Using Transcranial Direct Current Stimulation to Augment the Effect of Motor Imagery-Assisted Brain-Computer Interface Training in Chronic Stroke Patients—Cortical Reorganization Considerations
Introduction: Transcranial direct current stimulation (tDCS) has been shown to modulate cortical plasticity, enhance motor learning and post-stroke upper extremity motor recovery. It has also been demonstrated to facilitate activation of brain-computer interface (BCI) in stroke patients. We had prev...
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Frontiers Media S.A.
2020-08-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fneur.2020.00948/full |
| _version_ | 1818531270818267136 |
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| author | Effie Chew Effie Chew Wei-Peng Teo Wei-Peng Teo Ning Tang Kai Keng Ang Yee Sien Ng Juan Helen Zhou Juan Helen Zhou Irvin Teh Kok Soon Phua Ling Zhao Cuntai Guan |
| author_facet | Effie Chew Effie Chew Wei-Peng Teo Wei-Peng Teo Ning Tang Kai Keng Ang Yee Sien Ng Juan Helen Zhou Juan Helen Zhou Irvin Teh Kok Soon Phua Ling Zhao Cuntai Guan |
| author_sort | Effie Chew |
| collection | DOAJ |
| description | Introduction: Transcranial direct current stimulation (tDCS) has been shown to modulate cortical plasticity, enhance motor learning and post-stroke upper extremity motor recovery. It has also been demonstrated to facilitate activation of brain-computer interface (BCI) in stroke patients. We had previously demonstrated that BCI-assisted motor imagery (MI-BCI) can improve upper extremity impairment in chronic stroke participants. This study was carried out to investigate the effects of priming with tDCS prior to MI-BCI training in chronic stroke patients with moderate to severe upper extremity paresis and to investigate the cortical activity changes associated with training.Methods: This is a double-blinded randomized clinical trial. Participants were randomized to receive 10 sessions of 20-min 1 mA tDCS or sham-tDCS before MI-BCI, with the anode applied to the ipsilesional, and the cathode to the contralesional primary motor cortex (M1). Upper extremity sub-scale of the Fugl-Meyer Assessment (UE-FM) and corticospinal excitability measured by transcranial magnetic stimulation (TMS) were assessed before, after and 4 weeks after intervention.Results: Ten participants received real tDCS and nine received sham tDCS. UE-FM improved significantly in both groups after intervention. Of those with unrecordable motor evoked potential (MEP-) to the ipsilesional M1, significant improvement in UE-FM was found in the real-tDCS group, but not in the sham group. Resting motor threshold (RMT) of ipsilesional M1 decreased significantly after intervention in the real-tDCS group. Short intra-cortical inhibition (SICI) in the contralesional M1 was reduced significantly following intervention in the sham group. Correlation was found between baseline UE-FM score and changes in the contralesional SICI for all, as well as between changes in UE-FM and changes in contralesional RMT in the MEP- group.Conclusion: MI-BCI improved the motor function of the stroke-affected arm in chronic stroke patients with moderate to severe impairment. tDCS did not confer overall additional benefit although there was a trend toward greater benefit. Cortical activity changes in the contralesional M1 associated with functional improvement suggests a possible role for the contralesional M1 in stroke recovery in more severely affected patients. This has important implications in designing neuromodulatory interventions for future studies and tailoring treatment.Clinical Trial Registration: The study was registered at https://clinicaltrials.gov (NCT01897025). |
| first_indexed | 2024-12-11T17:30:17Z |
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| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-11T17:30:17Z |
| publishDate | 2020-08-01 |
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| spelling | doaj.art-0fbc2358f630410eac5b9f6e85f246f72022-12-22T00:56:51ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-08-011110.3389/fneur.2020.00948544866Using Transcranial Direct Current Stimulation to Augment the Effect of Motor Imagery-Assisted Brain-Computer Interface Training in Chronic Stroke Patients—Cortical Reorganization ConsiderationsEffie Chew0Effie Chew1Wei-Peng Teo2Wei-Peng Teo3Ning Tang4Kai Keng Ang5Yee Sien Ng6Juan Helen Zhou7Juan Helen Zhou8Irvin Teh9Kok Soon Phua10Ling Zhao11Cuntai Guan12Division of Neurology, Department of Medicine, National University Hospital, Singapore, SingaporeYong Loo Lin School of Medicine, National University of Singapore, Singapore, SingaporeNational Institute of Education, Nanyang Technological University, Singapore, SingaporeSchool of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, AustraliaDivision of Neurology, Department of Medicine, National University Hospital, Singapore, SingaporeInstitute for Infocomm Research (I2R), A*STAR, Singapore, SingaporeDepartment of Rehabilitation Medicine, Singapore General Hospital, Singapore, SingaporeCenter for Sleep and Cognition, Center for Translational MR Research, Yong Loo Lin