y p
play

Y P Behavioral Intervention Research Using tDCS Plasticity O - PDF document

Apr 12, 2023 •171 likes •265 views

Berenson-Allen Center for Noninvasive Brain Stimulation Beth Israel Deaconess Medical Center Harvard Medical School Adaptive Y P Behavioral Intervention Research Using tDCS Plasticity O Dylan J. Edwards PhD Director, Moss Rehabilitation

  1. Berenson-Allen Center for Noninvasive Brain Stimulation Beth Israel Deaconess Medical Center Harvard Medical School Adaptive Y P Behavioral Intervention Research Using tDCS Plasticity O Dylan J. Edwards PhD Director, Moss Rehabilitation Research Institute, Philadelphia C Professor of Neuroscience, ECU Australia Maladaptive T O N Robotics for assessment of performance kinematics Patient O Pre – training Promoting Post - training useful D Intervention plasticity in motor cortex E Patient + S Intervention A E TMS Demonstration !"#$ L P

  2. ?"'0$8":';8"A0B+%-4"'+$,-./ Y P O C 23$"+45/4",+"0$56)/"-*,/4/**/),78"-"7,0'6%67"564-,0+$"+*"-,"%/-7,"9"'0$"-," :"';"+4"-$"0$,/$70,&"+*"<=>"';"*+4"?"'0$@ T !"#$%&"'()*"'+$,-./"/**/),01/ %&!'()*+*!+,-.+/000 O N O Corticomotor excitability in stroke D E Webster et al (2006) S A E L Functional Improvements TMS correlates P sRT/cRT Resting MT 7%>+62;'-*+&*%,-*.//?* !"#$%&'(%)*+&*%,-*.//0* Pinch force acceleration Transcallosal Inhibition @"AA'"*+&*%,-*.//4* 1%,2"3*+&*%,-*.//4* 5633+,*+&*%,-*.//4* B(+A)'*+&*%,8-*.//:* fingers/thumb AROM 7%,+,,'*+&*%,8-*.//4****9'3* MEP Amplitude B(+A)'*+&*%,8-*.//= Movement accuracy +&*%,8-*.//:*5633+,*+&* 1%)C6(*+&*%,8-*.//=* %,-*.//:*9;+<(*+&*%,8-* 7%>+62;'*+&*%,8-*.//=* Purdue Pegboard .//=*5633+,*+&*%,-* @"AA'"-*+&*%,8-*.//:** .//=** JTT D+(;%;)-*+&*%,8-*.//E* Webster et al (2006) Webster et al (2006) Webster et al (2006) IMPROVED CORTICOMOTOR OUTPUT FROM IPSI-LESIONAL M1 IMPROVED CORTICOMOTOR OUTPUT FROM IPSI-LESIONAL M1 & IMPROVED MOTOR BEHAVIOUR & IMPROVED MOTOR BEHAVIOUR

  3. Anodal tDCS favors clinical improvement in stroke… Y P O C T Butler et al. O N O How does repetitive behavior affect D motor cortex? E S A E L P Motor map does not change unless in skill context Simple repetitive finger movements increase excitability

  4. Y Anodal tDCS prior to excitatory PAS P further boosts How does combined intervention affect excitability, while during tDCS motor cortex? reverses effect to O reduced excitability C Nitsche et al (2007) T O N Anodal tDCS combined with robotic motor training O Is coupling tDCS with training good? D 1mV E Pre-tDCS Post-tDCS Post-Robot S A E Anodal tDCS combined with robotic motor training !"#"$%&'"()*(+,&"-%.,'(-"%/01"/(.)('#,&,'%#(*0&'.,)& L P C+1/'/$,"DB//5"EB/-F8"'/-$G" C+1/'/$,"D'++,H$/77" ;0'" I/10-,0+$" Highest correlation with clinical function Group SICI Index Conditioned / uncond MEP amplitude * p < 0.05 1 * 0.5 0 Pre Post Post “Kinematic Robot-Based Evaluation Scales and Clinical Counterparts to Measure Upper tDCS tDCS Robot Limb Motor Performance in Patients With Chronic Stroke” (Bosecker et al, 2009) Edwards et al (2009)

