or wide-pulse NMES on walking performance, neuromuscular function, and disability status of persons with relapsing-remitting MS. Methods. Individuals with MS (52.6 ± 7.4 years) were randomly assigned to either the narrow-pulse (n = 13) or wide-pulse (n = 14) group. The NMES intervention was performed on the dorsiflexor and plantar flexor muscles of both legs (10 minutes each muscle, 4 s on and 12 s off) at a tolerable level for 18 sessions across 6 weeks. Outcomes were obtained before (week 0) and after (week 7) the intervention and 4 weeks later (week 11). Results. There was no influence of stimulus-pulse duration on the outcomes (P > .05); thus, the data were collapsed across groups. The NMES intervention improved (P < .05) gait speed and walking endurance, dorsiflexor strength in the more-affected leg, plantar flexor strength in the less-affected leg, force control for plantar flexors in the less-affected leg, and self-reported levels of fatigue and walking limitations. Conclusion. There was no influence of stimulus-pulse duration on the primary outcomes (gait speed and walking endurance). The 6-week NMES intervention applied to the lower leg muscles of persons with mild to moderate levels of disability can improve their walking performance and provide some symptom relief.

Effects of Electrical Stimulation in People with Post-Concussion Syndromes: A Pilot Study

Post-concussion syndrome (PCS) is a complex disorder with various symptoms. There is limited evidence to support that any intervention enhances recovery after a concussion. This pilot study aimed to examine the efficacy of neck paraspinal muscles electrical stimulation (ES) in conjunction with physical therapy (PT) on reducing the severity of post concussive symptoms. Twenty-four individuals with PCS were randomly assigned to the ES group (PT + ES) or the control group (PT only). Both groups received the intervention twice a week for eight weeks. Clinical measures including the Concussion Signs/Symptoms Checklist, balance error scoring system, King-Devick test, ImPACT, and the Standardized Assessment of Concussion were used to evaluate the symptoms. We investigated the recovery rate by calculating slopes of changes over time for each participant. A changing slope was derived by linearly fitting the symptoms severity over time with the initial severity score as the intercept. Significant overall improvement was observed in both groups after the interventions. There was no significant difference seen in total symptom recovery rate between two groups (-1.49 ± 1.59 versus -1.2 ± 1.56, p = 0.32). The cognitive symptoms recovery rate of the ES group was faster than the control group (-0.5 ± 0.49 and -0.13 ± 0.46 respectively, p = 0.04). Physical therapy targeting the cervical region is beneficial for persons with PCS. Moreover, peripheral electrical stimulation on the paraspinal muscles surrounding the neck region could potentially advance the cognitive function recovery of persons with PCS.

Is Salivary Chromogranin A a Valid Psychological Stress Biomarker During Sensory Stimulation in People withAdvanced Dementia?

Salivary chromogranin A (sCgA) is gaining attention as a biomarker of psychological stress. The objective of this work was to determine whether individualized music intervention and multisensory stimulation environment (MSSE) in a Snoezelen room produce changes in sCgA in severely demented older patients, and to assess the possible existence of differences in sCgA levels between the two types of interventions. Older adults with severe dementia (n = 22) were randomly assigned to two intervention groups. They participated in MSSE or individualized music interventions in 30-min weekly sessions for 16 weeks. Levels of sCgA were evaluated before and after a session, or 30-min interval, at four different time points: before starting the trial, in the middle and end of the intervention period, and two months later. Comparison of sCgA values obtained after each session with those obtained before (or at the same hour in before trial and follow-up samplings) showed no significant differences either in the individualized music or in the MSSE group at any sampling time. Comparison between the two types of interventions, both before and after each session, in the four sampling times, did not produce any significant difference either. Furthermore, no significant correlation was obtained between agitation, anxiety, cognitive function, and dementia severity with sCgA levels. In conclusion, despite beneficial effects of both individualized music and MSSE interventions being previously reported on neuropsychiatric outcomes for older patients with dementia, sCgA seems to not be a good indicator of these benefits.

A modular, closed-loop platform for intracranial stimulation in people with neurological disorders.

Neuromodulation systems based on electrical stimulation can be used to investigate, probe, and potentially treat a range of neurological disorders. The effects of ongoing neural state and dynamics on stimulation response, and of stimulation parameters on neural state, have broad implications for the development of closed-loop neuro-modulation approaches. We describe the development of a modular, low-latency platform for pre-clinical, closed-loop neuromodulation studies with human participants. We illustrate the uses of the platform in a stimulation case study with a person with epilepsy undergoing neuro-monitoring prior to resective surgery. We demonstrate the efficacy of the system by tracking interictal epileptiform discharges in the local field potential to trigger intracranial electrical stimulation, and show that the response to stimulation depends on the neural state.

Is Motor Cortical Excitability Altered in People with Chronic Pain? A Systematic Review and Meta-Analysis.

