technique-considerations-use-4x1-ring-high-definition-transcranial

Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation (HD-tDCS)

High-definition transcranial direct current stimulation (HD-tDCS) has recently been developed as a noninvasive brain stimulation approach that increases ...

Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School

Pontifical Catholic University of Ecuador

Objective: To conduct a systematic review evaluating the reporting of blinding in randomized controlled trials published in the field of Physical Medicine and Rehabilitation over two time periods. Data sources: We searched MEDLINE via PubMed for all randomized controlled trials published in American Journal of Physical Medicine and Rehabilitation, Archives of Physical Medicine and Rehabilitation, Clinical Rehabilitation, Disability and Rehabilitation and (Scandinavian) Journal of Rehabilitation Medicine in the years 2000 and 2010. Study selection: We initially identified 222 articles, and 139 (62.6%) met our selection criteria. Data extraction: Two independent investigators collected data regarding study characteristics and blinding from each article. Consistency of data extraction was evaluated. Data synthesis: When comparing articles from 2010 and 2000, the former showed significantly higher rates for reporting of blinding, explicitly describing key persons' blinding status, and discussing the absence of blinding as a study limitation. There was a trend for lower reporting among trials with positive outcomes. No improvement was observed in other CONSORT-enforced parameters. Conclusions: Although the reporting of blinding in Physical Medicine and Rehabilitation randomized controlled trials shows some improvement over the past decade, it still does not fulfill current recommendations. Given its critical role in determining internal validity, stricter enforcement of CONSORT guidelines is needed.

The reporting of blinding in physical medicine and rehabilitation randomized controlled trials: A systematic review.

Objectif : Pour r&eacute;aliser un examen syst&eacute;matique &eacute;valuant le signalement de l&#39;aveuglement dans contr&ocirc;l&eacute;s randomis&eacute;s publi&eacute;s dans le domaine de la m&eacute;decine physique et de r&eacute;adaptation au cours de deux p&eacute;riodes de temps. Sources de donn&eacute;es : nous avons effectu&eacute; une recherche MEDLINE via PubMed pour tous contr&ocirc;l&eacute;s randomis&eacute;s publi&eacute;s dans l&#39;American Journal of Physical Medicine et r&eacute;habilitation, Archives of Physical Medicine et r&eacute;adaptation, clinique de r&eacute;habilitation, handicap et r&eacute;adaptation et (scandinave) Journal de m&eacute;decine de r&eacute;adaptation dans les ann&eacute;es 2000 et 2010. &Eacute;tudier la s&eacute;lection : nous avons d&#39;abord d&eacute;termin&eacute; les 222 articles et 139 (62,6 %) nos crit&egrave;res de s&eacute;lection. Extraction des donn&eacute;es : deux chercheurs ind&eacute;pendants a recueilli des donn&eacute;es concernant les caract&eacute;ristiques de l&#39;&eacute;tude et l&#39;aveuglement de chaque article. Coh&eacute;rence de l&#39;extraction des donn&eacute;es a &eacute;t&eacute; &eacute;valu&eacute;e. Synth&egrave;se de donn&eacute;es : lors de la comparaison des textes de 2010 et 2000, l&#39;ancien a montr&eacute; un taux sensiblement plus &eacute;lev&eacute;s pour signaler aveuglante, explicitement d&eacute;crivant le statut aveuglante des personnes cl&eacute;s et discut&eacute; de l&#39;absence d&#39;aveuglement comme une limitation de l&#39;&eacute;tude. Il y avait une tendance pour un rapport inf&eacute;rieur parmi les essais avec des r&eacute;sultats positifs. Aucune am&eacute;lioration a &eacute;t&eacute; observ&eacute;e dans les autres param&egrave;tres CONSORT-forc&eacute;es. Conclusions : M&ecirc;me si la d&eacute;claration des aveuglantes en m&eacute;decine physique et r&eacute;adaptation des essais contr&ocirc;l&eacute;s randomis&eacute;s montrent une am&eacute;lioration au cours de la derni&egrave;re d&eacute;cennie, qu&#39;il ne remplit toujours pas les recommandations actuelles. &Eacute;tant donn&eacute; son r&ocirc;le crucial dans la d&eacute;termination de la validit&eacute; interne, une application plus stricte des lignes directrices CONSORT est n&eacute;cessaire.

Le signalement de l&#39;aveuglement en m&eacute;decine physique et r&eacute;adaptation des essais contr&ocirc;l&eacute;s randomis&eacute;s : une revue syst&eacute;matique.