  5. Key Findings: Effect of Intervention on Motor Performance 2)$"-"&.(31%,&,&4(5%1%6,4- K076-%"L6/"M"N//5A-)F Training Training + Training + Training + Alone tDCS (pre) tDCS (during) tDCS post Y 20 P 11 Normalised data (%) J-$5"B+70,0+$ 1203004 1203005 neutral extension 2 ;0' C/-$"DB//5 B/47+$"-),01/8" O '-)H0$/"B-7701/ C/-$"DB//5 D'++,H$/77 1203056 120307/ 8+%9+(),:;*++ -7 <*=&,!&9: B/47+$"B-7701/8" C 4+A+,"-),01/ -16 Significant improvement Significant decrement T O<'0$78"<POJQ"'+1/'/$,"ER'0$7"'+1,8":"'0$"4/7,G"SR Group Data n=12 Giacobbe et al., (2013) O N Timing of tDCS and behavioral therapy !"#$'*(%+,)-%./')0"&)1.2.#3)"0)&145)+#/)6'7+8."&+,)17'&+*9) !"#$%&'(')*+,,',,-'./0*1232/*45,*678* ;:1<:=)5>55:?=)) !"#$%&&'#()) !"#$% FM (max 66) &"% O !"#$% &"% D :#('&,'+8'/) Usual care !"#$% &"% !"#$% &"% $'()*+%#,-)*% 5'@%'#A+,)) E !"#$% &"% 6./'.,:4'*72-=9):,2.*8<')9=(*>678?* 1232/*9,,:,/';*/<')9=(* S 6>1;>>=)5>55:?=)) ./0!)+%123)%% !"#$% &"%% * 36 session protocol chronic stroke Lo et al, NEJM (2010) A E L P H 1 : Robot +tDCS > Robot + SHAM tDCS on UEFM improvement Combined tDCS-Robotic Training Study Design Training Period Edwards et al (2009) EVAL. EVAL. EVAL. EVAL. EVAL. 3x / wk, 12 weeks, 36 sessions 1 hour shoulder/elbow/wrist robotic training Group SICI Index Giacobbe et al (2013) Conditioned / uncond tDCS or sham pre training (2 groups) MEP amplitude 1 wk 1 wk 6 months * p < 0.05 1 • 82 patients, right hemiparesis * • >6 mnths post first ischemic stroke 0.5 • Robotic protocol alternates S/E-wrist robot across sessions • tDCS 2mA, 35cm 2, 0.9% NaCl soaked sponges 0 Pre tDCS Post tDCS Post Robot

  6. Y P O C T *Edwards et al. Accepted O N Infarct + O ! Parameters: Pars triangularis D • 2 runs of 20 minutes of cathodal stimulation • Electrode placement Cathode – R pars triangularis • Anode – L supraorbital region E • • Real – direct current of 2 mA • Sham – direct current of 0.1 mA S Northstar Trial • Worn during speech therapy A E ,ILD"*+4"-BH-70-"4/H-A0%0,-,0+$"" L • " B40'-40%&"7,650/5"-7"-")+'B%/'/$,",+"7B//)H",H/4-B& P 2).)1 789%/,% .@AB(G"*)1"(B3 ;< .@AB(C(D)(53EF3 :;< .@AB(@01,&4(53EF3 H:< .@AB(@01,&4(B3 .@AB(G"*)1"(53EF3 ?:< =>< O<:RTO<:?"U6A%0)-,0+$7

  7. 1x HD Anode Y A. P B. O C. C 4x HD Return Electrodes T O N C3 Peak = 163 V/m C3 Peak = 96 V/m 1000V TES 1000V TES 600V TES CS CS C3 Peak = 5 V/m anterior C3. A (ii). F3 A (i). C2. CS 100µV 20ms C3 Peak = 80 V/m O 200µV FC3 20ms CS C3 Peak = 192 V/m C3 Peak = 240 V/m 480V TES 600V TES CS CS D B (i). B (ii). C3 Peak = 163 V/m C3 Primary Motor Cortex CS C3 Peak = 53 V/m E C3 Peak = 144 V/m C3 Peak = 216 V/m 400V TES 600V TES CS CP3 CS CS A2. C (i). C (ii). S C3 Peak = 8 V/m P3 CS posterior Electric field/Current density Electric field/Current density 0 33% 66% Peak 0 33% 66% Peak A (335V/m) E L Net Biological response to DC field in human tissue with tDCS P (MEP amplitude v time) Physical presence of DC field in human tissue with Note: Theoretical tDCS (magnitude v time) Lasting effect MEP amplitude intensity onset time onset time Courtesy StarLab

  8. Opposing homeostatic Y forces Opposing homeostatic P forces O intensity C Reverse onset effects time Webster et al (2006) T O N O = J D E F M S !"#$%&'()'*+,-.&'/+0+'12%'-+3&40'5"06'72%37+.89$:72%37+.'90%2;&'<=>'+?"+.'@A'BCD'5"06'.&E'72%37+.89$:72%37+.' 90%2;&'+4/'<F>'90%2;&'.&9"24',+9;'&,-.2G&/'12%'H$+430+3I&'+4+.G9"9'21'"41+%7324'I2.$,&''<J>'@2-2#%+-6"7' ,+-9'21'@B*',202%'&I2;&/'-20&43+.9'12%'=KF'+4/82%'LMJ'6+4/',$97.&9'21'$4+N&70&/'6&,"9-6&%&'<%"#60>' +4/'<M>'+N&70&/'6&,"9-6&%&'<.&E>)'C&9-249&'+,-."0$/&9'+%&'42%,+."O&/'1%2,',"4",$,'<%&/>'02',+?",$,' <56"0&>)''P%+G'"9'42'%&9-249&)'' A E L P * Gerber et al, 2019

  9. Thank you Y P O C T O N O D E S A E L P

Recommend

More recommend