Evaluating the effect of the simultaneous cerebrospinal stimulation, motor imagery, virtual reality and pedaling on post-stroke patients
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Data
2024-09-16
Autores
Mehrpour, Sheida
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Universidade Federal do Espírito Santo
Resumo
Technology in medicine is transforming the healthcare landscape by enhancing diagnostics, treatment, and patient management. With the integration of advanced tools and systems, healthcare professionals can deliver more accurate and timely care. Innovations such as telemedicine, artificial intelligence, and electronic health records streamline processes and improve communication among providers. Additionally, technology facilitates personalized medicine, allowing treatments to be tailored to individual patients based on their unique needs. The ongoing evolution of medical technology not only increases efficiency but also expands access to healthcare, ensuring that patients receive the best possible outcomes. As technology continues to advance, its role in medicine will become even more pivotal in shaping the future of healthcare. Stroke is the leading cause of acquired physical disability in humans, and the second largest cause of global mortality. Technology in stroke rehabilitation plays a vital role in enhancing recovery outcomes for patients. Advanced tools such as virtual reality, robotics, Brain-Computer Interface based on Motor Imagery (BCI-MI), Non Invasive Brain Stimulation (NIBS) techniques, and telehealth platforms offer innovative ways to engage patients in their rehabilitation process. Virtual reality can simulate real life scenarios, helping patients practice daily activities in a safe environment, while robotic exoskeletons assist in retraining motor functions through repetitive movements. Telehealth enables remote therapy sessions, providing continuous support and flexibility for patients to engage in their recovery from home. Additionally, wearable devices allow for real-time monitoring of progress, ensuring that treatment plans can be adjusted to meet individual needs effectively. Overall, these technological advancements are reshaping stroke rehabilitation, making it more personalized, accessible, and efficient. Non-Invasive Brain Stimulation (NIBS) techniques, such as transcranial direct current stimulation (tDCS) and transcutaneous spinal Direct Current Stimulation (tsDCS), are increasingly being applied in stroke rehabilitation to enhance recovery outcomes. These methods work by modulating neuronal activity in targeted brain regions, promoting neuroplasticity and facilitating motor function recovery. By improving communication between brain areas affected by the stroke and those responsible for movement, NIBS can help patients regain lost skills more effectively. As research continues to advance, these techniques hold promise for optimizing rehabilitation strategies and improving the quality of life for stroke survivors. The main objective of this study is to develop new, low-cost rehabilitation methods to patients with subacute to chronic stroke, aiming to increase neuroplasticity and improve motor function through combining methods such as tDCS plus tsDCS, VR, MI and pedaling exercise. This research are divided into three separate Chapters to assess both the long-term effects (Chapter I) and the immediate effects (Chapters II and III) of the intervention. In chapter I, the study was set up with the Alternative Treatment Design (ATD), comprising three phases: baseline, sham stimulation, and real stimulation. For Chapters II and III, the study design was defined as a pre- and post-stimulation assessment. For the experiment in the first Chapter, four subacute hemiparetic stroke patients were selected. The same experiment and participants were recruited for Chapters two and three, but the methodology for evaluating the effects of the intervention differed between these Chapters. For Chapters two and three, a total of eight participants were selected, including four patients and four healthy individuals. In both experiments, participants were randomly assigned to two groups to receive cerebrospinal stimulation, according to two different protocols (conventional and periodic). Participants in the conventional stimulation group received 20 minutes of stimulation, while those in the periodic stimulation group underwent two 13-minute stimulation sessions separated by a 20-minute rest period. The anode electrode was placed over the M1 region of the affected hemisphere, guided by the 10/20 International System. The cathode electrode was positioned centrally on the spinous process of the thoracic vertebra at T11 (T10-T12) by palpation. For the first experiment the results were evaluated using surface electromyography (sEMG), Maximum Voluntary Contraction (MVC), Fugl-Meyer Assessment for Lower Extremity (FMA-LE), miniBESTest, goniometry, 10-meter walk test (10MWT), pedaling speed, as well as specific stroke scales. In the second experiment, in addition to stimulation, Virtual Reality was used to enhance Motor Imagery (MI) effect in order to evaluate the combined effect on Mu and Beta bands modulation in post-stroke patients and healthy individuals. Results from the second experiment were analyzed using quantitative electroencephalography (EEG) measures, such as cortical topography based on mean amplitude values, brain connectivity parameters such as Phase Locking Value (PLV) and Magnitude Squared Coherence (MSC). For Chapter III, the Hjorth parameters (activity, mobility, complexity) were used across two assessment sessions, pre- and post-stimulation. The results of the experiment presented in Chapter I indicated significant improvements in muscle contraction, motor function and gait among patients. Participants in the conventional stimulation protocol group showed enhancements in tibialis muscle contraction, as assessed by sEMG and ankle dorsiflexion goniometry. In contrast, those in the periodic stimulation protocol exhibited improvements in motor function measures such as FML-LE, MiniBestest, and the 10- meter walk. Findings from the Chapter II experiment revealed different patterns of brain connectivity under the combined effects of cerebello-spinal stimulation, along with VR and MI, in both patients and healthy controls, emphasizing the need for personalized treatments for post-stroke patients. Results of Chapter III showed that the beta band is more sensitive to modulation by the combined methods compared to the Mu band, which was more reactive in patients than in healthy controls. The Activity parameter had a greater influence on the modulation of Mu and Beta bands in both patients and healthy controls. While the Mobility parameter showed greater influence in patients, the Complexity parameter was more sensitive in healthy controls. Due to the variability of the results and the small sample size, it was challenging to distinguish the effects of the two stimulation protocols in Chapters II and III
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Acidente vascular cerebral , Reabilitação , Estimulação Cerebroespinhal de Corrente Contínua , Realidade Virtual , Imagética Motora , Eletroencefalográfia , Stroke , Cerebrospinal Direct Current Stimulation , Rehabilitation , Motor Imagery , Virtual Reality , Electroencephalography