High-Definition Transcranial Direct Current with Electrical Theta Burst on Post-Stroke Motor Rehabilitation: A Pilot Randomized Controlled Trial

How many hospitals have both of these and know how to work them together? In simple words; Where the fuck is the protocol so your hospital will do it right the first time?

High-Definition Transcranial Direct Current with Electrical Theta Burst on Post-Stroke Motor Rehabilitation: A Pilot Randomized Controlled Trial

Yi-Jing Huang, PhD, Shun-Min Wang, PhD, […], Chieh Chen, MD, Chien-An Chen, MS, Chun-Wei Wu, PhD, Jia-Jin Chen, PhD, Chih-Wei Peng, PhD, Che-Wei Lin, PhD, Shih-Wei Huang, PhD, and Shih-Ching Chen, PhD https://orcid.org/0000-0002-8630-1271 csc@tmu.edu.tw, +7 -7View all authors and affiliations

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https://doi.org/10.1177/15459683221121751

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Abstract

Background:

High-definition transcranial electrical theta burst superimposing direct current stimulation (HD-tDCS-eTBS) not only incorporates the therapeutic advantages of tDCS and TBS but enhances stimulation focality and practicality. However, the applicability of this innovative neuromodulatory device in post-stroke rehabilitation remains uncertain.

Objective:

This study aimed to assess the efficacy and safety of the HD-tDCS-eTBS on upper extremity (UE) motor function in patients with chronic stroke.

Methods:

A patient-blinded, randomized controlled study was conducted. Twenty-four participants were randomly assigned into either the active HD-tDCS-eTBS group or sham HD-tDCS-eTBS group. Both groups received 20 minutes of active/sham HD-tDCS-eTBS combined with 30 minutes of conventional UE rehabilitation each time, 3 times a week for 4 weeks. Outcome measures including the Fugl-Meyer Assessment of Upper Extremity, Wolf Motor Function Test, Jebsen-Taylor Hand Function Test, Finger-Nose Test, and Modified Ashworth Scale were assessed before and immediately after the intervention period.

Results:

Spasticity of shoulder adductor (P = .05), elbow extensor (P = .04), and thumb flexor (P < .01) were significantly reduced in the active HD-tDCS-eTBS group versus the sham group. Nonsignificant trends in the improvements of most other outcome measures were in favor of the active HD-tDCS-eTBS group with moderate to large effect sizes (P = .06–.26, η_p² = 0.06–0.16). No severe adverse events except for slight skin redness under the stimulus electrode was detected after the HD-tDCS-eTBS.

Conclusions:

Our findings support that HD-tDCS-eTBS is safe and has therapeutic potential for post-stroke UE motor rehabilitation.

Trial registration:

ClinicalTrials.gov (ID: NCT04278105).

Effects of electrode configurations in transcranial direct current stimulation after stroke

 Useless. I see nothing here that any objective starting points were identified, so not repeatable. No protocols came from it so not helpful in any regard for survivors.

Using Fugl-Meyer for anything in stroke is the height of stupidity, nothing objective in it, so nothing is repeatable.

tDCS wouldn't work on me since it is not going to enervate dead neurons, so I'm still screwed until something more useful comes along.  

And they didn't do hd-tDCS so more research still needed. 

Do mentors and senior researchers even think before starting research?

Effects of electrode configurations in transcranial direct current stimulation after stroke

  Kenneth Chelette
¹
, Cheryl Carrico
¹
, Laurie Nichols
¹
, Emily Salyers
¹
, Lumy Sawaki
¹

¹
 University of Kentucky, Physical Medicine and Rehabilitation Cardinal Hill Rehabilitation Hospital Lexington, KY, USA

 Abstract

 —Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that can modulate neuroplasticity (the capacity for brain reorganization). Neuroplastic change correlates with upper extremity (UE) recovery after brain lesions. Different electrode configurations of tDCS paired with UE motor training can have different effects in distinct populations. We are conducting the first randomized, double-blind, placebo-controlled trial to investigate which tDCS configuration may best enhance outcomes of UE motor training for stroke survivors with chronic,
severe hemiparesis (i.e., little or no wrist or hand movement). We have assigned subjects to 1 of 4 groups: 1) “Anodal”: anodal tDCS to excite ipsilesional motor cortex; 2) “Cathodal”: cathodal tDCS to inhibit contralesional motor cortex; 3) “Dual”: a simultaneous combination of anodal and cathodal tDCS; or 4) “Sham” tDCS. Intervention (10 sessions) consists of tDCS followed by 3 hours of intensive, task-oriented UE training in each session. Our primary outcome measure is Fugl-Meyer Assessment. Our secondary outcome measures are Action Research Arm Test and Stroke Impact Scale. We have conducted evaluations at baseline and post-intervention. Preliminary results from 26 of (projected) 44 subjects indicate substantially greater improvement for the “Cathodal” group than other groups. These findings differ from evidence about tDCS in rehabilitation of mild-to-moderate hemiparesis. Completion of our study will include full analysis of neuroplastic change associated with intervention.

