[ARTICLE] Opportunities for Guided Multichannel Non-invasive Transcranial Current Stimulation in Poststroke Rehabilitation – Full Text HTML

Stroke is a leading cause of serious long-term disability worldwide. Functional outcome depends on stroke location, severity and early intervention. Conventional rehabilitation strategies have limited effectiveness, and new treatments still fail to keep pace, in part due to a lack of understanding of the different stages in brain recovery and the vast heterogeneity in the post-stroke population. Innovative methodologies for restorative neurorehabilitation are required to reduce long-term disability and socioeconomic burden. Neuroplasticity is involved in post-stroke functional disturbances, and also during rehabilitation. Tackling post-stroke neuroplasticity by non-invasive brain stimulation is regarded as promising, but efficacy might be limited because of rather uniform application across patients despite individual heterogeneity of lesions, symptoms and other factors. Transcranial direct current stimulation (tDCS) induces and modulates neuroplasticity, and has been shown to be able to improve motor and cognitive functions. tDCS is suited to improve post-stroke rehabilitation outcomes, but effect sizes are often moderate and suffer from variability. Indeed, the location, extent and pattern of functional network connectivity disruption should be considered when determining the optimal location sites for tDCS therapies. Here, we present potential opportunities for neuroimaging-guided tDCS-based rehabilitation strategies after stroke that could be personalized. We introduce innovative multimodal intervention protocols based on multichannel tDCS montages, neuroimaging methods and real-time closed-loop systems to guide therapy. This might help to overcome current treatment limitations in post-stroke rehabilitation and increase our general understanding of adaptive neuroplasticity leading to neural reorganization after stroke.

Continue —> Frontiers | Opportunities for Guided Multichannel Non-invasive Transcranial Current Stimulation in Poststroke Rehabilitation | Stroke

Figure 1. Stimweaver simulations for (A) guided multichannel tDCS montages vs. (B) classical tDCS montages. (A) Multichannel tDCS representations for distributed cortical targets for (A.1) poststroke lower limb motor rehabilitation (top and back views, see Multichannel tDCS for Poststroke Lower Limb Motor Rehabilitation) and (A.2) poststroke aphasia rehabilitation (left and right views, see Multichannel tDCS for Poststroke Aphasia Rehabilitation). Optimal solution using eight Neuroelectrics Pistim circular electrodes (1 cm radius and Ag/Cl). Total injected current 4 mA. Plots of the normal component of the E-field (V/m) (left), tDCS target region (center left), priority level (center right), and relative error (right) shown on the gray matter. In the left column, positive (red) colors reflect ingoing, excitatory normal electric fields (blue the opposite). In the second column, red areas denote targets to facilitate activation and blue to suppress activation. The third column colors reflect the importance (weight) of each area taking positive values up to 20. A dark blue cortical area reflects minimum/default priority and a red area maximum priority. In-between colors denote the corresponding intermediate priority. The last column provides a visual display of the match of electric fields solution to target [the relative error (10)]. Note that this model may not fit each poststroke patient with lower limb (A.1) or language (A.2) impairment because areas important for restitution are likely to be different according to lesion size and location (see Multichannel tDCS for Poststroke Lower Limb Motor Rehabilitation and Multichannel tDCS for Poststroke Aphasia Rehabilitation for details). (B) Plots of the normal component of the E-field (volts per meter) of classical tDCS montages for (B.1) anodic poststroke motor rehabilitation (top, back, and frontal views) and (B.2) cathodic poststroke aphasia rehabilitation (left, right, and frontal views). Solutions using two Neuroelectrics Pistim circular electrodes. Total injected current 2 mA. (B.1) Anodic stimulation over the M1 affected area: “active” electrode on C1 and cathode (return electrode) over the contralateral supraorbital area (38). (B.2) Cathodic stimulation over the right homolog of Broca’s area: “active” electrode on F6 and anode (return electrode) over the contralateral supraorbital area (47).

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