Obiettivo: Per condurre una revisione sistematica, valutando la segnalazione di accecante studi randomizzati controllati randomizzati pubblicati nel campo della medicina fisica e riabilitazione in due periodi di tempo. Origini dati: abbiamo cercato di MEDLINE attraverso PubMed per tutti randomizzati controllati randomizzati pubblicati nell&#39;American Journal of Physical Medicine e riabilitazione, archivi di medicina fisica e riabilitazione, riabilitazione clinica, disabilit&agrave; e riabilitazione (scandinavo) Journal of Rehabilitation Medicine negli anni 2000 e il 2010. Lo studio di selezione: abbiamo identificato inizialmente 222 articoli e 139 (62.6%) ha incontrato i nostri criteri di selezione. Estrazione dei dati: due ricercatori indipendenti raccolti dati riguardanti le caratteristiche di studio e accecante da ciascun articolo. &Egrave; stata valutata la coerenza di estrazione dei dati. Sintesi dei dati: quando si confrontano gli articoli dal 2010 e 2000, l&#39;ex ha mostrato tassi significativamente pi&ugrave; elevati per la segnalazione di accecante, in modo esplicito che descrive lo stato accecante chiave persone e discutere l&#39;assenza di accecante come una limitazione di studio. C&#39;era una tendenza per la segnalazione inferiore tra le prove con risultati positivi. Nessun miglioramento &egrave; stato osservato in altri parametri applicata al consorte. Conclusioni: Nonostante la segnalazione di accecante in medicina fisica e riabilitazione randomizzati controllati randomizzati mostra qualche miglioramento nell&#39;ultimo decennio, che ancora non soddisfare le raccomandazioni correnti. Dato il suo ruolo fondamentale nel determinare la validit&agrave; interna, &egrave; necessario pi&ugrave; rigorosa applicazione delle linee guida CONSORT.

La segnalazione di accecante in medicina fisica e riabilitazione randomizzati controllati randomizzati: una revisione sistematica.

The aim of this article is to evaluate the neuroplastic changes associated with chronic neuropathic pain following burn injury and modulation feasibility using transcranial direct current stimulation (tDCS). This is a crossover, double-blinded case series involving three patients with chronic neuropathic pain following burn injury. Participants were randomly assigned to undergo single sessions of both sham and active anodal tDCS over the primary motor cortex, contralateral to the most painful site. Excitability of the motor cortex was assessed before and after each stimulation session with the use of transcranial magnetic stimulation. An overall decrease in cortical excitability was seen after active tDCS only, as characterized by a decrease in intracortical facilitation and amplitude of motor evoked potentials and an increase in intracortical inhibition. Clinical outcomes did not change after a single session of tDCS. Results are consistent with previous studies showing that patients with chronic neuropathic pain have defective intracortical inhibition. This case series shows early evidence that chronic pain following burn injury may share similar central neural mechanisms, which could be modulated using tDCS.

A feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury.

Le but de cet article est d&#39;&eacute;valuer les changements de neuroplastiques li&eacute;s &agrave; la douleur neuropathique chronique apr&egrave;s br&ucirc;lures blessures et modulation faisabilit&eacute; utilisant la stimulation transcr&acirc;nienne de courant continu (CDV). Il s&#39;agit d&#39;un crossover, s&eacute;ries de cas double insu portant sur trois patients atteints qui suit la douleur neuropathique chronique br&ucirc;lent. Les participants &eacute;taient assign&eacute;s au hasard &agrave; subir des sessions unique de trompe-l&#39;&oelig;il et tDCS anodique actif sur le cortex moteur primaire, controlat&eacute;ral au site plus douloureux. Excitabilit&eacute; du cortex moteur a &eacute;t&eacute; &eacute;valu&eacute;e avant et apr&egrave;s chaque s&eacute;ance de stimulation avec l&#39;utilisation de la stimulation magn&eacute;tique transcr&acirc;nienne. Une diminution globale de l&#39;excitabilit&eacute; corticale a &eacute;t&eacute; observ&eacute;e apr&egrave;s tDCS actif uniquement, comme caract&eacute;ris&eacute; par une diminution de facilitation intracortical et amplitude du moteur &eacute;voqu&eacute;e par potentiels et l&#39;augmentation de l&#39;inhibition intracortical. Les r&eacute;sultats cliniques n&#39;a pas chang&eacute; apr&egrave;s une seule s&eacute;ance de CDV. R&eacute;sultats sont en accord avec des &eacute;tudes ant&eacute;rieures montrant que les patients souffrant de douleur neuropathique chronique ont une inhibition intracortical d&eacute;fectueuse. Cette s&eacute;rie de cas pr&eacute;sente des signes pr&eacute;coces que la douleur chronique suivant des br&ucirc;lures peuvent partager semblables m&eacute;canismes neuronaux centraux, qui pourraient &ecirc;tre modul&eacute;s &agrave; l&#39;aide de CDV.

