Facilitation of corticospinal excitability by virtual reality exercise following anodal transcranial direct current stimulation in healthy volunteers and subacute stroke subjects

Someday in the far distant future there will be a written protocol for walking recovery. If YOU want it sooner than that YOU will need to demand your therapist initiate a translational clinical research trial on how best to get stroke patients walking.  This is not going to occur without YOU pushing it from the bottom. And if your hospital does not have research projects as goals for all therapists and doctors then you have a hospital that should not be used. Screaming would probably help.
Pay it forward people or future survivors will be screwed even worse than you were.
http://www.jneuroengrehab.com/content/11/1/124/abstract

Yeun Joon Kim, Jeonghun Ku, Sangwoo Cho, Hyun Jung Kim, Yun Kyung Cho, Teo Lim and Youn Joo Kang

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Journal of NeuroEngineering and Rehabilitation 2014, 11:124  doi:10.1186/1743-0003-11-124
Published: 18 August 2014

Abstract (provisional)

Background

There is growing evidence that the combination of non-invasive brain stimulation and motor skill training is an effective new treatment option in neurorehabilitation. We investigated the beneficial effects of the application of transcranial direct current stimulation (tDCS) combined with virtual reality (VR) motor training.

Methods

In total, 15 healthy, right-handed volunteers and 15 patients with stroke in the subacute stage participated. Four different conditions (A: active wrist exercise, B: VR wrist exercise, C: VR wrist exercise following anodal tDCS (1 mV, 20 min) on the left (healthy volunteer) or affected (stroke patient) primary motor cortex, and D: anodal tDCS without exercise) were provided in random order on separate days. We compared during and post-exercise corticospinal excitability under different conditions in healthy volunteers (A, B, C, D) and stroke patients (B, C, D) by measuring the changes in amplitudes of motor evoked potentials in the extensor carpi radialis muscle, elicited with single-pulse transcranial magnetic stimulation. For statistical analyses, a linear mixed model for a repeated-measures covariance pattern model with unstructured covariance within groups (healthy or stroke groups) was used.

Results

The VR wrist exercise (B) facilitated post-exercise corticospinal excitability more than the active wrist exercise (A) or anodal tDCS without exercise (D) in healthy volunteers. Moreover, the post-exercise corticospinal facilitation after tDCS and VR exercise (C) was greater and was sustained for 20 min after exercise versus the other conditions in healthy volunteers (A, B, D) and in subacute stroke patients (B, D).

Conclusions

The combined effect of VR motor training following tDCS was synergistic and short-term corticospinal facilitation was superior to the application of VR training, active motor training, or tDCS without exercise condition. These results support the concept of combining brain stimulation with VR motor training to promote recovery after a stroke.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.