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Métodos Terapéuticos y Terapias MTCI
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1.
Neurorehabil Neural Repair ; 33(9): 707-717, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31315515

RESUMEN

Background. Upper-limb chronic stroke hemiplegia was once thought to persist because of disproportionate amounts of inhibition imposed from the contralesional on the ipsilesional hemisphere. Thus, one rehabilitation strategy involves discouraging engagement of the contralesional hemisphere by only engaging the impaired upper limb with intensive unilateral activities. However, this premise has recently been debated and has been shown to be task specific and/or apply only to a subset of the stroke population. Bilateral rehabilitation, conversely, engages both hemispheres and has been shown to benefit motor recovery. To determine what neurophysiological strategies bilateral therapies may engage, we compared the effects of a bilateral and unilateral based therapy using transcranial magnetic stimulation. Methods. We adopted a peripheral electrical stimulation paradigm where participants received 1 session of bilateral contralaterally controlled functional electrical stimulation (CCFES) and 1 session of unilateral cyclic neuromuscular electrical stimulation (cNMES) in a repeated-measures design. In all, 15 chronic stroke participants with a wide range of motor impairments (upper extremity Fugl-Meyer score: 15 [severe] to 63 [mild]) underwent single 1-hour sessions of CCFES and cNMES. We measured whether CCFES and cNMES produced different effects on interhemispheric inhibition (IHI) to the ipsilesional hemisphere, ipsilesional corticospinal output, and ipsilateral corticospinal output originating from the contralesional hemisphere. Results. CCFES reduced IHI and maintained ipsilesional output when compared with cNMES. We found no effect on ipsilateral output for either condition. Finally, the less-impaired participants demonstrated a greater increase in ipsilesional output following CCFES. Conclusions. Our results suggest that bilateral therapies are capable of alleviating inhibition on the ipsilesional hemisphere and enhancing output to the paretic limb.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Rehabilitación de Accidente Cerebrovascular/métodos , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Estudios Cruzados , Evaluación de la Discapacidad , Femenino , Lateralidad Funcional , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Corteza Motora/fisiopatología , Paresia/etiología , Paresia/rehabilitación , Recuperación de la Función , Estimulación Magnética Transcraneal
2.
Phys Med Rehabil Clin N Am ; 26(4): 759-74, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26522911

RESUMEN

Despite showing early promise, several recent clinical trials of noninvasive brain stimulation (NIBS) failed to augment rehabilitative outcomes of the paretic upper limb. This article addresses why pairing NIBS with unilateral approaches is weakly generalizable to patients in all ranges of impairments. The article also addresses whether alternate therapies are better suited for the more impaired patients, where they may be more feasible and offer neurophysiologic advantages not offered with unilateral therapies. The article concludes by providing insight on how to create NIBS paradigms that are tailored to distinctly augment the effects of therapies across patients with varying degrees of impairment.


Asunto(s)
Terapia por Estimulación Eléctrica/métodos , Recuperación de la Función , Rehabilitación de Accidente Cerebrovascular , Estimulación Magnética Transcraneal/métodos , Extremidad Superior/fisiopatología , Humanos , Accidente Cerebrovascular/fisiopatología
3.
Restor Neurol Neurosci ; 33(6): 911-26, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26484700

RESUMEN

PURPOSE: To demonstrate, in a proof-of-concept study, whether potentiating ipsilesional higher motor areas (premotor cortex and supplementary motor area) augments and accelerates recovery associated with constraint induced movement. METHODS: In a randomized, double-blinded pilot clinical study, 12 patients with chronic stroke were assigned to receive anodal transcranial direct current stimulation (tDCS) (n = 6) or sham (n = 6) to the ipsilesional higher motor areas during constraint-induced movement therapy. We assessed functional and neurophysiologic outcomes before and after 5 weeks of therapy. RESULTS: Only patients receiving tDCS demonstrated gains in function and dexterity. Gains were accompanied by an increase in excitability of the contralesional rather than the ipsilesional hemisphere. CONCLUSIONS: Our proof-of-concept study provides early evidence that stimulating higher motor areas can help recruit the contralesional hemisphere in an adaptive role in cases of greater ipsilesional injury. Whether this early evidence of promise translates to remarkable gains in functional recovery compared to existing approaches of stimulation remains to be confirmed in large-scale clinical studies that can reasonably dissociate stimulation of higher motor areas from that of the traditional primary motor cortices.


Asunto(s)
Corteza Motora/fisiopatología , Manipulaciones Musculoesqueléticas/métodos , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/fisiopatología , Estimulación Transcraneal de Corriente Directa/métodos , Anciano , Método Doble Ciego , Femenino , Lateralidad Funcional/fisiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Corteza Motora/patología , Destreza Motora/fisiología , Proyectos Piloto , Pronóstico , Recuperación de la Función/fisiología , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/patología , Estimulación Magnética Transcraneal , Resultado del Tratamiento
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