Une &eacute;tude de faisabilit&eacute;, &eacute;valuer la plasticit&eacute; corticale dans la chronique qui suit la douleur neuropathique br&ucirc;lure.

Lo scopo di questo articolo &egrave; quello di valutare i cambiamenti neuroplastico associati con dolore neuropatico cronico a seguito di bruciare lesioni e modulazione di fattibilit&agrave; mediante stimolazione transcranica diretta corrente (TDC). Questo &egrave; un crossover, serie di casi doppio cieco su tre pazienti con dolore neuropatico cronico segue masterizzare lesioni. I partecipanti sono stati assegnati in modo casuale a subire le singole sessioni di farsa e di TDC anodica attivo sopra la corteccia motoria primaria, controlaterale al sito pi&ugrave; doloroso. Eccitabilit&agrave; della corteccia del motore &egrave; stata valutata prima e dopo ogni seduta di elettrostimolazione con l&#39;uso di stimolazione magnetica transcranica. Una diminuzione complessiva dell&#39;eccitabilit&agrave; corticale &egrave; stato visto dopo attivo TDC soltanto, come caratterizzata da una diminuzione della facilitazione intracorticali e ampiezza del motore evocata potenziali e un aumento della inibizione intracorticali. I risultati clinici non cambia dopo una singola sessione di TDC. I risultati sono coerenti con i precedenti studi che dimostrano che i pazienti con dolore neuropatico cronico hanno inibizione intracorticali difettoso. Questa serie di casi dimostra precoce evidenza che il dolore cronico seguenti lesioni ustione possono condividere simili meccanismi neurali centrali, che potrebbero essere modulate usando TDC.

Uno studio di fattibilit&agrave; valutare la plasticit&agrave; corticale in cronico dolore neuropatico segue bruciare lesioni.

Fibromyalgia is a prevalent chronic pain syndrome characterized by altered pain and sensory processing in the central nervous system, which is often refractory to multiple therapeutic approaches. Given previous evidence supporting analgesic properties of noninvasive brain stimulation techniques in this condition, this study examined the effects of a novel, more focal method of transcranial direct current stimulation (tDCS), using the 4Ã—1-ring configuration of high-definition (HD)-tDCS, on overall perceived pain in fibromyalgia patients. In this patient- and assessor-blind, sham-controlled, crossover trial, 18 patients were randomized to undergo single 20-minute sessions of anodal, cathodal, and sham HD-tDCS at 2.0 mA in a counterbalanced fashion. The center electrode was positioned over the left primary motor cortex. Pain scales and sensory testing were assessed before and after each intervention. A finite element method brain model was generated to predict electric field distribution. We found that both active stimulation conditions led to significant reduction in overall perceived pain as compared to sham. This effect occurred immediately after cathodal HD-tDCS and was evident for both anodal and cathodal HD-tDCS 30 minutes after stimulation. Furthermore, active anodal stimulation induced a significant bilateral increase in mechanical detection thresholds. These interventions proved well tolerated in our patient population.

Focal modulation of the primary motor cortex in fibromyalgia using 4Ã—1-ring high-definition transcranial direct current stimulation (HD-tDCS): immediate and delayed analgesic effects of cathodal and anodal stimulation.