Recruits sought for study to stimulate the ageing brain - University of Queensland researchers

I know it says healthy adults but be a pain in the ass and ask why such limited research. Then ask whether anodal tDCS, cathodal tDCS,  or HD-tDCS is being used and why that choice.
https://www.uq.edu.au/news/article/2018/05/recruits-sought-study-stimulate-ageing-brain

Brain training and stimulation in older adults may be the key to tackling cognitive decline and dementia, according to University of Queensland researchers.
Associate Professor Paul Dux and his team in the UQ School of Psychology are looking to recruit 200 healthy adults, aged 60 to 75, to take part in a study on cognitive training and brain stimulation.
“The ageing population has been identified as a key global health problem, bringing an increase in age-related disease and disability,” Dr Dux said.
“We need to examine and understand ways to prevent cognitive decline and dementia.
“Our study is using a form of non-invasive brain stimulation called transcranial direct current stimulation (tDCS), where we pass a very weak electrical current through two electrodes on the scalp.
“It’s virtually unnoticeable, causing only a mild sensation, and it has already shown promising effects in young adults.
“We combine the tDCS with a computerised behavioural training program where people try to improve their decision-making reaction times, and test people on a range of other tasks that measure memory and the ability to stay task-focussed.”
The study is being conducted at UQ’s St Lucia campus, where participants take part in eight sessions over a three month period.
“People come into the lab for an initial session where we take a number of base-line measurements assessing cognition, and they return for daily brain stimulation and training across a week,” Dr Dux said.
“There are follow-up sessions after one month and three months so we can see if the benefits continue over time.
“We recognise it’s a large time commitment, with each session ranging from one to four hours, so we will pay people $320 for taking part.
“More importantly, participants will be involved in one of the largest studies of its kind, helping us find ways to enhance cognition in people as they age, and that’s a huge issue facing world health.”
If you would like to participate, contact researcher Kristina Horne, k.horne@uq.edu.au or 0411 641 079.

Facts: ageing population, cognitive decline, dementia

• One of the biggest global health challenges is the ageing population.
• It is predicted that the global population of older adults will more than double by 2050. One in six workers is now aged over 65, and that figure will rise to one in three by 2050.
• Age-related cognitive decline has a profound impact on job performance and on how the health system is run.
• Age-related cognitive decline affects people’s everyday lives, such as the ability to plan, make decisions, solve problems, socialise, and care for themselves.
• About 30 per cent of adults over 65 will experience cognitive decline and face a substantially increased risk of developing dementia.
• The annual cost of dementia in Australia is now estimated at more than $15 billion, and is expected to increase to more than $36.8 billion by 2056.

Media: Associate Professor Paul Dux, p.dux@psy.uq.edu.au, +61 7 3365 6885, @PaulEDux; UQ Communications, habs.media@uq.edu.au +61 7 3346 3037, @UQhealth.
Video: An interview with Associate Professor Paul Dux is available for media repurposing. Contact Dani Nash, UQ Communications, dani.nash@uq.edu.au, +61 7 3346 3035.

Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke

Useless, even though it didn't work the protocols are not available for the next researcher to avoid. 

Is anyone ever going to put together a protocol on using tDCS and which type?   Otherwise all this fucking research and reviews are totally worthless.  This is why we need strong stroke leadership, to actually help stroke survivors.

• HD-tDCS (3)

• cathodal tDCS (6)   

• anodal tDCS (9)  

• tDCS (61)

Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke

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Manuela Hamoudi¹

Manuela Hamoudi

1University Hospital Freiburg, Freiburg, Germany
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, Heidi M. Schambra, MD²³

Heidi M. Schambra

2New York University, NY, USA3National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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, Brita Fritsch, MD¹

Brita Fritsch

1University Hospital Freiburg, Freiburg, Germany
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,

Annika Schoechlin-Marx, MD¹

Annika Schoechlin-Marx

1University Hospital Freiburg, Freiburg, Germany
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, Cornelius Weiller, MD¹

Cornelius Weiller

1University Hospital Freiburg, Freiburg, Germany
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, Leonardo G. Cohen, MD³

Leonardo G. Cohen

3National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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, Janine Reis, MD¹³

Janine Reis

1University Hospital Freiburg, Freiburg, Germany3National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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...

