Brain Injury Center

Utilizing Engineering and Medicine to Rehabilitate Traumatic Brain Injury-3

Posted on November 19, 2022

Because of its increased rates of morbidity and mortality, traumatic brain injury (TBI) is receiving more attention. It is described as a traumatic interruption of brain function, primarily brought on by an outside physical force, either structurally or physiologically. Even though there have been attempts over the past few decades to investigate therapeutic approaches for the rehabilitation of TBI, there is still a need for effective treatments, and current approaches to treating TBI are by no means adequate. New rehabilitation techniques are now available to TBI patients due to marriage of engineering and medicine.

Brain stimulation without harm (NIBS)

The widespread application of noninvasive brain stimulation (NIBS) technologies in recent years has significantly advanced our knowledge of the connections between the brain and behaviour. It has also drawn a lot of interest as a potential treatment for traumatic brain injury and other neurological and psychiatric conditions. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are the two major components of NIBS (TMS).

Using direct current to stimulate the brain (tDCS)

One form of NIBS is called transcranial direct current stimulation (tDCS). It can improve or inhibit synaptic plasticity over the long term and support sustained functional recovery. It can also increase or reduce cortical excitability depending on the polarity (anode or cathode). For controlling neuronal excitability during neuro-rehabilitation, it can offer a secure and non-invasive technique.

The development of posttraumatic disorders of consciousness (DOC) raises patient mortality and hinders recovery. According to a double-blind RCT trial, TBI patients' consciousness disorders can be significantly improved by tDCS.

The transcranial direct current stimulation (tDCS) after-effects are often transient, according to a systematic assessment of the effects of tDCS on the rehabilitation of traumatic brain injury (TBI). However, despite being utilised in clinical treatment, tDCS still requires improvement.

The benefits and drawbacks of cranial direct current stimulation (tDCS).

Advantages

A good safety profile and relative ease of usage
A risk-free, non-intrusive method
The stimulus was warmly received.
It is a simple, non-invasive, painless, and efficient therapy.

Disadvantages

The specific neurophysiological processes that these approaches activate are still up for discussion.
They are only able to directly influence cortical area activity.
Did not emphasise potential side effects or late-onset problems.
Increased usage may have negative side effects.
Insufficient large-sample clinical trials.

Recurrent transcranial magnetic stimulation (rTMS)

Another non-invasive technique for stimulating the human brain is rTMS. The treatment effects of rTMS on cortical excitability rely on the stimulation parameters used, such as the stimulus strength, frequency, and duration of stimulation. It can affect brain plasticity and cortical reconfiguration through stimulation-induced changes in neuronal excitability.

High-frequency (5 Hz) suprathreshold stimulation will promote cortical excitability, but low-frequency (1 Hz) rTMS delivered at the motor threshold or slightly suprathreshold intensities will reduce cortical excitability.

TBI frequently results in problems with memory and neurological behaviour. Low-field magnetic stimulation (LFMS), according to a study, greatly enhanced the cognitive and motor abilities of TBI mice. The cellular prion protein (PrPc) and/or circadian rhythm-related proteins may be controlled in order for LFMS to exert its neuroprotective effects.

In patients with disturbed consciousness following a TBI, rTMS was found to be able to enhance neuronal activity, regulate neural activity, and/or speed up recovery, according to a case study. Another study supported the notion that high-frequency transcranial magnetic stimulation could lower patients' pain levels and enhance quality of life. Another common symptom following a TBI is headache; a research to determine the effectiveness of rTMS in treating headache after a TBI found that it can both treat the headache symptom and temporarily improve mood.

Although rTMS has been utilised extensively in the treatment of TBI, there are still many things that may be done to make it more effective. We should take safety into account when using rTMS because there is evidence that it may cause unfavourable occurrences like seizures.

The benefits and drawbacks of repetitive transcranial magnetic stimulation.