Brain plasticity following MI-BCI training combined with tDCS in a randomized trial in chronic subcortical stroke subjects: a preliminary study

Brain-computer interface-assisted motor imagery (MI-BCI) or transcranial direct current stimulation (tDCS) has been used in stroke rehabilitation, though their combinatory effect is unknown. We investigated brain plasticity following a combined MI-BCI and tDCS intervention in chronic subcortical stroke patients with unilateral upper limb disability. Nineteen patients were randomized into tDCS and sham-tDCS groups. Diffusion and perfusion MRI, and transcranial magnetic stimulation were used to study structural connectivity, cerebral blood flow (CBF), and corticospinal excitability, respectively, before and 4 weeks after the 2-week intervention. After quality control, thirteen subjects were included in the CBF analysis. Eleven healthy controls underwent 2 sessions of MRI for reproducibility study. Whereas motor performance showed comparable improvement, long-lasting neuroplasticity can only be detected in the tDCS group, where white matter integrity in the ipsilesional corticospinal tract and bilateral corpus callosum was increased but sensorimotor CBF was decreased, particularly in the ipsilesional side. CBF change in the bilateral parietal cortices also correlated with motor function improvement, consistent with the increased white matter integrity in the corpus callosum connecting these regions, suggesting an involvement of interhemispheric interaction. The preliminary results indicate that tDCS may facilitate neuroplasticity and suggest the potential for refining rehabilitation strategies for stroke patients.

​

​

​

​

Transcranial Direct Current Stimulation of the Left Prefrontal Cortex Improves Attention in Patients with Traumatic Brain Injury: A Pilot Study

Patients underwent a computerized contrast reaction time task before and after the administration of real transcranial direct current stimulation (2 mA for 20 min) or sham transcranial direct current stimulation (2 mA for 1 min) to the left dorsolateral prefrontal cortex in a doubleblind, crossover manner.

​

​

​

​

Neurotherapy of traumatic brain injury/posttraumatic stress symptoms in OEF/OIF veterans.

Twenty-six patients with persistent post-traumatic symptoms (PTS) were seen by the first author 3 to 70 months after a MHI and had a quantitative EEG (qEEG). Neurofeedback therapy designed to normalize abnormal qEEG coherence scores was provided to determine the effectiveness of this approach. Five training sessions addressed each qEEG abnormality. Training continued until the patient, by self-report, indicated that significant improvement had occurred or until a total of 40 sessions were given.

​

​

​

​

Neurofeedback Therapy of Attention Deficits in Patients with Traumatic Brain Injury

Feedback of beta-activity (13-20 Hz) was used for the treatment of attentional impairments in twelve patients with moderate closed head injuries. A matched control group of nine patients was treated with a standard computerized training. All patients were tested before and after treatment with a set of attention tests.

​

​

​

​

Diagnosis and Treatment of Head Injury

Brain injury appears to affect from 132 to 367 people per 100,000. Traditional methods for diagnosing mild head injury, such as medical history, CAT scan and MRI, often show normal test results even though patients complain of significant neurocognitive dysfunctions. Robert Thatcher compiled a normative reference EEG database in 1979. The norms were replicated in several studies. These EEG databases allow a patient's EEG to be compared with a reference population. An emerging and promising treatment approach to mild head injury is the use of Quantitative EEG technology and EEG neurofeedback training.

​

​

​

​

The Usefulness of Quantitative EEG (QEEG) and Neurotherapy in the Assessment and Treatment of Post-Concussion Syndrome

Mild traumatic brain injury (TBI) is associated with damage to frontal, temporal and parietal lobes. Post-concussion syndrome has been used to describe a range of residual symptoms that persist 12 months or more after the injury, often despite a lack of evidence of brain abnormalities on MRI and CT scans. The core deficits of post-concussion syndrome are similar to those of ADHD and mood disorders, and sufferers often report memory, socialization problems and frequent headaches. While cognitive rehabilitation and psychological support are widely used, neither has been shown to be effective in redressing the core deficits of post-concussion syndrome. On the other hand, quantitative EEG has been shown to be highly sensitive (96%) in identifying post-concussion syndrome, and neurotherapy has been shown in a number of studies to be effective in significantly improving or redressing the symptoms of post-concussion syndrome, as well as improving similar symptoms in non-TBI patients.

​

​

​

​

Neurofeedback for Traumatic Brain Injury: Current Trends

Traumatic brain injuries constitute significant health and societal problems which can be ameliorated with some recent developments in neurofeedback. The field of neurofeedback has evolved from single channel to multiple-site training, and with LORETA Z-score training, deeper levels of the brain can reached. Neurofeedback for traumatic brain injury patients may provide improvements never before possible.

​

​

​

​

Neurofeedback Treatment for Traumatic Brain Injury

Following acute TBI rehabilitation there have been a limited number of strategies that have been used in the treatment of cognitive disorders. These methods have included restorative cognitive rehabilitation procedures that utilize stimulation and practice (e.g., of vigilance with a computer intervention); strategy cognitive rehabilitation (e.g., utilizing visualization, creating associations), compensatory cognitive rehabilitation strategies; and medications (e.g., cognitive enhancing medications directed at arousal, attention and/or memory). All of these methodologies provide at best modest improvements, but it is still common for patients with TBI to be told that after a year and a half they have obtained about all of the improvement that they can expect, and that, therefore, they must simply adjust to the current state of affairs.

​

​

​

​

Specific effects of EEG based neurofeedback training on memory functions in post-stroke victims

Using EEG based neurofeedback (NF), the activity of the brain is modulated directly and, therefore, the cortical substrates of cognitive functions themselves. In the present study, we investigated the ability of stroke patients to control their own brain activity via NF and evaluated specific effects of different NF protocols on cognition, in particular recovery of memory.