First Published April 22, 2018 Research Article

https://doi.org/10.1177/1545968318769164

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Article Information

Article first published online: April 22, 2018

https://doi.org/10.1177/1545968318769164

Manuela Hamoudi¹, Heidi M. Schambra, MD^{2, 3}, Brita Fritsch, MD¹, Annika Schoechlin-Marx, MD¹, Cornelius Weiller, MD¹, Leonardo G. Cohen, MD³, Janine Reis, MD^{1, 3}

¹University Hospital Freiburg, Freiburg, Germany

²New York University, NY, USA

³National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA

Corresponding Author: Janine Reis, MD, Department of Neurology, Albert-Ludwigs-University Freiburg, Breisacher Str 64, 79106 Freiburg, Germany. Email: janine.reis@uniklinik-freiburg.de

• Abstract
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Abstract

Background. Motor training alone or combined with transcranial direct current stimulation (tDCS) positioned over the motor cortex (M1) improves motor function in chronic stroke. Currently, understanding of how tDCS influences the process of motor skill learning after stroke is lacking. Objective. To assess the effects of tDCS on the stages of motor skill learning and on generalization to untrained motor function.  
Methods. In this randomized, sham-controlled, blinded study of 56 mildly impaired chronic stroke patients, tDCS (anode over the ipsilesional M1 and cathode on the contralesional forehead) was applied during 5 days of training on an unfamiliar, challenging fine motor skill task (sequential visual isometric pinch force task). We assessed online and offline learning during the training period and retention over the following 4 months. We additionally assessed the generalization to untrained tasks. Results. With training alone (sham tDCS group), patients acquired a novel motor skill. This skill improved online, remained stable during the offline periods and was largely retained at follow-up. When tDCS was added to training (real tDCS group), motor skill significantly increased relative to sham, mostly in the online stage. Long-term retention was not affected by tDCS. Training effects generalized to untrained tasks, but those performance gains were not enhanced further by tDCS. Conclusions. Training of an unfamiliar skill task represents a strategy to improve fine motor function in chronic stroke. tDCS augments motor skill learning, but its additive effect is restricted to the trained skill.

Neuroplasticity and network connectivity of the motor cortex following stroke: A transcranial direct current stimulation study

Is anyone ever going to put together a protocol on using tDCS and which type?   Otherwise all this fucking research and reviews are totally worthless.  This is why we need strong stroke leadership, to actually help stroke survivors.

• HD-tDCS (3)

• cathodal tDCS (6)   

• anodal tDCS (9)  

• tDCS (61)

Neuroplasticity and network connectivity of the motor cortex following stroke: A transcranial direct current stimulation study

Brenton Hordacre

Bahar Moezzi

Michael C. Ridding

First published: 

14 April 2018

https://doi.org/10.1002/hbm.24079

Funding information National Health and Medical Research Council (NHMRC), Grant/Award N ... More

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Abstract

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has potential for clinical utility in neurorehabilitation. However, recent evidence indicates that the responses to tDCS are highly variable. This study investigated whether electroencephalographic (EEG) measures of functional connectivity of the target network were associated with the response to ipsilesional anodal tDCS in stroke survivors. Ten chronic stroke patients attended two experimental sessions in a randomized cross‐over trial and received anodal or sham tDCS. Single‐pulse transcranial magnetic stimulation was used to quantify change in corticospinal excitability following tDCS. At the beginning of each session, functional connectivity was estimated using the debiased‐weighted phase lag index from EEG recordings at rest. Magnetic resonance imaging identified lesion location and lesion volume. Partial least squares regression identified models of connectivity which maximally accounted for variance in anodal tDCS responses. Stronger connectivity of a network with a seed approximating the stimulated ipsilesional motor cortex, and clusters of electrodes approximating the ipsilesional parietal cortex and contralesional frontotemporal cortex in the alpha band (8–13 Hz) was strongly associated with a greater increase of corticospinal excitability following anodal tDCS. This association was not observed following sham stimulation. Addition of a structural measure(s) of injury (lesion volume) provided an improved model fit for connectivity between the seed electrode and ipsilesional parietal cortex, but not the contralesional frontotemporal cortex. TDCS has potential to greatly assist stroke rehabilitation and functional connectivity appears a robust and specific biomarker of response which may assist clinical translation of this therapy.

