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Bilateral High-Definition Transcranial Direct Current Stimulation for Upper Extremity Rehabilitation in Stroke | IEEE Conference Publication | IEEE Xplore

Bilateral High-Definition Transcranial Direct Current Stimulation for Upper Extremity Rehabilitation in Stroke


Abstract:

Previous research shows that both anodal and cathodal high-definition transcranial direct current stimulation (HD-tDCS) may improve function of the upper extremity post s...Show More

Abstract:

Previous research shows that both anodal and cathodal high-definition transcranial direct current stimulation (HD-tDCS) may improve function of the upper extremity post stroke. However, most research has focused on the effects separately, therefore the purpose of this study was to determine the effects of performing simultaneous anodal-cathodal HD-tDCS. Five stroke participants received the stimulations in four visits with a two-week washout period: 1) anodal HD-tDCS to the ipsilesional primary motor cortex, 2) cathodal HD-tDCS to the contralesional dorsal premotor cortex, 3) bilateral anodal-cathodal HD-tDCS, and 4) sham. Active stimulation (anodal, cathodal, and bilateral) increased Fugl-Meyer upper extremity scores and decreased latency of ipsilesional M1-induced MEP. These results suggest that HD-tDCS could improve motor function of the upper extremity post-stroke, however, bilateral stimulation may not have an increased effect compared to anodal and cathodal HD-tDCS separately. This early phase study improves our understanding of neural circuitry and plasticity post stroke and HD-tDCS methods for improving function of the impaired arm post-stroke.
Date of Conference: 15-19 July 2024
Date Added to IEEE Xplore: 17 December 2024
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Conference Location: Orlando, FL, USA

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I. Introduction

Stroke occurs when the blood supply to the brain is reduced or blocked completely, which prevents brain tissue from getting oxygen and nutrients [1]. More than 795,000 people in the United States experience a stroke each year. It is the fifth leading cause of death and the leading cause of serious long-term disability [2]. Specifically, a stroke that occurs in the motor and somatosensory cortices will cause focal damage to the cortices and to their descending pathways [3]. This causes a variety of physical effects, including hemiparesis, loss of sensation in the extremities, abnormal muscle synergies, spasticity, and loss of fine motor skills. [4]. Most (80%) ischemic stroke survivors report movement impairment on the side of the body contralateral to the lesioned hemisphere [4]. As a result of the damage to the ipsilesional motor cortex or its descending pathway, i.e., the corticospinal tract (CST) [5], there is a maladaptive hyperexcitability in the cortico-reticulospinal tract (CRST) in the contralesional hemisphere [5], hyperexcitability in post stroke motor impairments, specifically in more severe individuals and particularly in the expression of abnormal muscle synergies in the paretic upper limb [6]. The medial CRST primarily originates from the dorsal premotor cortex (PMd) and travels through the pontine reticular formation [7]. Previous studies applying transcranial magnetic stimulation (TMS) to patients after stroke demonstrated that the medial CRST is responsive to the excitatory ipsilateral input from the PMd in the contralesional hemisphere [8], [9]. This finding makes the contralesional PMd a potential target for combating moderate-to-severe movement impairment.

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