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1.
BMJ Open ; 12(4): e055038, 2022 04 11.
Article in English | MEDLINE | ID: covidwho-1784816

ABSTRACT

INTRODUCTION: A substantial number of patients diagnosed with COVID-19 experience long-term persistent symptoms. First evidence suggests that long-term symptoms develop largely independently of disease severity and include, among others, cognitive impairment. For these symptoms, there are currently no validated therapeutic approaches available. Cognitive training interventions are a promising approach to counteract cognitive impairment. Combining training with concurrent transcranial direct current stimulation (tDCS) may further increase and sustain behavioural training effects. Here, we aim to examine the effects of cognitive training alone or in combination with tDCS on cognitive performance, quality of life and mental health in patients with post-COVID-19 subjective or objective cognitive impairments. METHODS AND ANALYSIS: This study protocol describes a prospective randomised open endpoint-blinded trial. Patients with post-COVID-19 cognitive impairment will either participate in a 3-week cognitive training or in a defined muscle relaxation training (open-label interventions). Irrespective of their primary intervention, half of the cognitive training group will additionally receive anodal tDCS, all other patients will receive sham tDCS (double-blinded, secondary intervention). The primary outcome will be improvement of working memory performance, operationalised by an n-back task, at the postintervention assessment. Secondary outcomes will include performance on trained and untrained tasks and measures of health-related quality of life at postassessment and follow-up assessments (1 month after the end of the trainings). ETHICS AND DISSEMINATION: Ethical approval was granted by the Ethics Committee of the University Medicine Greifswald (number: BB 066/21). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER: NCT04944147.


Subject(s)
COVID-19 , Cognitive Dysfunction , Transcranial Direct Current Stimulation , Brain , COVID-19/therapy , Clinical Trials, Phase II as Topic , Cognition , Cognitive Dysfunction/therapy , Humans , Prospective Studies , Quality of Life , Randomized Controlled Trials as Topic
4.
BMC Psychiatry ; 21(1): 579, 2021 11 17.
Article in English | MEDLINE | ID: covidwho-1526609

ABSTRACT

OBJECTIVE: Bipolar Disorder (BD) is one of the most common mental disorders associated with depressive symptoms and impairment in executive functions such as response inhibition. This study aimed to investigate the effectiveness of medication therapy combined with Transcranial Direct Current Stimulation (tDCS) on depression and response inhibition of patients with BD. METHOD: This is a double-blinded randomized clinical trial with pretest, posttest, and follow-up design. Participants were 30 patients with BD randomly assigned to two groups of Medication+tDCS (n = 15, receiving medications plus tDCS with 2 mA intensity over dorsolateral prefrontal cortex for 10 days, two sessions per day each for 20 min) and Medication (n = 15, receiving mood stabilizers including 2-5 tables of 300 mg (mg) lithium, 200 mg sodium valproate, and 200 mg carbamazepine two times per day). Pretest, posttest and 3-month follow-up assessments were the 21-item Hamilton Depression Rating Scale (HDRS) and a Go/No-Go test. Collected data were analyzed in SPSS v.20 software. RESULTS: The mean HDRS score in both groups was reduced after both interventional techniques, where the group received combined therapy showed more reduction (P < 0.01), although their effects were not maintained after 3 months. In examining response inhibition variable, only the combined therapy could reduce the commission error of patients under a go/no-go task (p < 0.05), but its effect was not maintained after 3 months. There was no significant difference in the group received medication therapy alone. CONCLUSION: Medication in combination with tDCS can reduce the depressive symptoms and improve the response inhibition ability of people with BD. TRIAL REGISTRATION: This study was registred by Iranian Registry of Clinical Trials (Parallel, ID: IRCT20191229045931N1 , Registration date: 24/08/2020).


Subject(s)
Bipolar Disorder , Depressive Disorder, Major , Transcranial Direct Current Stimulation , Bipolar Disorder/drug therapy , Depression , Double-Blind Method , Humans , Iran , Prefrontal Cortex , Treatment Outcome
6.
J Chin Med Assoc ; 85(1): 24-29, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1465265

ABSTRACT

Electrotherapy or electrical stimulation (ES) is a part of clinical intervention in the rehabilitation field. With rehabilitation intervention, electrotherapy may be provided as a treatment for pain relief, strengthening, muscle education, wound recovery, or functional training. Although these interventions may not be considered as the primary therapy for patients, the advantages of the ease of operation, lower costs, and lower risks render ES to be applied frequently in clinics. There have also been emerging ES tools for brain modulation in the past decade. ES interventions are not only considered analgesics but also as an important assistive therapy for motor improvement in orthopedic and neurological rehabilitation. In addition, during the coronavirus disease pandemic, lockdowns and self-quarantine policies have led to the discontinuation of orthopedic and neurological rehabilitation interventions. Therefore, the feasibility and effectiveness of home-based electrotherapy may provide opportunities for the prevention of deterioration or extension of the original therapy. The most common at-home applications in previous studies showed positive effects on pain relief, functional ES, muscle establishment, and motor training. Currently, there is a lack of certain products for at-home brain modulation; however, transcranial direct current stimulation has shown the potential of future home-based rehabilitation due to its relatively small and simple design. We have organized the features and applications of ES tools and expect the future potential of remote therapy during the viral pandemic.


