RIC Researchers Find Noninvasive Brain Stimulation Improves Patient Outcomes
Preliminary findings presented in Europe and California in May
CHICAGO, IL—Recovering function after a stroke is the top goal for patients and the therapists who work with them. But what if there were a way to help patients get more out of therapy? Researchers at the Rehabilitation Institute of Chicago (RIC) who stimulate the brain before a therapy session have found that patients not only recover greater function, they also find patients still exhibit those gains six months after therapy ends.
An ongoing study suggests that noninvasive brain stimulation (NIBS) paired with task-specific occupational therapy may significantly improve outcomes for patients with upper-limb deficiencies compared with those who received therapy alone, an indication that the approach promotes lasting neuroplastic change. RIC researchers are also exploring how NIBS can improve lower-limb function and the recovery of speech for patients with aphasia.
“Noninvasive brain stimulation is a way of priming the brain before therapy,” said Dr. Richard Harvey, medical director of RIC’s stroke rehabilitation program. “We’re taking rehabilitation techniques that work and making them work even better by using priming to help the brain better learn functional skills.”
Researchers used transcranial magnetic stimulation, which is a powerful electromagnet that, when placed near the scalp, can generate an electric current that activates neurons, sending a pulse down to a muscle. “We prime the brain by changing cortical excitability,” Harvey said. “This means the brain is already doing what it is supposed to do when learning a skill, even before practice begins. Stimulation makes the brain more receptive to what it’s going to learn to do during therapy.”
Harvey presented the preliminary findings at the 2012 European Stroke Conference May 22-25. The study’s abstract describes the encouraging findings from the first 15 patients enrolled in the study; there will be 30 total in this phase of the project. The second phase of the study is planned as a multi-site, international collaboration beginning in 2013 with RIC as the lead site.
In RIC’s Neuralplasticity Laboratory, researchers also are working with stroke survivors to apply NIBS to the area of the brain that controls lower-limb activity. “The lower limb motor cortex can be a technically tricky area of the brain to study, and our lab has been a world leader in developing techniques for NIBS that work for the legs,” said RIC researcher Lynn Rogers, PhD, who is heading up this project. Investigators are currently designing a study that will pair NIBS with gait training to help patients walk more evenly after experiencing a stroke.
And with Leora Cherney, director of RIC's Center for Aphasia Research and Treatment, investigators are combining a different form of NIBS with speech and language therapy. “The additional ’twist’ of this study is that we are not only using neuronavigation to guide where to stimulate, we’re also using functional magnetic resonance images to target areas of the brain that each individual is using when trying to perform speech and language tasks,” Rogers said. “It’s an attempt to individualize the stimulation therapy in the hopes of achieving the greatest gains for each specific person.”
Cherney presented results of this study May 20-24 at the Clinical Aphasiology Conference in Lake Tahoe, California, and the meeting of the Organization for Human Brain Mapping in Beijing June 10-14. She also will share them at the International Aphasia Rehabilitation Conference in Melbourne, Australia in October.