https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-017-0253-y
- Kathryn S. Hayward,
- Sandra G. Brauer,
- Kathy L. RuddyEmail author,
- David Lloyd and
- Richard G. Carson
Journal of NeuroEngineering and Rehabilitation201714:46
DOI: 10.1186/s12984-017-0253-y
© The Author(s). 2017
Received: 27 March 2017
Accepted: 15 May 2017
Published: 30 May 2017
Abstract
Background
Therapy that combines
repetitive training with non-invasive brain stimulation is a potential
avenue to enhance upper limb recovery after stroke. This study aimed to
investigate the feasibility of transcranial Random Noise Stimulation
(tRNS), timed to coincide with the generation of voluntary motor
commands, during reaching training.
Methods
A triple-blind pilot RCT was
completed. Four stroke survivors with chronic (6-months to 5-years) and
severe arm paresis, not taking any medications that had the potential to
alter cortical excitability, and no contraindications to tRNS or MRI
were recruited. Participants were randomly allocated to 12 sessions of
reaching training over 4-weeks with active or sham tRNS delivered over
the lesioned hemisphere motor representation. tRNS was triggered to
coincide with a voluntary movement attempt, ceasing after 5-s. At this
point, peripheral nerve stimulation enabled full range reaching. To
determine feasibility, we considered adverse events, training outcomes,
clinical outcomes, corticospinal tract (CST) structural integrity, and
reflections on training through in-depth interviews from each individual
case.
Results
Two participants received
active and two sham tRNS. There were no adverse events. All training
sessions were completed, repetitive practice performed and clinically
relevant improvements across motor outcomes demonstrated. The amount of
improvement varied across individuals and appeared to be independent of
group allocation and CST integrity.
Conclusion
Reaching training that
includes tRNS timed to coincide with generation of voluntary motor
commands is feasible. Clinical improvements were possible even in the
most severely affected individuals as evidenced by CST integrity.
Trial registration
This study was registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR) http://www.ANZCTR.org.au/ACTRN12614000952640.aspx. Registration date 4 September 2014, first participant date 9 September 2014.
No comments:
Post a Comment