Department of Neurology at UMMS-Baystate
Bioelectrical and Neuroengineering | Nervous System Diseases | Neurology | Neuroscience and Neurobiology
Stroke is a leading cause of disability, most commonly with motor deficit. The motor recovery is associated with the structural and/or functional degree of injury to descending motor pathways. Additionally, neuroplasticity contributes to the recovery by unmasking pre-existing connections, establishing new synaptic contacts, reorganizing peri-lesional and contralesional regions. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique, enhances neuroplasticity. When combined with peripheral therapy, tDCS can enhance motor skill acquisition/consolidation by modulating afferent inputs to the cortex while concurrently receiving central stimulation. Furthermore, meta-analyses showed that bihemispheric stimulation (anodal over affected M1, cathodal over contralesional M1) is better than unihemispheric stimulation, and that higher current density may have a stronger effect. Constraint-Induced Movement Therapy (CIMT) is a standardized, efficacy-proven peripheral rehabilitation therapy to overcome learned non-use of the affected upper extremity. It has two critical components: i)Intense Training of the affected extremity with very specific well-defined interventions; ii)Constraining the unaffected extremity for a certain amount of hours per day.
TRANSPORT2, a randomized, double-blinded, multi-centered clinical trial, aims to determine whether there is a treatment effect among three tDCS doses (sham/2mA/4mA) combined with CIMT in 129 patients with first-ever unihemispheric ischemic stroke in the past 30-180 days, resulting in hemiparesis. The primary outcome is the Fugl-Myer Upper-Extremity (FM-UE) scale, a measure of motor impairment, on day 15 after the start of the intervention. Secondary outcomes include i)Wolf-Motor-Function-Test, measure of functional motor activity; ii)Stroke-Impact-Scale, measure of quality of life. We also examine whether the structural and functional integrity of the descending motor tract, measured by MRI(wCST-LL) and TMS(MEPs) are correlated with changes in FM-UE scale, and evaluate their utility as biomarkers of patient selection in future studies. We hypothesize that combination of bihemispheric tDCS at 2 or 4 mA with CIMT will lead to a greater motor improvement on day 15.
stroke, transcranial direct current stimulation (tDCS), motor skills
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DOI of Published Version
25th Annual University of Massachusetts Medical School Research Retreat 2020
Gunduz ME, Shinde AB, Lerud KD, Feng W, Schlaug G. (2020). Transcranial Direct Current Stimulation for Post-stroke Motor Recovery - a Phase II Study (TRANSPORT2). University of Massachusetts Medical School Publications. https://doi.org/10.13028/wws8-0r35. Retrieved from https://escholarship.umassmed.edu/publications/42
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