High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study
IntroductionPrevious studies found that post-stroke motor impairments are associated with damage to the lesioned corticospinal tract (CST) and hyperexcitability of the contralesional cortico-reticulospinal tract (CRST). This proof-of-concept study aims to develop a non-invasive brain stimulation pro...
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| Format: | Article |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Human Neuroscience |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fnhum.2023.1286238/full |
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| author | Jordan N. Williamson Shirley A. James Dorothy He Sheng Li Evgeny V. Sidorov Yuan Yang Yuan Yang Yuan Yang Yuan Yang Yuan Yang Yuan Yang |
| author_facet | Jordan N. Williamson Shirley A. James Dorothy He Sheng Li Evgeny V. Sidorov Yuan Yang Yuan Yang Yuan Yang Yuan Yang Yuan Yang Yuan Yang |
| author_sort | Jordan N. Williamson |
| collection | DOAJ |
| description | IntroductionPrevious studies found that post-stroke motor impairments are associated with damage to the lesioned corticospinal tract (CST) and hyperexcitability of the contralesional cortico-reticulospinal tract (CRST). This proof-of-concept study aims to develop a non-invasive brain stimulation protocol that facilitates the lesioned CST and inhibits the contralesional CRST to improve upper extremity rehabilitation in individuals with moderate-to-severe motor impairments post-stroke.MethodsFourteen individuals (minimum 3 months post ischemic stroke) consented. Physician decision of the participants baseline assessment qualified eight to continue in a randomized, double-blind cross-over pilot trial (ClinicalTrials.gov Identifier: NCT05174949) with: (1) anodal high-definition transcranial direct stimulation (HD-tDCS) over the ipsilesional primary motor cortex (M1), (2) cathodal HD-tDCS over contralesional dorsal premotor cortex (PMd), (3) sham stimulation, with a two-week washout period in-between. Subject-specific MR images and computer simulation were used to guide HD-tDCS and verified by Transcranial Magnetic Stimulation (TMS) induced Motor Evoked Potential (MEP). The motor behavior outcome was evaluated by an Fugl-Meyer Upper Extremity score (primary outcome measure) and the excitability of the ipslesoinal CST and contralesional CRST was determined by the change of MEP latencies and amplitude (secondary outcome measures).ResultsThe baseline ipsilesional M1 MEP latency and amplitude were correlated with FM-UE. FM-UE scores were improved post HD-tDCS, in comparison to sham stimulation. Both anodal and cathodal HD-tDCS reduced the latency of the ipsilesional M1 MEP. The contralesional PMd MEP disappeared/delayed after HD-tDCS.DiscussionThese results suggest that HD-tDCS could improve the function of the lesioned corticospinal tract and reduce the excitability of the contralesional cortico-reticulospinal tract, thus, improving motor function of the upper extremity in more severely impaired individuals. |
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| language | English |
| last_indexed | 2025-03-21T13:16:29Z |
| publishDate | 2023-10-01 |
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| spelling | doaj.art-69c1b2c0e87b4435a99680742c7730782024-06-26T14:32:39ZengFrontiers Media S.A.Frontiers in Human Neuroscience1662-51612023-10-011710.3389/fnhum.2023.12862381286238High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot studyJordan N. Williamson0Shirley A. James1Dorothy He2Sheng Li3Evgeny V. Sidorov4Yuan Yang5Yuan Yang6Yuan Yang7Yuan Yang8Yuan Yang9Yuan Yang10Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United StatesUniversity of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, OK, United StatesUniversity of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, United StatesDepartment of Physical Medicine and Rehabilitation, UT Health Huston, McGovern Medical School, Houston, TX, United StatesDepartment of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United StatesDepartment of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL, United StatesClinical Imaging Research Center, Stephenson Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL, United StatesBeckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, Urbana, IL, United StatesDepartment of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United StatesDepartment of Rehabilitation Sciences, College of Allied Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States0Gallogly College of Engineering, Stephenson School of Biomedical Engineering, University of Oklahoma, Oklahoma City, OK, United StatesIntroductionPrevious studies found that post-stroke motor impairments are associated with damage to the lesioned corticospinal tract (CST) and hyperexcitability of the contralesional cortico-reticulospinal tract (CRST). This proof-of-concept study aims to develop a non-invasive brain stimulation protocol that facilitates the lesioned CST and inhibits the contralesional CRST to improve upper extremity rehabilitation in individuals with moderate-to-severe motor impairments post-stroke.MethodsFourteen individuals (minimum 3 months post ischemic stroke) consented. Physician decision of the participants baseline assessment qualified eight to continue in a randomized, double-blind cross-over pilot trial (ClinicalTrials.gov Identifier: NCT05174949) with: (1) anodal high-definition transcranial direct stimulation (HD-tDCS) over the ipsilesional primary motor cortex (M1), (2) cathodal HD-tDCS over contralesional dorsal premotor cortex (PMd), (3) sham stimulation, with a two-week washout period in-between. Subject-specific MR images and computer simulation were used to guide HD-tDCS and verified by Transcranial Magnetic Stimulation (TMS) induced Motor Evoked Potential (MEP). The motor behavior outcome was evaluated by an Fugl-Meyer Upper Extremity score (primary outcome measure) and the excitability of the ipslesoinal CST and contralesional CRST was determined by the change of MEP latencies and amplitude (secondary outcome measures).ResultsThe baseline ipsilesional M1 MEP latency and amplitude were correlated with FM-UE. FM-UE scores were improved post HD-tDCS, in comparison to sham stimulation. Both anodal and cathodal HD-tDCS reduced the latency of the ipsilesional M1 MEP. The contralesional PMd MEP disappeared/delayed after HD-tDCS.DiscussionThese results suggest that HD-tDCS could improve the function of the lesioned corticospinal tract and reduce the excitability of the contralesional cortico-reticulospinal tract, thus, improving motor function of the upper extremity in more severely impaired individuals.https://www.frontiersin.org/articles/10.3389/fnhum.2023.1286238/fulltranscranial direct current stimulationtranscranial magnetic stimulationstrokeupper extremity rehabilitationmotor evoked potential |
| spellingShingle | Jordan N. Williamson Shirley A. James Dorothy He Sheng Li Evgeny V. Sidorov Yuan Yang Yuan Yang Yuan Yang Yuan Yang Yuan Yang Yuan Yang High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study Frontiers in Human Neuroscience transcranial direct current stimulation transcranial magnetic stimulation stroke upper extremity rehabilitation motor evoked potential |
| title | High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study |
| title_full | High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study |
| title_fullStr | High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study |
| title_full_unstemmed | High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study |
| title_short | High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study |
| title_sort | high definition transcranial direct current stimulation for upper extremity rehabilitation in moderate to severe ischemic stroke a pilot study |
| topic | transcranial direct current stimulation transcranial magnetic stimulation stroke upper extremity rehabilitation motor evoked potential |
| url | https://www.frontiersin.org/articles/10.3389/fnhum.2023.1286238/full |
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