title: Opportunities for Guided Multichannel Non-invasive Transcranial Current Stimulation in Poststroke Rehabilitation.
abstract: Stroke is a leading cause of serious long-term disability worldwide. Functional outcome depends on stroke location, severity, and early intervention. Conventional rehabilitation strategies have limited effectiveness, and new treatments still fail to keep pace, in part due to a lack of understanding of the different stages in brain recovery and the vast heterogeneity in the poststroke population. Innovative methodologies for restorative neurorehabilitation are required to reduce long-term disability and socioeconomic burden. Neuroplasticity is involved in poststroke functional disturbances and also during rehabilitation. Tackling poststroke neuroplasticity by non-invasive brain stimulation is regarded as promising, but efficacy might be limited because of rather uniform application across patients despite individual heterogeneity of lesions, symptoms, and other factors. Transcranial direct current stimulation (tDCS) induces and modulates neuroplasticity, and has been shown to be able to improve motor and cognitive functions. tDCS is suited to improve poststroke rehabilitation outcomes, but effect sizes are often moderate and suffer from variability. Indeed, the location, extent, and pattern of functional network connectivity disruption should be considered when determining the optimal location sites for tDCS therapies. Here, we present potential opportunities for neuroimaging-guided tDCS-based rehabilitation strategies after stroke that could be personalized. We introduce innovative multimodal intervention protocols based on multichannel tDCS montages, neuroimaging methods, and real-time closed-loop systems to guide therapy. This might help to overcome current treatment limitations in poststroke rehabilitation and increase our general understanding of adaptive neuroplasticity leading to neural reorganization after stroke.
authors.affiliation: Neuroelectrics Barcelona , Barcelona , Spain.
authors.forename: Begonya
authors.initials: B
authors.lastname: Otal
authors.affiliation: INRIA (Sophia Antipolis), Université Montpellier , Montpellier , France.
authors.forename: Anirban
authors.initials: A
authors.lastname: Dutta
authors.affiliation: University of Medicine Göttingen , Göttingen , Germany.
authors.forename: Águida
authors.initials: Á
authors.lastname: Foerster
authors.affiliation: Neuroelectrics Barcelona , Barcelona , Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Ripolles
authors.affiliation: Department of Radiology, Brain and Mind Research Institute, Weill Cornell Medical College , New York, NY , USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Kuceyeski
authors.affiliation: Institute of Biophysics and Biomedical Engineering (IBEB), Faculdade de Ciências, Universidade de Lisboa , Lisboa , Portugal.
authors.forename: Pedro C
authors.initials: PC
authors.lastname: Miranda
authors.affiliation: Non-Invasive Brain Stimulation and Human Motor Control Laboratory, Burke-Cornell Medical Research Institute , White Plains, NY , USA.
authors.forename: Dylan J
authors.initials: DJ
authors.lastname: Edwards
authors.affiliation: Department of Clinical Neurophysiology, Medical Faculty of Military Medical Academy, University of Defense , Belgrade , Serbia.
authors.forename: Tihomir V
authors.initials: TV
authors.lastname: Ilić
authors.affiliation: Leibniz Research Centre for Working Environment and Human Factors, Technical University of Dortmund, Dortmund, Germany; Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Nitsche
authors.affiliation: Neuroelectrics Barcelona, Barcelona, Spain; Starlab Barcelona, Barcelona, Spain.
authors.forename: Giulio
authors.initials: G
authors.lastname: Ruffini
keywords: multichannel stimulation; near-infrared spectroscopy; neuroimaging; non-invasive brain stimulation; tDCS; transcranial current stimulation