Can Transcranial Direct Current Stimulation Enhance Poststroke Motor Recovery? Development of a Theoretical Patient-Tailored Model.

Hordacre, B; McCambridge, AB; Ridding, MC; Bradnam, LV

Can Transcranial Direct Current Stimulation Enhance Poststroke Motor Recovery? Development of a Theoretical Patient-Tailored Model.

Hordacre, B McCambridge, AB Ridding, MC Bradnam, LV

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Publisher:: Ovid Technologies (Wolters Kluwer Health)
Publication Type:: Journal Article
Citation:: Neurology, 2021, pp. 10.1212/WNL.0000000000012187-10.1212/WNL.0000000000012187
Issue Date:: 2021-05-13

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Field	Value	Language
dc.contributor.author	Hordacre, B
dc.contributor.author	McCambridge, AB
dc.contributor.author	Ridding, MC
dc.contributor.author	Bradnam, LV
dc.date.accessioned	2021-06-24T04:29:22Z
dc.date.available	2021-03-29
dc.date.available	2021-06-24T04:29:22Z
dc.date.issued	2021-05-13
dc.identifier.citation	Neurology, 2021, pp. 10.1212/WNL.0000000000012187-10.1212/WNL.0000000000012187
dc.identifier.issn	0028-3878
dc.identifier.issn	1526-632X
dc.identifier.uri	http://hdl.handle.net/10453/149741
dc.description.abstract	New treatments that can facilitate neural repair and reduce persistent impairments have significant value in promoting recovery following stroke. One technique that has gained interest is transcranial direct current stimulation (tDCS) as early research suggested it could enhance plasticity and enable greater behavioral recovery. However, several studies have now identified substantial inter-subject variability in response to tDCS and clinical trials revealed insufficient evidence of treatment effectiveness. A possible explanation for the varied and negative findings is that the physiological model of stroke recovery that researchers have used to guide the application of tDCS based treatments in stroke is overly simplistic and does not account for stroke heterogeneity or known determinants that affect the tDCS response. Here, we propose that tDCS could have a more clearly beneficial role in enhancing stroke recovery if greater consideration is given to individualizing treatment. By critically reviewing the proposed mechanisms of tDCS, stroke physiology across the recovery continuum, and known determinants of tDCS response, we propose a new, theoretical, patient-tailored approach to delivering tDCS after stroke. The proposed model includes a step-by-step principled selection strategy for identifying optimal neuromodulation targets and outlines key areas for further investigation. Tailoring tDCS treatment to individual neuroanatomy and physiology is likely our best chance at producing robust and meaningful clinical benefit for people with stroke and would, therefore, accelerate opportunities for clinical translation.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Ovid Technologies (Wolters Kluwer Health)
dc.relation	University of Technology Sydney
dc.relation.ispartof	Neurology
dc.relation.isbasedon	10.1212/wnl.0000000000012187
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1103 Clinical Sciences, 1109 Neurosciences, 1702 Cognitive Sciences
dc.subject.classification	Neurology & Neurosurgery
dc.title	Can Transcranial Direct Current Stimulation Enhance Poststroke Motor Recovery? Development of a Theoretical Patient-Tailored Model.
dc.type	Journal Article
utslib.location.activity	United States
utslib.for	1103 Clinical Sciences
utslib.for	1109 Neurosciences
utslib.for	1702 Cognitive Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Graduate School of Health/GSH.Physiotherapy
utslib.copyright.status	closed_access	*
dc.date.updated	2021-06-24T04:29:20Z
pubs.publication-status	Published

Abstract:

New treatments that can facilitate neural repair and reduce persistent impairments have significant value in promoting recovery following stroke. One technique that has gained interest is transcranial direct current stimulation (tDCS) as early research suggested it could enhance plasticity and enable greater behavioral recovery. However, several studies have now identified substantial inter-subject variability in response to tDCS and clinical trials revealed insufficient evidence of treatment effectiveness. A possible explanation for the varied and negative findings is that the physiological model of stroke recovery that researchers have used to guide the application of tDCS based treatments in stroke is overly simplistic and does not account for stroke heterogeneity or known determinants that affect the tDCS response. Here, we propose that tDCS could have a more clearly beneficial role in enhancing stroke recovery if greater consideration is given to individualizing treatment. By critically reviewing the proposed mechanisms of tDCS, stroke physiology across the recovery continuum, and known determinants of tDCS response, we propose a new, theoretical, patient-tailored approach to delivering tDCS after stroke. The proposed model includes a step-by-step principled selection strategy for identifying optimal neuromodulation targets and outlines key areas for further investigation. Tailoring tDCS treatment to individual neuroanatomy and physiology is likely our best chance at producing robust and meaningful clinical benefit for people with stroke and would, therefore, accelerate opportunities for clinical translation.

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http://hdl.handle.net/10453/149741