EVALUATING THE EFFECT OF THE SIMULTANEOUS CEREBROSPINAL STIMULATION, MOTOR IMAGERY, VIRTUAL REALITY AND PEDALING ON POST-STROKE PATIENTS
Name: SHEIDA MEHRPOUR
Publication date: 16/09/2024
Examining board:
Name |
Role |
|---|---|
| ADRIANO DE OLIVEIRA ANDRADE | Coorientador |
| ANTONIO ALBERTO RIBEIRO FERNANDES | Examinador Interno |
| BRENO VALENTIM NOGUEIRA | Examinador Interno |
| CAROLINE CUNHA DO ESPÍRITO SANTO | Examinador Externo |
| DENIS DELISLE RODRÍGUEZ | Examinador Externo |
Pages
Summary: Stroke is the leading cause of acquired physical disability in humans and the second largest cause of global mortality. Non-invasive brain stimulation techniques (NIBS), such as transcranial direct current stimulation (tDCS), transcutaneous spinal Direct
Current Stimulation (tsDCS), and Virtual Reality (VR) based on Motor Imagery (MI), can be applied in post-stroke therapy. 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. The research is divided into three separate chapters to assess both the long-term effects (chapter 1) and the immediate effects (chapters 2 and 3) of the intervention. In chapter 1, the study was
set up with the Alternative Treatment Design (ATD), comprising three phases: baseline, sham stimulation, and real stimulation. For chapters 2 and 3, 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 used 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 controls. In the 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 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 controls. Results from the second experiment will be 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) and For chapter 3, the Hjorth parameters (activity, mobility, complexity) were used across two assessment sessions, pre- and post-stimulation. Findings from the first experiment showed significant improvements in motor function and gait. The results from the second part provided valuable insights for personalized treatments for stroke patients.
