TITLE
Models to Tailor Brain Stimulation Therapies in Stroke

AUTHORS
Plow EB; Sankarasubramanian V; Cunningham DA; Potter-Baker K; Varnerin N; Cohen LG; Sterr A; Conforto AB; Machado AG. Institution Plow, E B. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. Sankarasubramanian, V. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 4 4195, USA. Cunningham, D A. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; School of Biomedical Sciences, Kent State University, Kent, OH 44242, USA. Potter-Baker, K. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. Varnerin, N. Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. Cohen, L G. Human Cortical Physiology and Stroke Neurorehabilitation Section, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, MD 20892, USA. Sterr, A. University of Surrey, Guildford, Surrey GU2 7XH, UK. Conforto, A B. Neurology Clinical Division, Neurology Department, Hospital das Clinicas, Sao Paulo University, 05508-090 Sao Paulo, SP, Brazil; Hospital Israelita Albert Einstein, 05652-900 Sao Paulo, SP, Brazil. Machado, A G. Center for Neurological Restoration, Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, Cleveland Clinic, Cleveland, OH 44195, USA.

SOURCE
Neural Plasticity. 2016:4071620, 2016.

ABSTRACT
A great challenge facing stroke rehabilitation is the lack of information on how to derive targeted therapies. As such, techniques once considered promising, such as brain stimulation, have demonstrated mixed efficacy across heterogeneous samples in clinical studies. Here, we explain reasons, citing its one-type-suits-all approach as the primary cause of variable efficacy. We present evidence supporting the role of alternate substrates, which can be targeted instead in patients with greater damage and deficit. Building on this groundwork, this review will also discuss different frameworks on how to tailor brain stimulation therapies. To the best of our knowledge, our report is the first instance that enumerates and compares across theoretical models from upper limb recovery and conditions like aphasia and depression. Here, we explain how different models capture heterogeneity across patients and how they can be used to predict which patients would best respond to what treatments to develop targeted, individualized brain stimulation therapies. Our intent is to weigh pros and cons of testing each type of model so brain stimulat ion is successfully tailored to maximize upper limb recovery in stroke.

Publication Type Journal Article.

Research Support, N.I.H., Extramural.

Research Support, Non-U.S. Gov’t. Review.