通过远程监督的大脑刺激对帕金森氏病的家庭治疗

An exciting therapy option for Parkinson’s disease is transcranial direct current stimulation (tDCS), a type of noninvasive brain stimulation. In arecently published study in神经工程和康复杂志, Dr. Leigh Charvet and colleagues trialed this stimulation method in home settings with remote supervision from technicians. They found compliance to be extremely high with patients appreciating the opportunity to access treatment from home. Further insights into tDCS application for motor rehabilitation are and will be published in神经工程和康复杂志’s thematic series.

Transcranial direct current stimulation (tDCS) is a type of noninvasive brain stimulation where a mild electrical current is passed through two or more scalp electrodes placed to target a specific brain region. There are early signs of therapeutic benefit using tDCS, both to improve symptoms across central nervous system (CNS) disorders (e.g., depressed mood), but especially to enhance training outcomes when paired with a rehabilitative activity (e.g., cognitive or motor exercises). tDCS is presumed to increase the brain’s plasticity during the stimulation period, with repeated application or treatment yielding the most consistent persisting effects in brain excitability and clinically relevant effects.

TDC之所以吸引人,是因为它是安全,可容忍且相对较低的成本。此外,这些设备是轻巧且便携式的,可以灵活地进行治疗。

远程监督的TDC用于运动康复

基础和临床研究清楚地表明了反复刺激的累积益处。因此,为了获得最佳和持续的临床益处,需要许多TDC治疗。康复运动计划可以跨越数周或数月的每日练习。

Demonstration of the stimulation headset being used in conjunction with exercise.
©Leigh Charvet博士

对于大多数参与者来说,前往诊所接受多次每日课程是不可行的。对于我们在纽约市的中心,访问的平均通勤时间超过两个小时,而且价格昂贵。对于忙于工作和家庭职责以及受到旅行挑战的人来说,这是一个艰辛的困难。

作为解决方案,我们开发了一种使用远程监督(远程监督或RS-TDC)将治疗方法从诊所移开的方法。使用远程医疗平台可显着增加获得治疗的机会,我们发现参与者在家中可以接受治疗时的合规性和协议依从性较高。

我们没有通过实时指导和通过视频会议和严格结构化的方法来仔细地复制房屋中的诊所管理实践。非常重要的是要注意,我们的远程监督保持了相同的诊所标准,以进行监测,安全和治疗程序。

TDC的安全功能和过程以及远程监督

我们试验中使用的刺激设备是针对远程使用的明确设计的,我们与参与者一起在整个会话中生活。为了确保头皮电极可靠地放置,我们有一个带有标记的弹性头部带,以确认参与者和技术人员在整个视频会议期间的正确位置。每个设备都被一次性使用的可编程剂量释放代码锁定。我们控制每个设备编程的代码数量,当他们充分准备开始治疗并满足所有安全检查时,我们会口头向参与者陈述剂量释放代码。

Being able to monitor each participant remotely with video-conferencing software allows us to control when treatment is delivered to the participant and we are able to address any problems that may arise during the treatment session immediately. Importantly, if contact between the electrodes is disrupted or if there is impedance then the stimulation will cease. The devices provide reliable control over the intensity and timing of stimulation with a continuous visual indication of electrode contact quality while stimulation is active.

Remotly supervised tDCS for Parkinson’s disease and multiple sclerosis – generaliziability of the protocol

The aim of this particular study was to demonstrate its feasibility in participants with Parkinson’s disease (PD). This was found to be the case, at-home access for PD patients led to exceptionally high protocol compliance. The preliminary results in the PD population confirmed the generalizability and utility of our RS-tDCS protocol while indicating preliminary efficacy of tDCS for the improvement of perceived fatigue and cognitive processing speed.

It was remarkable how much the PD participants appreciated the opportunity to access treatment from home, and it was an immediately popular study.

我们以前已经确定,我们的协议非常成功地为多发性硬化症(MS)的人提供众多年龄(18至75岁)和残疾水平(包括轮椅依赖并依靠轮椅的人)非常成功。照顾者)。该协议能够有效研究TDC的长期影响,现在我们在某些参与者中进行了多达60个课程,并配对认知或运动训练。

我们继续将我们的发现与以前的MS队列进行比较,并确定我们的RS-TDCS方案对这些神经系统疾病的人们具有相似的好处和副作用。

It was remarkable how much the PD participants appreciated the opportunity to access treatment from home, and it was an immediately popular study. As would be expected when living with a movement disorder, and like many of our MS participants, it is quite a burden to travel to and from clinic each day. For instance, one participant comes to mind who would clearly not have otherwise been able to access therapy at all as he could not travel to his appointments alone and his spouse had a very busy work schedule. He reported feeling increased alertness after each session and was very interested in any opportunity to extend his treatment sessions (as many are). We also found that participants especially liked a nondrug option for therapy.

Future perspective for tDCS application for Parkinson’s diseases

Our findings support further study of the effects of tDCS for the PD population, and we believe that the RS-tDCS method can allow for large-scale studies with adequate sample sizes and extended session to inform the parameters for clinical use such as dosing. We hope to expand and demonstrate the feasibility of our RS-tDCS protocol across neurological disorders in order to reach those that may most benefit from this treatment in the future.

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