Efficacy of repetitive transcranial magnetic stimulation/transcranial direct current stimulation in cognitive neurorehabilitation.
Cognitive deficits are a common consequence of neurologic disease, in particular, of traumatic brain injury, stroke, and neurodegenerative disorders, and there is evidence that specific cognitive training may be effective in cognitive rehabilitation. Several investigations emphasize the fact that interacting with cortical activity, by means of cortical stimulation, can positively affect the short-term cognitive performance and improve the rehabilitation potential of neurologic patients. In this respect, preliminary evidence suggests that cortical stimulation may play a role in treating aphasia, unilateral neglect, and other cognitive disorders. Several possible mechanisms can account for the effects of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) on cognitive performance. They all reflect the potential of these methods to improve the subject's ability to relearn or to acquire new strategies for carrying out behavioral tasks. The responsible mechanisms remain unclear but they are most likely related to the activation of impeded pathways or inhibition of maladaptive responses. Modifications of the brain activity may assist relearning by facilitating local activity or by suppressing interfering activity from other brain areas. Notwithstanding the promise of these preliminary findings, to date no systematic application of these methods to neurorehabilitation research has been reported. Considering the potential benefit of these interventions, further studies taking into consideration large patient populations, long treatment periods, or the combination of different rehabilitation strategies are needed. Brain stimulation is indeed an exciting opportunity in the field of cognitive neurorehabilitation, which is clearly in need of further research.
Miniussi
Carlo
C
Department of Biomedical Sciences and Biotechnology, National Institute of Neuroscience-Italy, University of Brescia and Cognitive Neuroscience Section, IRCCS San Giovanni di Dio Fatebenefratelli, Brescia, Italy. miniussi@med.unibs.it
Cappa
Stefano F
SF
Cohen
Leonardo G
LG
Floel
Agnes
A
Fregni
Felipe
F
Nitsche
Michael A
MA
Oliveri
Massimiliano
M
Pascual-Leone
Alvaro
A
Paulus
Walter
W
Priori
Alberto
A
Walsh
Vincent
V
D001288:Attention / Q000502:physiology; D002540:Cerebral Cortex / Q000502:physiology; D003072:Cognition Disorders / Q000534:rehabilitation*; D006801:Humans; D007802:Language; D008568:Memory / Q000502:physiology; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D004561:Transcutaneous Electric Nerve Stimulation / Q000379:methods*; D016896:Treatment Outcome