Chronic pain is characterised by maladaptive neuroplasticity in many systems, including the motor system. There is evidence that patients with chronic pain demonstrate altered corticospinal and intracortical excitability; however, findings are inconsistent and existing literature in this area has not been systematically reviewed. To systematically review studies examining corticospinal and intracortical excitability using transcranial magnetic stimulation in people with chronic pain compared to healthy controls and to provide a meta-analysis of study outcomes. Databases were searched for controlled studies evaluating corticospinal and intracortical excitability in chronic pain conditions. Outcome measure data were entered into separate meta-analyses and effect sizes calculated. A subgroup analysis based on the type of chronic pain population was also performed. Forty-three studies were included, encompassing a pooled total of 1009 people with chronic pain and 658 control participants. Significant effect sizes (P < 0.05) indicated that in chronic pain populations the duration of the silent period and the extent of short-interval intracortical inhibition were both reduced and short-interval intracortical facilitation was enhanced. The subgroup analysis revealed that only the neuropathic pain group exhibited significant effect sizes for these outcome measures. Effect sizes for the remaining outcome measures were not significant There is evidence of motor cortex disinhibition in chronic pain populations, suggestive of a disruption in GABA-mediated intracortical inhibition. Disinhibition was more pronounced in populations with neuropathic pain. These findings provide new insights into the relationship between chronic pain and motor cortex excitability, which may have meaningful implications for the future treatment of chronic pain conditions.

Computerized assessment of communication for cognitive stimulation for people with cognitive decline using spectral-distortion measures and phylogenetic inference.

Therapeutic communication and interpersonal relationships in care homes can help people to improve their mental wellbeing. Assessment of the efficacy of these dynamic and complex processes are necessary for psychosocial planning and management. This paper presents a pilot application of photoplethysmography in synchronized physiological measurements of communications between the care-giver and people with dementia. Signal-based evaluations of the therapy can be carried out using the measures of spectral distortion and the inference of phylogenetic trees. The proposed computational models can be of assistance and cost-effectiveness in caring for and monitoring people with cognitive decline.

Modulation of the cerebellum using theta-burst stimulation in people with cervical dystonia

Modulation of the cerebellum using theta-burst stimulation in people with cervical dystonia

TMS-evoked twitches in the passive limb change direction according to muscle activation of the active limb

s / Brain Stimulation 8 (2015) 326e342 330 The cerebellum may provide a therapeutic target for non-invasive stimulation in people with cervical dystonia (CD). This study assessed the effect of 10 sessions of intermittent theta-burst stimulation (iTBS) of the cerebellum on symptoms, quality of life and cortical neurophysiology. Fourteen participants (to date) were randomised into intermittent (n 1⁄4 7) or sham (n 1⁄4 7) TBS groups. TMS was used to elicit MEPs from upper trapezius muscles. Dystonia severity and quality of life were assessed using TWSTRS (primary outcome) and CDQ24 questionnaires, pre intervention (pre), after five (mid) and ten (post1) interventions. The CDQ24 was also assessed 4 (post2) and 12 (post3) weeks later. Questionnaire datawere analysed using non-parametric tests. The Mann-Whitney test revealed no difference between groups for the TWSTRS (all P > 0.66). Friedman test showed a reduction in the iTBS group (X2 (2) 1⁄4 8.86, P 1⁄4 0.012), but not in the sham group (X2 (2) 1⁄4 0.67, P 1⁄4 0.72). For TWSTRS pain subsection, there was a group difference at post1 (iTBS -2.93 0.74; sham TBS 0.053 0.94, P 1⁄4 0.046) and a reduction from baseline across time after iTBS (X2 (2) 1⁄4 8.67, P 1⁄4 0.013), but not sham TBS (X2 (2) 1⁄4 4.26, P 1⁄4 0.12). For CDQ-24, the groups differed at post3 (P 1⁄4 0.029) with a trend toward a group difference at post2 (P1⁄4 0.063). Therewas a difference from baseline across time for iTBS (X2 (4)1⁄4 11.14, P1⁄4 0.025), but not sham TBS (X2 (4)1⁄4 4.69, p1⁄4 0.32). MEPs were unaffected by iTBS or sham TBS (all P > 0.21). These preliminary results suggest iTBS may provide an effective intervention for people with CD, particularly for symptoms of pain and for quality of life.

Electrical Stimulation of Motor Cortex in the Uninjured Hemisphere after Chronic Unilateral Injury Promotes Recovery of Skilled Locomotion through Ipsilateral Control

Partial injury to the corticospinal tract (CST) causes sprouting of intact axons at their targets, and this sprouting correlates with functional improvement. Electrical stimulation of motor cortex augments sprouting of intact CST axons and promotes functional recovery when applied soon after injury. We hypothesized that electrical stimulation of motor cortex in the intact hemisphere after chronic lesion of the CST in the other hemisphere would restore function through ipsilateral control. To test motor skill, rats were trained and tested to walk on a horizontal ladder with irregularly spaced rungs. Eight weeks after injury, produced by pyramidal tract transection, half of the rats received forelimb motor cortex stimulation of the intact hemisphere. Rats with injury and stimulation had significantly improved forelimb control compared with rats with injury alone and achieved a level of proficiency similar to uninjured rats. To test whether recovery of forelimb function was attributable to ipsilateral control, we selectively inactivated the stimulated motor cortex using the GABA agonist muscimol. The dose of muscimol we used produces strong contralateral but no ipsilateral impairments in naive rats. In rats with injury and stimulation, but not those with injury alone, inactivation caused worsening of forelimb function; the initial deficit was reinstated. These results demonstrate that electrical stimulation can promote recovery of motor function when applied late after injury and that motor control can be exerted from the ipsilateral motor cortex. These results suggest that the uninjured motor cortex could be targeted for brain stimulation in people with large unilateral CST lesions.

