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...
| Main Authors: | , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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2020
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| Online Access: | https://hdl.handle.net/10356/145640 |
| _version_ | 1811688329082568704 |
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| author | Chew, Effie Teo, Wei-Peng Tang, Ning Ang, Kai Keng Ng, Yee Sien Zhou, Helen Juan Teh, Irvin Phua, Kok Soon Zhao, Ling Guan, Cuntai |
| author2 | School of Computer Science and Engineering |
| author_facet | School of Computer Science and Engineering Chew, Effie Teo, Wei-Peng Tang, Ning Ang, Kai Keng Ng, Yee Sien Zhou, Helen Juan Teh, Irvin Phua, Kok Soon Zhao, Ling Guan, Cuntai |
| author_sort | Chew, Effie |
| collection | NTU |
| 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. |
| first_indexed | 2024-10-01T05:30:28Z |
| format | Journal Article |
| id | ntu-10356/145640 |
| institution | Nanyang Technological University |
| language | English |
| last_indexed | 2024-10-01T05:30:28Z |
| publishDate | 2020 |
| record_format | dspace |
| spelling | ntu-10356/1456402020-12-30T08:03:36Z Using transcranial direct current stimulation to augment the effect of motor imagery-assisted brain-computer interface training in chronic stroke patients—cortical reorganization considerations Chew, Effie Teo, Wei-Peng Tang, Ning Ang, Kai Keng Ng, Yee Sien Zhou, Helen Juan Teh, Irvin Phua, Kok Soon Zhao, Ling Guan, Cuntai School of Computer Science and Engineering Science::Medicine Stroke Motor Recovery 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. National Medical Research Council (NMRC) Published version This study was supported by grants from the National Medical Research Council, Singapore (NIG09may022). 2020-12-30T08:03:36Z 2020-12-30T08:03:36Z 2020 Journal Article Chew, E., Teo, W.-P., Tang, N., Ang, K. K., Ng, Y. S., Zhou, H. J., . . . Guan, C. (2020). 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, 11, 948-. doi:10.3389/fneur.2020.00948 1664-2295 https://hdl.handle.net/10356/145640 10.3389/fneur.2020.00948 32973672 11 en NIG09may022 Frontiers in Neurology © 2020 Chew, Teo, Tang, Ang, Ng, Zhou, Teh, Phua, Zhao and Guan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. application/pdf |
| spellingShingle | Science::Medicine Stroke Motor Recovery Chew, Effie Teo, Wei-Peng Tang, Ning Ang, Kai Keng Ng, Yee Sien Zhou, Helen Juan Teh, Irvin Phua, Kok Soon Zhao, Ling Guan, Cuntai 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 | 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 | Science::Medicine Stroke Motor Recovery |
| url | https://hdl.handle.net/10356/145640 |
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