title: Tailoring Brain Stimulation to the Nature of Rehabilitative Therapies in Stroke: A Conceptual Framework Based on their Unique Mechanisms of Recovery.
abstract: Despite showing early promise, several recent clinical trials of noninvasive brain stimulation (NIBS) failed to augment rehabilitative outcomes of the paretic upper limb. This article addresses why pairing NIBS with unilateral approaches is weakly generalizable to patients in all ranges of impairments. The article also addresses whether alternate therapies are better suited for the more impaired patients, where they may be more feasible and offer neurophysiologic advantages not offered with unilateral therapies. The article concludes by providing insight on how to create NIBS paradigms that are tailored to distinctly augment the effects of therapies across patients with varying degrees of impairment.
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; School of Biomedical Sciences, Kent State University, Kent, OH, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Cunningham
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Kelsey A
authors.initials: KA
authors.lastname: Potter-Baker
authors.affiliation: MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Jayme S
authors.initials: JS
authors.lastname: Knutson
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
authors.forename: Vishwanath
authors.initials: V
authors.lastname: Sankarasubramanian
authors.affiliation: Center for Neurological Restoration, Neurological Institute, Department of Neurosurgery, Neurological Institute, Cleveland, OH, USA; Department of Neuroscience and Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA.
authors.forename: Andre G
authors.initials: AG
authors.lastname: Machado
authors.affiliation: Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA; Department of Physical Medicine & Rehabiliation, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address: plowe2@ccf.org.
authors.forename: Ela B
authors.initials: EB
authors.lastname: Plow
mesh_terms: D004599:Electric Stimulation Therapy / Q000379:methods*; D006801:Humans; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Bilateral therapy; Motor impairment; Noninvasive brain stimulation; Repetitive transcranial magnetic stimulation; Stroke; Transcranial direct current stimulation; Unilateral therapy; Upper limb