Occipital cortex activation by long-term repetitive tactile stimulation is necessary for object recognition in blinds: A case report

Tactile vision has been approached from a variety of angles using different techniques. So far, a certain kind of object (and text) recognition has been shown, though seeing as such has not been achieved yet, and it remains unclear. Trough repetitive passive tactile stimulation perceptual processing is transferred from temporo-parietal to occipital areas, which affects object recognition. We report the results of passive tactile stimulation, as well as rTMS, applied to a 50 year old left handed blind male with over 97% loss of vision, who suffers from Peter’s anomaly and microphthalmia. After 15 weeks of passive tactile stimulation, the subject showed increased activity in occipital areas associated with the development of visual-like perception which remained unchanged after three months without passive tactile stimulation. Inhibitory rTMS over the visual cortex led to noticeable reduction of spatial recognition performance and visual sensations in this subject. Stable changes in occipital cortical activity can be associated with subjective sensations of seeing. Once occipital activation has been achieved, it is necessary for spatial object recognition. Both facts highlight the implication of occipital areas in tactile vision and the cortical plasticity of passive tactile long-term stimulation in people with blindness.

“Non-invasive” brain stimulation is not non-invasive

The functions of the healthy brain can be studied in two main ways. Firstly, the changes in the brain's state can be measured using techniques such as EEG or functional MRI. Secondly, the activity of the brain can be disrupted through the use of brain stimulation. The famous experiments of Wilder Penfield and colleagues in the 1950s showed the power of brain stimulation in people whose brain was exposed in surgery, and highlighted the possibility of inducing changes in the brain's state to demonstrate the involvement of specific brain areas in particular functions (Jasper and Penfield, 1954). Two main techniques are available for human brain stimulation: transcranial magnetic stimulation (TMS) and transcranial current stimulation (tCS). More recently, it has been suggested that TMS and tCS might be used to enhance brain function, as well as to disrupt activity. These techniques have collectively become known as “non-invasive brain stimulation.” We argue that this term is inappropriate and perhaps oxymoronic, as it obscures both the possibility of side-effects from the stimulation, and the longer-term effects (both adverse and desirable) that may result from brain stimulation. We also argue that the established tendency for the effects of TMS and tCS to spread from the target brain area to neighboring areas is in itself contrary to the definition of non-invasiveness. We argue that the traditional definition of an invasive procedure, one which requires an incision or insertion in the body, should be re-examined, and we propose that it be widened to include targeted transcutaneous interventions.

Multisensory stimulation for people with dementia: a review of the literature.

The use of multisensory stimulation in people with dementia is becoming increasingly popular in the last decades. The aim of this review is to analyze the therapeutic effectiveness of multisensory stimulation in people with dementia. We made a search on Medline and Web of Science databases referred to all researches published from the year 1990 to 2012, which used multisensory stimulation techniques in people with dementia. The revision of the 18 articles which fulfilled the inclusion/exclusion criteria seems to prove evidence that multisensory stimulation environments produce immediate positive effects on the behavior and mood of people with dementia. Based on the above, we think it can be a useful nonpharmacological intervention on neuropsychological symptoms though, in any case, it would be necessary to start more reliable protocols from the methodological point of view in order to establish its long-term effectiveness.

Nonpharmacological Treatment of Alzheimer Disease

To review the key nonpharmacological treatment approaches to the cognitive and functional symptoms of Alzheimer disease (AD). We searched and critically analyzed the most recent relevant literature pertaining to the nonpharmacological treatment of AD. There is evidence from a modest number of well-conducted randomized controlled trials (RCTs) that various nonpharmacological approaches, including cognitive training, cognitive rehabilitation, and cognitive stimulation therapy (CST), confer modest but significant benefits in the treatment of cognitive symptoms in people with AD, and that there may be additive benefits in combination with cholinesterase inhibitor therapy. Cognitive rehabilitation also appears to result in functional benefits in AD. The modest number of RCTs focusing on cognitive training in AD is consistent with the results of larger cognitive training trials in healthy older people. however, there is no convincing evidence of any benefits associated with brain training games. An emerging evidence base indicates that different approaches to cognitive training and cognitive stimulation in people with AD confer modest but significant benefits. The best evidence base is for CST, although this approach is labour-intensive, and requires further evaluation of cost-effectiveness. There is currently no evidence that brain training games provide any significant benefit to people with AD.