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Register a new userHow transcranial direct current stimulation facilitates post-stroke rehabilitation
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Whether transcranial direct current stimulation (tDCS) benefits stroke rehabilitation remains unclear. To investigate how tDCS reorganizes brain circuitry, nineteen post-stroke patients underwent rehabilitation sessions with bi-hemispheric real vs sham tDCS intervention. Resting motor threshold measurements showed tDCS evoked higher excitability in the motor cortex that enhanced the descending conduction from the lesioned primary motor cortex to the target hand muscle. Granger causality analysis further revealed brain circuitry rewiring among the lesioned cerebellum, premotor, and primary motor cortex in the tDCS group compared to the sham owing to the newly formed connections close to the anodal electrode. Rebuilding of these critical pathways was clear via the increase of event related desynchronisation (ERD) and white matter integrity in the same lesioned region. Furthermore, only the tDCS group demonstrated a positive recovery trend in the penumbra regions by the longitudinal functional magnetic resonance imaging (fMRI) analysis. To interpret tDCS mechanism, we introduce a polarized gamma-aminobutyric acid (GABA) theory, where GABAA receptor activity depends on the orientation of dipolar GABA that can be manipulated by tDCS field. Results suggest that tDCS intervention lowers motor excitability via re-orienting GABA, leading to reorganization of the lesioned cortical network, and the motor descending pathway, finally the recovery of motor function.
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Physical head phantoms allow assessing source reconstruction procedures in electroencephalography and electrical stimulation profiles during transcranial electric stimulation. Volume conduction in the head is strongly influenced by the skull representing the main conductivity barrier. Realistic modeling of its characteristics is thus important for phantom development. In the present study, we proposed plastic clay as a material for modeling the skull in phantoms. We analyzed five clay types varying in granularity and fractions of fireclay, each with firing temperatures from 550 {deg}C to 950 {deg}C. We investigated the conductivity of standardized clay samples when immersed in a 0.9% sodium chloride solution with time-resolved four-point impedance measurements. To test the reusability of the clay model, these measurements were repeated after cleaning the samples by rinsing in deionized water for 5 h. We found time-dependent impedance changes for approximately 5 min after immersion in the solution. Thereafter, the conductivities stabilized between 0.0716 S/m and 0.0224 S/m depending on clay type and firing temperatures. The reproducibility of the measurement results proved the effectiveness of the rinsing procedure. Clay provides formability, is permeable for ions, can be adjusted in conductivity value and is thus suitable for the skull modeling in phantoms.
Transcranial static magnetic stimulation is a novel noninvasive method of reduction of the cortical excitability in certain neurological diseases that, unlike ordinary transcranial magnetic stimulation, makes use of static magnetic fields generated by permanent magnets. The physical principle underlying transcranial magnetic stimulation is well known, that is, the Faradays law. By contrast, the physical mechanism that explains the interaction between neurons and static magnetic fields in transcranial static magnetic stimulation remains unclear, which makes it difficult to improve and fine tune the treatment. In the present work it is discussed the possibility that this mechanism might be the Lorentz force exerted on the ions flowing along the membrane channels of neurons. To support this hypothesis, a dimensional analysis it is carried out to compare the Larmor radius of the ions in the presence of a static magnetic field with the dimensions of the cross section of human axons and membrane channels in neurons. This analysis shows that whereas a moderate static magnetic field is not expected to affect the ion flux through axons, nevertheless it can affect the ion flux along membrane channels. The overall effect of the static magnetic field would be to introduce an additional friction between the ions and the walls of the membrane channels, thus reducing its conductance. Calculations performed by using a Hodgkin-Huxley model demonstrate that even a slight reduction of the conductance of the membrane channels can lead to the suppression of the action potential, thus inhibiting neuronal activity.
Objective: Evaluate the feasibility and potential impacts on hand function using a wearable stimulation device (the VTS Glove) which provides mechanical, vibratory input to the affected limb of chronic stroke survivors. Methods: A double-blind, randomized, controlled feasibility study including sixteen chronic stroke survivors (mean age: 54; 1-13 years post-stroke) with diminished movement and tactile perception in their affected hand. Participants were given a wearable device to take home and asked to wear it for three hours daily over eight weeks. The device intervention was either (1) the VTS Glove, which provided vibrotactile stimulation to the hand, or (2) an identical glove with vibration disabled. Participants were equally randomly assigned to each condition. Hand and arm function were measured weekly at home and in local physical therapy clinics. Results: Participants using the VTS Glove showed significantly improved Semmes-Weinstein monofilament exam, reduction in Modified Ashworth measures in the fingers, and some increased voluntary finger flexion, elbow and shoulder range of motion. Conclusions: Vibrotactile stimulation applied to the disabled limb may impact tactile perception, tone and spasticity, and voluntary range of motion. Wearable devices allow extended application and study of stimulation methods outside of a clinical setting.
Artificial intelligence (AI) and robotic coaches promise the improved engagement of patients on rehabilitation exercises through social interaction. While previous work explored the potential of automatically monitoring exercises for AI and robotic coaches, the deployment of these systems remains a challenge. Previous work described the lack of involving stakeholders to design such functionalities as one of the major causes. In this paper, we present our efforts on eliciting the detailed design specifications on how AI and robotic coaches could interact with and guide patients exercises in an effective and acceptable way with four therapists and five post-stroke survivors. Through iterative questionnaires and interviews, we found that both post-stroke survivors and therapists appreciated the potential benefits of AI and robotic coaches to achieve more systematic management and improve their self-efficacy and motivation on rehabilitation therapy. In addition, our evaluation sheds light on several practical concerns (e.g. a possible difficulty with the interaction for people with cognitive impairment, system failures, etc.). We discuss the value of early involvement of stakeholders and interactive techniques that complement system failures, but also support a personalized therapy session for the better deployment of AI and robotic exercise coaches.
Acoustic impedance mismatches between soft tissues and bones are known to result in strong aberrations in optoacoustic and ultrasound images. Of particular importance are the severe distortions introduced by the human skull, impeding transcranial brain imaging with these modalities. While modelling of ultrasound propagation through the skull may in principle help correcting for some of the skull-induced aberrations, these approaches are commonly challenged by the highly heterogeneous and dispersive acoustic properties of the skull and lack of exact knowledge on its geometry and internal structure. Here we demonstrate that the spatio-temporal properties of the acoustic distortions induced by the skull are preserved for signal sources generated at neighboring intracranial locations by means of optoacoustic excitation. This optoacoustic memory effect is exploited for building a three-dimensional model accurately describing the generation, propagation and detection of time-resolved broadband optoacoustic waveforms traversing the skull. The memory-based model-based inversion is then shown to accurately recover the optical absorption distribution inside the skull with spatial resolution and image quality comparable to those attained in skull-free medium.
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