Combined Transcranial Direct Current Stimulation and Virtual Reality-Based Paradigm for Upper Limb Rehabilitation in Individuals with Restricted Movements. A Feasibility Study with a Chronic Stroke Survivor with Severe Hemiparesis

How many fucking times does virtual reality need to be proven in research before someone writes up a fucking stroke protocol on it? NEVER I BET.
With 89 virtual reality posts back to September, 2011 it just shows the fucking incompetence in stroke.   Is this anodal tDCS, cathodal tDCS or HD-tDCS?
https://link.springer.com/article/10.1007/s10916-018-0949-y

• Authors
• Authors and affiliations

• María Antonia Fuentes
• Adrián Borrego
• Jorge Latorre
• Carolina Colomer
• Mariano Alcañiz
• María José Sánchez-LedesmaEmail author
• Enrique Noé
• Roberto Llorens

• María Antonia Fuentes
  • 1
• Adrián Borrego
  • 2
• Jorge Latorre
  • 2
• Carolina Colomer
  • 1
• Mariano Alcañiz
  • 2
• María José Sánchez-Ledesma
  • 3
  Email author
• Enrique Noé
  • 1
• Roberto Llorens
  • 1
  • 2

1. 1.Servicio de Neurorrehabilitación y Daño Cerebral de los Hospitales VITHAS-NISAFundación Hospitales NISAValenciaSpain
2. 2.Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en BioingenieríaUniversitat Politècnica de ValènciaValenciaSpain
3. 3.VisualMed Systems GroupUniversity of SalamancaSalamancaSpain

Patient Facing Systems

First Online: 02 April 2018

Part of the following topical collections:

1. Emergent Visualization Systems in Biomedical Sciences (TEEM 2017)

Abstract

Impairments of the upper limb function are a major cause of disability and rehabilitation. Most of the available therapeutic options are based on active exercises and on motor and attentional inclusion of the affected arm in task oriented movements. However, active movements may not be possible after severe impairment of the upper limbs. Different techniques, such as mirror therapy, motor imagery, and non-invasive brain stimulation have been shown to elicit cortical activity in absence of movements, which could be used to preserve the available neural circuits and promote motor learning. We present a virtual reality-based paradigm for upper limb rehabilitation that allows for interaction of individuals with restricted movements from active responses triggered when they attempt to perform a movement. The experimental system also provides multisensory stimulation in the visual, auditory, and tactile channels, and transcranial direct current stimulation coherent to the observed movements. A feasibility study with a chronic stroke survivor with severe hemiparesis who seemed to reach a rehabilitation plateau after two years of its inclusion in a physical therapy program showed clinically meaningful improvement of the upper limb function after the experimental intervention and maintenance of gains in both the body function and activity. The experimental intervention also was reported to be usable and motivating. Although very preliminary, these results could highlight the potential of this intervention to promote functional recovery in severe impairments of the upper limb.

Soterix Medical Inc. Awarded $2.5M NIH Grant to Run Phase-2 Efficacy Trial to Treat Aphasia After Stroke with HD-tDCS

Does your doctor know about this and checked to see if you might be able to get into the trial? Isn't that what your doctor should be doing? AT A MINIMUM?
What other protocol does your doctor have you doing to treat your aphasia? What is the efficacy rating? I bet s/he has no fucking clue about its efficacy?  That lack of knowledge should be a fireable offense. I take no prisoners.
http://www.businesswire.com/news/home/20160615005430/en/Soterix-Medical-Awarded-2.5M-NIH-Grant-Run

NEW YORK--(BUSINESS WIRE)--Soterix Medical, Inc. (SMI), the leading non-invasive neuromodulation medical technology company, announces the award of a $2.5 million grant from the National Institute of Neurological Disorders and Stroke to support a Phase-2 Clinical Trial aimed at establishing the effectiveness of individualized High-Definition transcranial Direct Current Stimulation (HD-tDCS ^TM) for adjunctive treatment of anomia in chronic post-stroke aphasia. The multi-center, randomized, sham-controlled, double-blind trial includes collaborators from Georgetown University, University of North Carolina, Medstar Research Institute, The City College of New York (CCNY) and University of South Carolina. Additional trial information can be found here.

