Article type: Research Article
Authors: Cunningham, David A.a; b | Varnerin, Nicolea | Machado, Andrec | Bonnett, Corina | Janini, Daniela | Roelle, Saraha | Potter-Baker, Kelseya | Sankarasubramanian, Vishwanatha | Wang, Xiaofengd | Yue, Guange | Plow, Ela B.a; c; f; *
Affiliations:
[a] Department of Biomedical Engineering, Lerner Research Inst., Cleveland Clinic, Cleveland, OH, USA |
[b] School of Biomedical Sciences, Kent State University, Kent, OH, USA |
[c] Center for Neurological Restoration, Neurosurgery, Neurological Inst., Cleveland Clinic, Cleveland, OH, USA |
[d] Department of Quantitative Health Sciences, Cleveland Clinic, OH, USA |
[e] Human Performance & Engineering Laboratory, Kessler Foundation Research Center, West Orange, NJ, USA |
[f] Department of Physical Medicine & Rehab, Neurological Inst., Cleveland Clinic, Cleveland, OH, USA
Correspondence:
[*]
Corresponding author: Ela B. Plow, PhD, PT, Assistant Staff, Biomedical
Engineering, 9500 Euclid Ave, ND20, Cleveland Clinic, Cleveland, 44195
OH, USA. Tel.: +1 216 445 4589; Fax: +1 216 444 9198; E-mail: plowe2@ccf.org
Abstract:
Purpose:
To
demonstrate, in a proof-of-concept study, whether potentiating
ipsilesional higher motor areas (premotor cortex and supplementary motor
area) augments and accelerates recovery associated with constraint
induced movement.
Methods:
In a randomized, double-blinded pilot clinical
study, 12 patients
with chronic stroke were assigned to receive anodal transcranial direct
current stimulation (tDCS) (n = 6) or sham (n = 6) to the ipsilesional
higher motor areas during constraint-induced movement therapy. We
assessed functional and neurophysiologic outcomes before and after 5
weeks of therapy. Results:Only patients receiving tDCS demonstrated
gains in function and dexterity. Gains were accompanied by an increase
in excitability of the contralesional rather than the ipsilesional
hemisphere.
Conclusions:
Our proof-of-concept study provides early
evidence that stimulating higher motor areas can help recruit the
contralesional hemisphere in an adaptive role in cases of greater
ipsilesional injury. Whether this early evidence of promise translates
to remarkable gains in functional recovery compared to existing
approaches of stimulation remains to be confirmed in large-scale
clinical studies that can reasonably dissociate stimulation of higher
motor areas from that of the traditional primary motor cortices.
Keywords: Stroke
rehabilitation, transcranial direct current stimulation,
constraint-induced movement therapy, premotor cortex, motor recovery,
transcranial magnetic stimulation
DOI: 10.3233/RNN-150574
Journal: Restorative Neurology and Neuroscience, vol. 33, no. 6, pp. 911-926, 2015
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