ABSTRACT
Abstract The novel SARS-CoV-2 virus has infected millions of people around the world, and will become endemic, resulting in an urgent need to discover and validate inexpensive and accessible treatments that can reduce morbidity and persistent post-infectious symptoms. Noninvasive brain stimulation methods, such as transcranial electrical stimulation (tES), may have a potential role in the treatment of Coronavirus Disease 2019 (COVID-19) related symptoms. This potential is theorized based on the known mechanisms of biological action and demonstrated benefits in non-COVID-19 patients for various known sequelae of COVID-19 illness and recovery (e.g., fatigue, cognitive dysfunction, central sensitization, and emotional dysregulation), with now several initiatives of its application in the context of COVID-19 clinical course. Here, we will summarize the technological advantages, the rationale, and mechanism of action of using tES techniques to manage COVID-19 infection through four pathways: (1) Acute intervention, (2) Add-on treatment to augment rehabilitation following critical illness, (3) Post-Acute Sequelae of SARS-CoV-2, and (4) Treatment of outbreak related mental distress exacerbated by surrounding psychosocial stressors related to COVID-19 pandemic. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: tES, PASC, SARS-CoV-2 InfectionCopyright © 2023
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: To establish a reliable method for remote at-home gait assessment for clinical examination and monitoring. Background: Gait measurement is important for multiple sclerosis (MS) clinical evaluation, with changes indicating disease progression and potential disability. There is a critical need for remote at-home assessments in response to COVID-19 pandemic and beyond. Design/Methods: We developed a protocol for remote and precise gait assessment using a commercially-available tri-axial accelerometer system (RunScribe), validated with gait measurements obtained at in-clinic baseline visit using a gold-standard wearable tri-axial accelerometer (G-sensor, BTS Bioengineering). A 42-year old woman with progressive MS (EDSS: 6.5) and moderate-severe level of mobility impairment (T25-FW time: 33.8 sec;TUG time: 41.86 sec) completed an initial gait assessment during a routine outpatient visit and was provided with two shoelace wearable sensors (shoe mount) in the context of a telemedicine visit. She was trained during the video visit to setup and position the sensors, connect to the app, and complete a walking test at home. She repeated the gait assessments independently on a weekly basis. In-clinic baseline measures were compared with the remotely-obtained measurements for validation. Results: In-clinic baseline walking speed was 0.54 m/s, while left and right stride length were 0.56 m and 0.60 m, respectively. During the first video visit walking speed was 0.48 m/s, while the stride length was 0.47 m and 0.48 m for left and right side, respectively. The patient completed 5 weekly gait self-assessments with an average gait velocity of 0.47 ± 0.10 m/s. The gait parameters were reliable over time when measured at home and comparable to those obtained at baseline in-clinic. Conclusions: The spatiotemporal parameters measured in at-home setting by shoe-mounted accelerometers provided valid remote measurement of gait parameters. This protocol provides a method for obtaining reliable assessment of gait functioning in the context of telemedicine.