“I am very pleased that NIH has funded this extremely important Phase-2 trial. The full development of this electrical stimulation platform and the safety outcomes have potentially broader clinical applicability included motor recovery in stroke and analgesic effects in central pain”

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Aphasia is an impairment of language, affecting production or comprehension of speech and the ability to read or write. It is a debilitating long-term consequence for 1 in 5 stroke cases. For these patients, HD-tDCS, combined with speech therapy, has the potential to improve language function. HD-tDCS delivers current to an individually targeted brain region to enhance plasticity during speech therapy and thus improve functional outcomes. Individualized targeting is particularly important in stroke rehabilitation where the presence of brain lesions leads to drastically altered stimulation pattern. Based on each patient brain scan (MRI), therapy can be targeted by clinicians to specific viable brain areas determined with functional MRI, making HD-tDCS, the first non-invasive individualized neuromodulation technique.
The Phase-2 Clinical Trial follows a successful Phase-1 Clinical Trial that demonstrated that Soterix Medical’s exclusive Neurotargeting software could be used to individualize therapy to each patient, with the goal to boost plasticity in the targeted brain regions. The hardware system uses patent protected “HD” electrode arrays.
Dr. Abhishek Datta, Scientist and CTO of SMI and Dr. Lucas C. Parra, Professor of Biomedical Engineering at CCNY will lead the study as Principal Investigators.
“This grant from the National Institute of Health will advance the validation of HD- tDCS as the only neuromodulation platform that is non-invasive, low-intensity, and targeted. Soterix Medical is the technology leader in non-invasive neuromodulation with a commitment to enhance the treatment of neuropsychiatric disorders and neuro-rehabilitation after injury. This trial supports our mission to translate medical research in neuromodulation to clinical practice.” said Dr. Datta. “I am very pleased that NIH has funded this extremely important Phase-2 trial. The full development of this electrical stimulation platform and the safety outcomes have potentially broader clinical applicability included motor recovery in stroke and analgesic effects in central pain,” said Dr. Parra.
CAUTION: tDCS is limited by Federal (or United States) law to investigational use only.
BACKGROUND: High-Definition tDCS (HD-tDCS) is an exclusive Neuromodulation technology developed by Soterix Medical Inc. Invented at The City College of New York, it is the only technology platform that allows tolerated non-invasive delivery of therapeutic current to desired brain regions. As a result, HD-tDCS offers potential for safe and effective treatment of neuropsychiatric disorders not possible with any other technology. HD-tDCS is made possible through innovations in electrode design allowing safe and tolerated passage of current through proprietary “High-Definition” electrodes, individualized brain current-flow modeling and through patented targeting algorithms indicating how to place and energize HD-electrodes on the head.

Contacts

Soterix Medical, Inc.
Kamran Nazim, +1-888-990-8327
contact@soterixmedical.com

 

Soterix Medical Announces Completion of Stroke-Aphasia Trial

The article here: I dislike the proprietary part.
http://www.digitaljournal.com/pr/1014812

The NINDS page on aphasia here:
http://www.ninds.nih.gov/disorders/aphasia/aphasia.htm

Picture here:
http://photos.prnewswire.com/medias/switch.do?prefix=/appnb&page=/getStoryRemapDetails.do&prnid=20130115%252fNY42528&action=details

Abstract of trial here:
http://www.brainstimjrnl.com/article/S1935-861X%2812%2900183-0/abstract

Abstract 

Background

Transcranial direct current stimulation (tDCS) induces long-lasting NMDA receptor-dependent cortical plasticity via persistent subthreshold polarization of neuronal membranes. Conventional bipolar tDCS is applied with two large (35 cm²) rectangular electrodes, resulting in directional modulation of neuronal excitability. Recently a newly designed 4 × 1 high-definition (HD) tDCS protocol was proposed for more focal stimulation according to the results of computational modeling. HD tDCS utilizes small disc electrodes deployed in 4 × 1 ring configuration whereby the physiological effects of the induced electric field are thought to be grossly constrained to the cortical area circumscribed by the ring.

Objective

We aim to compare the physiological effects of both tDCS electrode arrangements on motor cortex excitability.

Methods

tDCS was applied with 2 mA for 10 min. Fourteen healthy subjects participated, and motor cortex excitability was monitored by transcranial magnetic stimulation (TMS) before and after tDCS.

Results

Excitability enhancement following anodal and a respective reduction after cathodal stimulation occurred in both, conventional and HD tDCS. However, the plastic changes showed a more delayed peak at 30 min and longer lasting after-effects for more than 2 h after HD tDCS for both polarities, as compared to conventional tDCS.

Conclusion

The results show that this new electrode arrangement is efficient for the induction of neuroplasticity in the primary motor cortex. The pattern of aftereffects might be compatible with the concept of GABA-mediated surround inhibition, which should be explored in future studies directly.