School of Medicine, Singapore, SingaporeNeuroscience and Behavioral Disorders Program, Duke-NUS Medical School, Singapore, SingaporeSchool of Medicine, University of Leeds, Leeds, United KingdomSchool of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, AustraliaDivision of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore0School of Computer Science and Engineering, Nanyang Technological University, Singapore, SingaporeIntroduction: Transcranial direct current stimulation (tDCS) has been shown to modulate cortical plasticity, enhance motor learning and post-stroke upper extremity motor recovery. It has also been demonstrated to facilitate activation of brain-computer interface (BCI) in stroke patients. We had previously demonstrated that BCI-assisted motor imagery (MI-BCI) can improve upper extremity impairment in chronic stroke participants. This study was carried out to investigate the effects of priming with tDCS prior to MI-BCI training in chronic stroke patients with moderate to severe upper extremity paresis and to investigate the cortical activity changes associated with training.Methods: This is a double-blinded randomized clinical trial. Participants were randomized to receive 10 sessions of 20-min 1 mA tDCS or sham-tDCS before MI-BCI, with the anode applied to the ipsilesional, and the cathode to the contralesional primary motor cortex (M1). Upper extremity sub-scale of the Fugl-Meyer Assessment (UE-FM) and corticospinal excitability measured by transcranial magnetic stimulation (TMS) were assessed before, after and 4 weeks after intervention.Results: Ten participants received real tDCS and nine received sham tDCS. UE-FM improved significantly in both groups after intervention. Of those with unrecordable motor evoked potential (MEP-) to the ipsilesional M1, significant improvement in UE-FM was found in the real-tDCS group, but not in the sham group. Resting motor threshold (RMT) of ipsilesional M1 decreased significantly after intervention in the real-tDCS group. Short intra-cortical inhibition (SICI) in the contralesional M1 was reduced significantly following intervention in the sham group. Correlation was found between baseline UE-FM score and changes in the contralesional SICI for all, as well as between changes in UE-FM and changes in contralesional RMT in the MEP- group.Conclusion: MI-BCI improved the motor function of the stroke-affected arm in chronic stroke patients with moderate to severe impairment. tDCS did not confer overall additional benefit although there was a trend toward greater benefit. Cortical activity changes in the contralesional M1 associated with functional improvement suggests a possible role for the contralesional M1 in stroke recovery in more severely affected patients. This has important implications in designing neuromodulatory interventions for future studies and tailoring treatment.Clinical Trial Registration: The study was registered at https://clinicaltrials.gov (NCT01897025).https://www.frontiersin.org/article/10.3389/fneur.2020.00948/fullstrokemotor recoverytranscranial direct current stimulationbrain-computer interfacemotor imagery |
| spellingShingle | Effie Chew Effie Chew Wei-Peng Teo Wei-Peng Teo Ning Tang Kai Keng Ang Yee Sien Ng Juan Helen Zhou Juan Helen Zhou Irvin Teh Kok Soon Phua Ling Zhao Cuntai Guan Using Transcranial Direct Current Stimulation to Augment the Effect of Motor Imagery-Assisted Brain-Computer Interface Training in Chronic Stroke Patients—Cortical Reorganization Considerations Frontiers in Neurology stroke motor recovery transcranial direct current stimulation brain-computer interface motor imagery |
| title | Using Transcranial Direct Current Stimulation to Augment the Effect of Motor Imagery-Assisted Brain-Computer Interface Training in Chronic Stroke Patients—Cortical Reorganization Considerations |
| title_full | Using Transcranial Direct Current Stimulation to Augment the Effect of Motor Imagery-Assisted Brain-Computer Interface Training in Chronic Stroke Patients—Cortical Reorganization Considerations |
| title_fullStr | Using Transcranial Direct Current Stimulation to Augment the Effect of Motor Imagery-Assisted Brain-Computer Interface Training in Chronic Stroke Patients—Cortical Reorganization Considerations |
| title_full_unstemmed | Using Transcranial Direct Current Stimulation to Augment the Effect of Motor Imagery-Assisted Brain-Computer Interface Training in Chronic Stroke Patients—Cortical Reorganization Considerations |
| title_short | Using Transcranial Direct Current Stimulation to Augment the Effect of Motor Imagery-Assisted Brain-Computer Interface Training in Chronic Stroke Patients—Cortical Reorganization Considerations |
| title_sort | using transcranial direct current stimulation to augment the effect of motor imagery assisted brain computer interface training in chronic stroke patients cortical reorganization considerations |
| topic | stroke motor recovery transcranial direct current stimulation brain-computer interface motor imagery |
| url | https://www.frontiersin.org/article/10.3389/fneur.2020.00948/full |
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