ABSTRACT
There is a critical need for therapeutic interventions for Post-Acute Sequelae (PASC) of SARS-CoV-2 infection patients worldwide. tDCS has the potential for therapeutic targeting of these PASC symptoms, with devices that can be portable and wearable for home-based access. At-home tDCS access is highly relevant to complete the necessary clinical trials for PASC and has the potential to provide patients with an immediate treatment option. We have led the field in rigorous, reliable, and standardized home-based brain stimulation with the development of the remotely supervised or RS-tDCS platform. Participants are provided with remotely-controlled devices, trained in safe and effective operation, and then supervised for daily use through live videoconference. Extensively tested over >8 years (>12,000 at-home tDCS sessions in >500 patients to date), the feasibility of our RS-tDCS procedures has been verified for use across all ages (18-80 years), including those with advanced cognitive or motor disabilities and/or limited technical experience, and also reaching those at socioeconomic healthcare disadvantage for inclusion in RCTs. The RS-tDCS platform has allowed for the continued enrollment in ongoing RCTs during the COVID-19 onsite clinical research pause (with >100 participants by completing all study procedures from home). The telehealth delivery of the intervention results in rapid enrollment and high retention and adherence for repeated and extended sessions (e.g., >97% completion rates across RCTs to date). While tDCS remains under investigational status in the U.S., in 2019, we also launched tDCS as a clinical telehealth service as innovative care. In this at-home service, tDCS is delivered to patients at home and stimulation parameters can be individualized to be paired with interventions such as physical exercise, online adaptive computerized cognitive training, and guided mindfulness meditation. Patients with PASC, seen through our tDCS program, will be presented as examples of the at-home tDCS treatment approach. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: tDCS, Telehealth Intervention, PASC, SARS-CoV-2Copyright © 2023
ABSTRACT
Objective: We report the approach and initial outcomes for two patients with Post-Acute Sequelae of SARS-CoV-2 (PASC) seen at our clinical transcranial direct current stimulation (tDCS) telehealth service at NYU Langone Health. Background: PASC is the syndrome of persisting (>1 month) symptoms following COVID-19 illness, which often include fatigue, cognitive dysfunction, pain, and emotional disturbance, and can lead to significant reductions in levels of daily functioning and quality of life. As the numbers of individuals who recover from COVID-19 continue to rise world-wide, there is a critical need for therapeutic interventions for this patient population. tDCS has potential for therapeutic targeting of these PASC symptoms, with the advantage of portable and wearable devices for home-based access. Design/Methods: Patients were a 42 and 57-year-old women with PASC seen 7 and 9 months following their acute COVID-19 illness. Each daily tDCS session was delivered at-home via a video visit for 30 minutes x 2.0 mA using a left anodal dorsolateral prefrontal cortex montage. Stimulation was paired with physical exercise, online adaptive computerized cognitive training, and guided mindfulness meditation, individualized to each patient. Sessions were delivered 3-5 days per week. Clinical neuropsychological evaluation was completed before and after the intervention, and we developed a symptom inventory based on the full range of PASC symptoms reported in the literature (Assessment of PASC;A-PASC) to measure treatment outcomes. Results: The patients experienced significant improvements across cognitive, emotional, physical, and functional domains, and both returned to work and resumed most of their daily activities following the intervention. Conclusions: tDCS can be delivered as a teleintervention warranting its evaluation as an accessible and scalable treatment option for PASC. Further study and clinical trials of PASC are warranted.
ABSTRACT
Objective: We report the feasibility and efficacy of a cognitive telerehabilitation protocol, combining remotely supervised transcranial direct current stimulation (RS-tDCS) and computerized adaptive cognitive training, for at-home intervention targeting cognitive sequelae of traumatic brain injury (TBI). Background: Cognitive impairments following a TBI often persist long after acute recovery. Options for longer-term cognitive remediation are needed, and telerehabilitation can provide continued access to interventions. Design/Methods: Patient was a 29-year-old man with persisting cognitive problems four years following TBI. He completed 20 daily at-home computer-based cognitive training sessions paired with tDCS (2.0 mA × 20 minutes, left anodal dorsolateral prefrontal cortex). Treatments were completed with real-time supervision via videoconference. Neuropsychological evaluation was completed before and after the intervention. Results: The patient had significant improvements (>1 SD) on measures of attention and working memory, semantic fluency, and information processing speed. Conclusions: At-home and remotely supervised telerehabilitation including tDCS is a feasible intervention, and remediated persisting cognitive impairments in a TBI survivor. Findings are particularly relevant for patients who cannot attend the clinic due to the COVID-19 social distancing limitations, as well as other barriers, such as time restriction, financial cost, distance from the clinic, or level of disability.