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It takes two: noninvasive brain stimulation combined with neurorehabilitation.

Authors
  • Page, Stephen J1
  • Cunningham, David A2
  • Plow, Ela3
  • Blazak, Brittani4
  • 1 School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH; B.R.A.I.N. Laboratory, Columbus, OH. Electronic address: [email protected]
  • 2 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; School of Biomedical Sciences, Kent State University, Kent, OH.
  • 3 Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; Department of Physical Medicine and Rehabilitation, Neurological Institute, Cleveland Clinic, Cleveland, OH.
  • 4 School of Health and Rehabilitation Sciences, The Ohio State University Medical Center, Columbus, OH; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
Type
Published Article
Journal
Archives of physical medicine and rehabilitation
Publication Date
Apr 01, 2015
Volume
96
Issue
4 Suppl
Identifiers
DOI: 10.1016/j.apmr.2014.09.019
PMID: 25813373
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The goal of postacute neurorehabilitation is to maximize patient function, ideally by using surviving brain and central nervous system tissue when possible. However, the structures incorporated into neurorehabilitative approaches often differ from this target, which may explain why the efficacy of conventional clinical treatments targeting neurologic impairment varies widely. Noninvasive brain stimulation (eg, transcranial magnetic stimulation [TMS], transcranial direct current stimulation [tDCS]) offers the possibility of directly targeting brain structures to facilitate or inhibit their activity to steer neural plasticity in recovery and measure neuronal output and interactions for evaluating progress. The latest advances as stereotactic navigation and electric field modeling are enabling more precise targeting of patient's residual structures in diagnosis and therapy. Given its promise, this supplement illustrates the wide-ranging significance of TMS and tDCS in neurorehabilitation, including in stroke, pediatrics, traumatic brain injury, focal hand dystonia, neuropathic pain, and spinal cord injury. TMS and tDCS are still not widely used and remain poorly understood in neurorehabilitation. Therefore, the present supplement includes articles that highlight ready clinical application of these technologies, including their comparative diagnostic capabilities relative to neuroimaging, their therapeutic benefit, their optimal delivery, the stratification of likely responders, and the variable benefits associated with their clinical use because of interactions between pathophysiology and the innate reorganization of the patient's brain. Overall, the supplement concludes that whether provided in isolation or in combination, noninvasive brain stimulation and neurorehabilitation are synergistic in the potential to transform clinical practice. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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