La fibromyalgie est un syndrome de douleur chronique r&eacute;pandue caract&eacute;ris&eacute; par une douleur alt&eacute;r&eacute;e et sensorielles dans le syst&egrave;me nerveux central, qui est souvent r&eacute;fractaire &agrave; de multiples approches th&eacute;rapeutiques. Compte tenu des pr&eacute;c&eacute;dentes preuves &agrave; l&#39;appui des propri&eacute;t&eacute;s analg&eacute;siques de techniques de stimulation c&eacute;r&eacute;brale non invasive dans cet &Eacute;tat, cette &eacute;tude a examin&eacute; les effets d&#39;un roman, une m&eacute;thode focale plus de stimulation transcr&acirc;nienne de courant continu (CDV), &agrave; l&#39;aide de la configuration de 4 &times; 1-anneau de haute d&eacute;finition (HD)-STD, sur globale douleur per&ccedil;ue chez les patients fibromyalgiques. Dans ce patient et &eacute;valuateur-aveugle, contr&ocirc;l&eacute;e par imposture, essai crois&eacute;, 18 patients ont &eacute;t&eacute; randomis&eacute;s pour subir des sessions de 20 minutes unique d&#39;anodiques, cathodiques ni truqu&eacute;s HD-STD 2.0 mA fa&ccedil;on contrebalanc&eacute;. L&#39;&eacute;lectrode centrale a &eacute;t&eacute; positionn&eacute; sur le cortex moteur primaire gauche. &Eacute;chelles de douleur et de tests sensoriels ont &eacute;t&eacute; &eacute;valu&eacute;s avant et apr&egrave;s chaque intervention. Un mod&egrave;le de cerveau de m&eacute;thode &eacute;l&eacute;ments finis a &eacute;t&eacute; g&eacute;n&eacute;r&eacute; pour pr&eacute;dire la distribution du champ &eacute;lectrique. Nous avons constat&eacute; que les deux conditions de stimulation active conduit &agrave; une r&eacute;duction significative de la douleur per&ccedil;ue globale par rapport &agrave; la farce. Cet effet a eu lieu imm&eacute;diatement apr&egrave;s cathodiques HD-STD et &eacute;tait &eacute;vident pour les anodiques et cathodiques HD-STD 30 minutes apr&egrave;s la stimulation. En outre, stimulation anodique active induit une augmentation bilat&eacute;rale importante des seuils de d&eacute;tection m&eacute;canique. Ces interventions s&#39;est r&eacute;v&eacute;l&eacute; bien tol&eacute;r&eacute;es dans notre population de patients.

Focale modulation du cortex moteur primaire dans la fibromyalgie &agrave; l&#39;aide de stimulation de courant continu 4 &times; 1 anneau transcr&acirc;nienne haute d&eacute;finition (HD-CDV): effets analg&eacute;siques imm&eacute;diats et diff&eacute;r&eacute;s de stimulation cathodique et anodique.

La fibromialgia &egrave; una sindrome di dolore cronico diffuso caratterizzata da dolore alterata e sensoriale di elaborazione del sistema nervoso centrale, che spesso &egrave; refrattario a molteplici approcci terapeutici. Dato precedente prove a sostegno di propriet&agrave; analgesiche di tecniche di stimolazione cerebrale non invasiva in questa condizione, questo studio ha esaminato gli effetti di un romanzo, pi&ugrave; Metodo focale della stimolazione transcranica diretta corrente (TDC), utilizzando la configurazione di 4 &times; 1-anello di alta definizione (HD)-TDC, sul dolore percepito globale in pazienti con fibromialgia. In questo paziente e assessore-cieco, sham-controllato, trial crossover, 18 pazienti sono stati randomizzati a sottoporsi a sedute di 20 minuti singoli di anodica, cathodal e sham HD-TDC a 2.0 mA in maniera controbilanciata. L&#39;elettrodo centrale &egrave; stato posizionato sopra la sinistra corteccia motoria primaria. Pain scale e test sensoriali sono stati valutati prima e dopo ogni intervento. Un modello di cervello del metodo degli elementi finiti &egrave; stato generato per predire la distribuzione del campo elettrico. Abbiamo trovato che entrambe condizioni di stimolazione attiva ha portato a una significativa riduzione del dolore percepito complessiva rispetto alla sham. Questo effetto si &egrave; verificato immediatamente dopo cathodal HD-TDC e fu evidente per entrambi anodica e cathodal HD-TDC 30 minuti dopo la stimolazione. Inoltre, attiva stimolazione anodica indotto un significativo aumento delle soglie di rilevazione meccanica bilaterale. Questi interventi si &egrave; rivelato ben tollerati nella nostra popolazione di pazienti.

Modulazione focale della corteccia motoria primaria nella fibromialgia mediante stimolazione di corrente continua ad alta definizione transcranica 4 &times; 1-anello (HD-TDC): immediati e ritardati effetti analgesici di stimolazione anodica e cathodal.

Mauricio F. Villamar

Laboratory of Neuromodulation,
Department of Physical Medicine & Rehabilitation,
Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation

Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School

Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation (HD-tDCS)

Mauricio F. Villamar

Laboratory of Neuromodulation,Department of Physical Medicine & Rehabilitation,Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation

Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School

Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation (HD-tDCS)

Laboratory of Neuromodulation,
Department of Physical Medicine & Rehabilitation,
Laboratory of Neuromodulation, Department of Physical Medicine & Rehabilitation