title: Noninvasive brain stimulation to modulate neuroplasticity in traumatic brain injury.
abstract: OBJECTIVE
  To review the use of noninvasive brain stimulation (NBS) as a therapeutic tool to enhance neuroplasticity following traumatic brain injury (TBI).
  
  
  METHODS
  Based on a literature search, we describe the pathophysiological events following TBI and the rationale for the use of transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in this setting.
  
  
  RESULTS
  The pathophysiological mechanisms occurring after TBI vary across time and therefore require differential interventions. Theoretically, given the neurophysiological effects of both TMS and tDCS, these tools may: 1) decrease cortical hyperexcitability acutely after TBI; 2) modulate long-term synaptic plasticity as to avoid maladaptive consequences; and 3) combined with physical and behavioral therapy, facilitate cortical reorganization and consolidation of learning in specific neural networks. All of these interventions may help decrease the burden of disabling sequelae after brain injury.
  
  
  CONCLUSIONS
  Evidence from animal and human studies reveals the potential benefit of NBS in decreasing the extent of injury and enhancing plastic changes to facilitate learning and recovery of function in lesioned neural tissue. However, this evidence is mainly theoretical at this point. Given safety constraints, studies in TBI patients are necessary to address the role of NBS in this condition as well as to further elucidate its therapeutic effects and define optimal stimulation parameters.
authors.affiliation: Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Mauricio Fernando
authors.initials: MF
authors.lastname: Villamar
authors.forename: Andrea
authors.initials: A
authors.lastname: Santos Portilla
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.forename: Ross
authors.initials: R
authors.lastname: Zafonte
mesh_terms: D000208:Acute Disease; D000222:Adaptation, Physiological / Q000502:physiology; D001930:Brain Injuries / Q000503:physiopathology* / Q000628:therapy*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004599:Electric Stimulation Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D009473:Neuronal Plasticity / Q000502:physiology*; D026741:Physical Therapy Modalities; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects