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Background
Many patients do not fully regain motor function after ischemic stroke. Transcranial direct current stimulation (TDCS) targeting the motor cortex may improve motor outcome as an add-on intervention to physical rehabilitation. However, beneficial effects on motor function vary largely among patients within and across TDCS trials. In addit...
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Beta-band (15–30 Hz) synchronization between the EMG signals of active limb muscles can serve as a non-invasive assay of corticospinal tract integrity. Tasks engaging a single limb often primarily utilize one corticospinal pathway, although bilateral neural circuits can participate in goal-directed actions involving multi-muscle coordination and ut...
Stroke is a central nervous system disease that causes structural lesions and functional impairments of the brain, resulting in varying types, and degrees of dysfunction. The bimodal balance-recovery model (interhemispheric competition model and vicariation model) has been proposed as the mechanism of functional recovery after a stroke. We analyzed...
Citations
... The ability to manipulate brain activity directly through external stimuli of various physical natures is a major driver in advancing innovative therapeutic strategies. In fact, neurostimulation techniques are widely used as neuroscientific investigation tools, in the development of neuroprostheses, and very successfully in the treatment of a broad variety of neurological conditions, such as Parkinson's Disease (Cole et al., 2022), epilepsy (Krishna et al., 2016;Li and Cook, 2018;Dell et al., 2019;Davis and Gaitanis, 2020;Ryvlin et al., 2021), distinct cognitive (Bonizzato et al., 2023;Kolmos et al., 2023), and psychiatric dysfunctions (Nuttin et al., 2014), to promote functional recovery in brain injury patients (Bao et al., 2020), including stroke (Kolmos et al., 2023). On the other hand and despite its established status, the effectiveness of neurostimulation varies considerably among patients and across clinical trials of different applications. ...
... The ability to manipulate brain activity directly through external stimuli of various physical natures is a major driver in advancing innovative therapeutic strategies. In fact, neurostimulation techniques are widely used as neuroscientific investigation tools, in the development of neuroprostheses, and very successfully in the treatment of a broad variety of neurological conditions, such as Parkinson's Disease (Cole et al., 2022), epilepsy (Krishna et al., 2016;Li and Cook, 2018;Dell et al., 2019;Davis and Gaitanis, 2020;Ryvlin et al., 2021), distinct cognitive (Bonizzato et al., 2023;Kolmos et al., 2023), and psychiatric dysfunctions (Nuttin et al., 2014), to promote functional recovery in brain injury patients (Bao et al., 2020), including stroke (Kolmos et al., 2023). On the other hand and despite its established status, the effectiveness of neurostimulation varies considerably among patients and across clinical trials of different applications. ...
... To address the variability issue in stroke patients specifically, Kolmos and colleagues conducted a randomized, double-blinded, sham-controlled trial investigating the efficacy of personalized tDCS in patients with subacute ischemic stroke and upper-extremity paresis (Kolmos et al., 2023). The trial involved 60 patients who received supervised rehabilitation training along with two sessions of 20 min of focal tDCS targeting the ipsilesional primary motor hand area (i.e., M1-HAND) per week for 4 weeks. ...
Despite considerable advancement of first choice treatment (pharmacological, physical therapy, etc.) over many decades, neurological disorders still represent a major portion of the worldwide disease burden. Particularly concerning, the trend is that this scenario will worsen given an ever expanding and aging population. The many different methods of brain stimulation (electrical, magnetic, etc.) are, on the other hand, one of the most promising alternatives to mitigate the suffering of patients and families when conventional treatment fall short of delivering efficacious treatment. With applications in virtually all neurological conditions, neurostimulation has seen considerable success in providing relief of symptoms. On the other hand, a large variability of therapeutic outcomes has also been observed, particularly in the usage of non-invasive brain stimulation (NIBS) modalities. Borrowing inspiration and concepts from its pharmacological counterpart and empowered by unprecedented neurotechnological advancement, the neurostimulation field has seen in recent years a widespread of methods aimed at the personalization of its parameters, based on biomarkers of the individuals being treated. The rationale is that, by taking into account important factors influencing the outcome, personalized stimulation can yield a much-improved therapy. Here, we review the literature to delineate the state-of-the-art of personalized stimulation, while also considering the important aspects of the type of informing parameter (anatomy, function, hybrid), invasiveness, and level of development (pre-clinical experimentation versus clinical trials). Moreover, by reviewing relevant literature on closed loop neuroengineering solutions in general and on activity dependent stimulation method in particular, we put forward the idea that improved personalization may be achieved when the method is able to track in real time brain dynamics and adjust its stimulation parameters accordingly. We conclude that such approaches have great potential of promoting the recovery of lost functions and enhance the quality of life for patients.
... A meta-analysis showed that AI is a feasible and safe method for improving upper-limb function in post-stroke rehabilitation compared with common therapy [2]. For this reason, several proposals have been presented to rehabilitate post-stroke patients considering on the illness level, such as virtual reality combined with physical therapy [3], neurorehabilitation [4], and corticomuscular or electrical stimulation [5], [6]. In contrast, the use of exoskeletons or robotic devices is feasible for neuromotor rehabilitation [7]. ...
In recent years, advancements in rehabilitation techniques have been made to leverage biosignals and passive movement as integral components of physical interventions to restore upper limb mobility in people with disabilities. This study introduces a novel Motor Imagery (MI) protocol based on Action Observation (AO) using static visual cues and a robotic glove used in the right hand. To address this, Machine Learning (ML) techniques were assessed using features based on Power Spectral Density (PSD) in the mu (μ, 8–13 Hz) and beta (β, 13–30 Hz) frequency bands. Four distinct classifiers were explored: Kernel Naive Bayes (NB), Quadratic Support Vector Machine (QSVM), Fine k-nearest neighbors (KNN), and Logistic Regression (LR). These classifiers were employed to discriminate between open- and closed-hand MI tasks. Based on the evaluated metrics, it was concluded that the implemented methodology is feasible for classifying MI tasks from the same limb, where the QSVM classifier showed the most promising results, with a mean accuracy of approximately 75%. Future work will focus on implementing the system to control the robotic glove in the context of post-stroke rehabilitation, underscoring its potential clinical utility.
Stroke is one of the most common acute neurological disorders and a leading cause of disability worldwide. Evidence-based treatments over the last two decades have driven a revolution in the clinical management and design of stroke services. We need a highly skilled, multidisciplinary workforce that includes neurologists as core members to deliver modern stroke care. In the UK, the dedicated subspecialty training programme for stroke medicine has recently been integrated into the neurology curriculum. All neurologists will be trained to contribute to each aspect of the stroke care pathway. We discuss how training in stroke medicine is evolving for neurologists and the opportunities and challenges around practising stroke medicine in the UK and beyond.