Subject(s)
COVID-19/epidemiology , Electric Stimulation Therapy/methods , Neurological Rehabilitation , Orthopedic Procedures , SARS-CoV-2 , Electric Stimulation Therapy/adverse effects , Humans , Transcranial Direct Current Stimulation , Transcutaneous Electric Nerve Stimulation
7.
Sensors (Basel) ; 21(15)2021 Jul 31.
Article in English | MEDLINE | ID: covidwho-1346532

ABSTRACT

BACKGROUND: The effectiveness of transcranial direct current stimulation (tDCS) in the upper limb (UL) motor rehabilitation of stroke has been widely studied. However, the long-term maintenance of its improvements has not yet been proven. METHODS: A systematic search was conducted in MEDLINE/Pubmed, Web of Science, PEDRo, and Scopus databases from inception to April 2021. Randomized controlled trials were included if they performed a tDCS intervention combined with UL rehabilitation in stroke patients, performed several sessions (five or more), and assessed long-term results (at least three-month follow-up). Risk of bias and methodological quality were evaluated with the Cochrane RoB-2 and the Oxford quality scoring system. RESULTS: Nine studies were included, showing a high methodological quality. Findings regarding UL were categorized into (1) functionality, (2) strength, (3) spasticity. All the studies that showed significant improvements retained them in the long term. Baseline functionality may be a limiting factor in achieving motor improvements, but not in sustaining them over the long term. CONCLUSION: It seems that the improvements achieved during the application of tDCS combined with UL motor rehabilitation in stroke were preserved until the follow-up time (from 3 months to 1 year). Further studies are needed to clarify the long-term effects of tDCS.


Subject(s)
Stroke Rehabilitation , Stroke , Transcranial Direct Current Stimulation , Humans , Randomized Controlled Trials as Topic , Recovery of Function , Treatment Outcome , Upper Extremity
8.
Rev. Assoc. Med. Bras. (1992) ; 67(1): 26-28, Jan. 2021. graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1270961

ABSTRACT

SUMMARY The novel coronavirus disease (COVID-19) has infected millions of people worldwide and generated many sequels in the survivors, such as muscular pain and fatigue. These symptoms have been treated through pharmacological approaches; however, infected people keep presenting physical limitations. Besides, the COVID-19 damage to the central nervous system has also been related to the presence of some physical impairment, so strategies that focus on diverse brain areas should be encouraged. Transcranial Direct Current Stimulation (tDCS) is a non-pharmacological tool that could be associated with pharmacological treatments to improve the central nervous system function and decrease the exacerbation of the immune system response. tDCS targeting pain and fatigue-related areas could provide an increase in neuroplasticity and enhancements in physical functions. Moreover, it can be used in infirmaries and clinical centers to treat COVID-19 patients.


Subject(s)
Humans , Transcranial Direct Current Stimulation , COVID-19 , Pain , Fatigue/etiology , Fatigue/therapy , SARS-CoV-2
9.
R I Med J (2013) ; 103(10): 47-50, 2020 Dec 01.
Article in English | MEDLINE | ID: covidwho-952731

ABSTRACT

The COVID-19 pandemic has transformed the practice of medicine. We interviewed Physical Medicine and Rehabilitation (PM&R) specialist physicians providing rehabilitation services throughout Rhode Island to organize a narrative assessing the pandemic's impact on the state's rehabilitation community and the responses of its leaders. Almost half of rehabilitation providers needed to suspend their services during the initial peak of the pandemic. Most experienced reductions in the size of their practices, as well as personnel issues that contributed to burnout. All physicians used telemedicine to connect with patients. Many reported issues with accessing personal protective equipment and providing clinical opportunities for trainees. Inpatient rehabilitation policies and practices helped to maintain access for COVID-positive and negative patients, yet challenges were faced when configuring physical space to abide by CDC social distancing guidelines and providing care without patient visitors. Despite setbacks, the pandemic outlined opportunities for improvement of healthcare organization and delivery.


