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Non-invasive brain stimulation improves fine motor movement in stroke patients

An meta-analysis of published studies found that non-invasive brain stimulation may have beneficial effects on fine motor movement in stroke patients and healthy participants.

The meta-analysis examined the effects of two common non-invasive brain stimulation technologies – transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) – on hand and finger movement, like picking up objects, writing, or similarly precise tasks that are often affected after a stroke.

The investigators observed statistically significant gains in fine motor movement in stroke patients following tDCS and TMS; however, time since onset of stroke event, the severity of impairment, combination of non-invasive brain stimulation with other interventions, and risk of bias were all relevant factors. Fine motor improvement in healthy participants' non-dominant hand (a surrogate to an impaired hand) was also observed.

"Encouragingly, research to refine these gains, understand their impact on lifestyle, and determine best responders to these types of treatments is happening now," said lead author Dr Anthony O'Brien, of the Spaulding Neuromodulation Centre, an affiliate of Harvard Medical School.

Abstract
The aim of this study was to determine whether non‐invasive brain stimulation (NIBS) techniques improve fine motor performance in stroke. We searched PubMed, EMBASE, Web of Science, SciELO and OpenGrey for randomized clinical trials on NIBS for fine motor performance in stroke patients and healthy participants. We computed Hedges’ g for active and sham groups, pooled data as random‐effects models and performed sensitivity analysis on chronicity, montage, frequency of stimulation and risk of bias. Twenty‐nine studies (351 patients and 152 healthy subjects) were reviewed. Effect sizes in stroke populations for transcranial direct current stimulation and repeated transcranial magnetic stimulation were 0.31 [95% confidence interval (CI), 0.08–0.55; P = 0.010; Tau2, 0.09; I2, 34%; Q, 18.23; P = 0.110] and 0.46 (95% CI, 0.00–0.92; P = 0.05; Tau2, 0.38; I2, 67%; Q, 30.45; P = 0.007). The effect size of non‐dominant healthy hemisphere transcranial direct current stimulation on non‐dominant hand function was 1.25 (95% CI, 0.09–2.41; P = 0.04; Tau2, 1.26; I2, 93%; Q, 40.27; P < 0.001). Our results show that NIBS is associated with gains in fine motor performance in chronic stroke patients and healthy subjects. This supports the effects of NIBS on motor learning and encourages investigation to optimize their effects in clinical and research settings.

Authors
AT O'Brien, F Bertolucci, G Torrealba-Acosta, R Huerta, F Fregni, A Thibaut

[link url="https://www.sciencedaily.com/releases/2018/05/180511123240.htm"]Wiley material[/link]
[link url="https://onlinelibrary.wiley.com/doi/abs/10.1111/ene.13643"]European Journal of Neurology abstract[/link]

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