Individualisation of transcranial electric stimulation to improve motor function after stroke: Current challenges and future perspective

Joris van der Cruijsen

Research output: Types of ThesisDoctoral ThesisInternal

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Abstract

Transcranial electric stimulation (tES) is a non-invasive brain stimulation technique that could potentially improve motor rehabilitation after stroke. However, the effects of tES are in general stronger in healthy individuals compared to people with stroke. Interindividual variability in brain structure and function due to stroke potentially explain this difference in effects. This thesis describes the development of methods to facilitate the individualisation of tES in people with stroke and identifies objective neurophysiological correlates of motor learning that could potentially help to monitor the response to tES.

In chapter 2, EEG correlates of explicit motor task learning were derived in healthy, young participants. Chapter 3 investigated the effects of 3 different tDCS configurations (sham, targeting contralateral M1 and targeting the full resting motor network) on corticospinal excitability. Both conventional and motor network tDCS did not increase corticospinal excitability relative to sham stimulation. Chapter 4 describes methods to create head models of people with stroke and assesses the effects of stroke lesions on the electric fields within stimulation targets. Chapter 5 describes a method to experimentally determine the electric conductivity of the stroke lesion. Finally, Chapter 6 analyses the electric fields generated by conventional tDCS in people with stroke and age-matched controls. It is shown that the one-size-fits-all approach results in more variable electric fields in people with stroke compared to controls. Optimisation of the electrode positions to maximise the electric field in stimulation targets increases the electric fields in people with stroke to the same level as found in healthy controls.

This thesis shows anatomical and motor function variability exists between people with stroke due to differences in lesion characteristics. While there are several opportunities to individualise tES, more research is needed to investigate if this improves the effects of tES. As such, clinical implementation of tES seems unrealistic in the foreseeable future.
Original languageEnglish
Awarding Institution
  • Erasmus University Rotterdam
Supervisors/Advisors
  • Selles, Ruud, Supervisor
  • Frens, Maarten, Supervisor
  • Oostendorp, Thom, Co-supervisor
Award date21 Nov 2023
Place of PublicationRotterdam
Print ISBNs978-94-6361-906-6
Publication statusPublished - 21 Nov 2023

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