Subject(s)
COVID-19/enzymology , COVID-19/therapy , Physical and Rehabilitation Medicine/organization & administration , Telemedicine/methods , Transcranial Direct Current Stimulation/methods , Humans , Rhode Island
10.
Behav Neurosci ; 134(5): 369-383, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-811615

ABSTRACT

This study investigated whether the application of high definition transcranial DC stimulation (HD-tDCS) to the dorsolateral prefrontal cortex reduces cue-induced food craving when combined with food-specific inhibitory control training. Using a within-subjects design, participants (N = 55) received both active and sham HD-tDCS across 2 sessions while completing a Go/No-Go task in which foods were either associated with response inhibition or response execution. Food craving was measured pre and post stimulation using a standardized questionnaire as well as desire to eat ratings for foods associated with both response inhibition and response execution in the training task. Results revealed no effect of HD-tDCS on reducing state food craving or desire to eat. Due to the COVID-19 pandemic, we were unable to achieve our maximum preplanned sample size or our minimum desired Bayesian evidence strength across all a priori hypotheses; however 6 of the 7 hypotheses converged with moderate or stronger evidence in favor of the null hypothesis over the alternative hypothesis. We discuss the importance of individual differences and provide recommendations for future studies with an emphasis on the importance of cognitive interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Subject(s)
Craving/physiology , Food Preferences/physiology , Prefrontal Cortex/physiology , Adult , Bayes Theorem , Cross-Over Studies , Cues , Female , Food , Humans , Male , Surveys and Questionnaires , Transcranial Direct Current Stimulation/methods
12.
Brain Stimul ; 13(4): 1124-1149, 2020.
Article in English | MEDLINE | ID: covidwho-273738

ABSTRACT

BACKGROUND: The COVID-19 pandemic has broadly disrupted biomedical treatment and research including non-invasive brain stimulation (NIBS). Moreover, the rapid onset of societal disruption and evolving regulatory restrictions may not have allowed for systematic planning of how clinical and research work may continue throughout the pandemic or be restarted as restrictions are abated. The urgency to provide and develop NIBS as an intervention for diverse neurological and mental health indications, and as a catalyst of fundamental brain research, is not dampened by the parallel efforts to address the most life-threatening aspects of COVID-19; rather in many cases the need for NIBS is heightened including the potential to mitigate mental health consequences related to COVID-19. OBJECTIVE: To facilitate the re-establishment of access to NIBS clinical services and research operations during the current COVID-19 pandemic and possible future outbreaks, we develop and discuss a framework for balancing the importance of NIBS operations with safety considerations, while addressing the needs of all stakeholders. We focus on Transcranial Magnetic Stimulation (TMS) and low intensity transcranial Electrical Stimulation (tES) - including transcranial Direct Current Stimulation (tDCS) and transcranial Alternating Current Stimulation (tACS). METHODS: The present consensus paper provides guidelines and good practices for managing and reopening NIBS clinics and laboratories through the immediate and ongoing stages of COVID-19. The document reflects the analysis of experts with domain-relevant expertise spanning NIBS technology, clinical services, and basic and clinical research - with an international perspective. We outline regulatory aspects, human resources, NIBS optimization, as well as accommodations for specific demographics. RESULTS: A model based on three phases (early COVID-19 impact, current practices, and future preparation) with an 11-step checklist (spanning removing or streamlining in-person protocols, incorporating telemedicine, and addressing COVID-19-associated adverse events) is proposed. Recommendations on implementing social distancing and sterilization of NIBS related equipment, specific considerations of COVID-19 positive populations including mental health comorbidities, as well as considerations regarding regulatory and human resource in the era of COVID-19 are outlined. We discuss COVID-19 considerations specifically for clinical (sub-)populations including pediatric, stroke, addiction, and the elderly. Numerous case-examples across the world are described. CONCLUSION: There is an evident, and in cases urgent, need to maintain NIBS operations through the COVID-19 pandemic, including anticipating future pandemic waves and addressing effects of COVID-19 on brain and mind. The proposed robust and structured strategy aims to address the current and anticipated future challenges while maintaining scientific rigor and managing risk.


Subject(s)
Biomedical Research/methods , Delivery of Health Care/methods , Nervous System Diseases/therapy , Telemedicine/methods , Transcranial Direct Current Stimulation/methods , Transcranial Magnetic Stimulation/methods , Aged , Behavior, Addictive/therapy , Betacoronavirus , Brain/physiology , COVID-19 , Child , Clinical Trials as Topic , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , SARS-CoV-2 , Stroke/therapy , Substance-Related Disorders/therapy
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