Post-stroke balance rehabilitation under multi-level electrotherapy: a conceptual review

You'll have to see what your doctor does with this to update your stroke balance protocol.
http://journal.frontiersin.org/Journal/10.3389/fnins.2014.00403/full?
Anirban Dutta^1,2*, Uttama Lahiri³, Abhijit Das⁴, Michael A. Nitsche⁵ and David Guiraud^1,2

• ¹DEMAR (INRIA Sophia Antipolis), INRIA, CNRS: UMR5506, Université Montpellier II - Sciences et Techniques, Université Montpellier I, Montpellier, France
• ²Laboratoire d'Informatique de Robotique et de Microélectronique de Montpellier, CNRS: UMR5506, Université Montpellier II - Sciences et Techniques, Montpellier, France
• ³Electrical Engineering, Indian Institute of Technology, Gandhinagar, India
• ⁴Department of Neurorehabilitation, Institute of Neurosciences, Kolkata, India
• ⁵Department of Clinical Neurophysiology, Göttingen University Medical School, Göttingen, Germany

Stroke is caused when an artery carrying blood from heart to an area in the brain bursts or a clot obstructs the blood flow thereby preventing delivery of oxygen and nutrients. About half of the stroke survivors are left with some degree of disability. Innovative methodologies for restorative neurorehabilitation are urgently required to reduce long-term disability. The ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function, and connections is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. It has been shown that active cortical participation in a closed-loop brain machine interface (BMI) can induce neuroplasticity in cortical networks where the brain acts as a controller, e.g., during a visuomotor task. Here, the motor task can be assisted with neuromuscular electrical stimulation (NMES) where the BMI will act as a real-time decoder. However, the cortical control and induction of neuroplasticity in a closed-loop BMI is also dependent on the state of brain, e.g., visuospatial attention during visuomotor task performance. In fact, spatial neglect is a hidden disability that is a common complication of stroke and is associated with prolonged hospital stays, accidents, falls, safety problems, and chronic functional disability. This hypothesis and theory article presents a multi-level electrotherapy paradigm toward motor rehabilitation in virtual reality that postulates that while the brain acts as a controller in a closed-loop BMI to drive NMES, the state of brain can be can be altered toward improvement of visuomotor task performance with non-invasive brain stimulation (NIBS). This leads to a multi-level electrotherapy paradigm where a virtual reality-based adaptive response technology is proposed for post-stroke balance rehabilitation. In this article, we present a conceptual review of the related experimental findings.