TARGETED TRANSCRANIAL ELECTROTHERAPY SYSTEM TO ACCELERATE STROKE RECOVERY

描述(由申请人提供)： 弱电流经颅直流电刺激是一种无创、低成本、耐受性好的技术，可使中枢神经系统发生持久的功能改变。越来越多的证据支持使用tdcs来改善中风的康复。TDC的行为和治疗结果取决于被靶向的大脑区域。然而，传统的方法是有限的，因为它们不能充分激活目标区域和/或导致整个头部的非特异性刺激。为了解决这一问题，已经提出了使用专门设计的电极阵列的高清晰度TDC(HD-TDC)。与传统的电极蒙太奇相比，高清晰度方法产生了更多的焦点和针对性的刺激。它允许在设计有针对性和个性化的电疗时具有非凡的灵活性。当聚焦于周围区域时，预计多电极高清晰度方法不仅可以获得更多的焦点刺激，而且更重要的是，在施加到电极的总电流相同的情况下，还可以在周围区域获得更大的强度。因此，高清晰度方法有望不仅实现更安全，而且更有力地激活康复目标，从而取得更有效的康复成果。该项目将设计、制作和验证第一个针对中风康复进行优化的电疗系统--“康复HD-tDCS”(RHD-tDCS)；此外，该系统还首次应用先进的软件算法和现有的HD-tDCS技术，利用病变的存在，以单独优化的方式将电流引导到精确的目标。该项目的主要目标是集中和可靠地刺激周围皮质靶点，以促进中风的康复。这项技术的有效性将在改善中风失语症患者的语言训练上得到证明。成功的第一阶段的里程碑是：1.在中风病变及其周围区域的准确解剖模型中自动建模和优化电流流动。2.可编程刺激装置的原型和针对这些卒中区域进行优化的电极蒙太奇。3.成功应用RHD-tDCS装置进行失语症的康复治疗。本项目中开发的刺激装置和方案进一步适用于中风和其他有前景的靶向电疗领域的运动康复。 公共卫生相关性： 通过头皮进行小电流电刺激可以显著改善康复训练，特别是中风后语言技能的恢复。该项目旨在开发名为康复高清晰度经颅直流电刺激(RHD-tDCS)的先进技术，该技术可以通过多个电极将治疗性电流引导到参与功能恢复的大脑区域，同时保留大脑的其余部分。这有望提高中风康复训练的安全性、可靠性和有效性。

DESCRIPTION (provided by applicant): Transcranial Direct Current Stimulation (tDCS) with weak currents is a non-invasive, low-cost, and well tolerated technique producing lasting functional changes in the central nervous system. There is increasing evidence supporting the use of tDCS to improve stroke rehabilitation. Behavioral and therapeutic outcomes of tDCS depend on the brain areas being targeted. However, conventional approaches are limited in that they insufficiently activate the target region and/or result in unspecific stimulation throughout the entire head. To address this, High-Definition tDCS (HD-tDCS) using arrays of specifically designed electrodes has been proposed. The high-definition approach results in more focal and targeted stimulation as compared to conventional electrode montages. It allows for exceptional flexibility in designing targeted and individualized electrotherapy. When focusing on peri-lesional areas the multi-electrode high-definition approach is predicted to achieve not only more focal stimulation but importantly, also increased intensity in the peri-lesional areas with the same total currents applied to the electrodes. Thus, the high-definition approach holds promise to achieving not only safer but also stronger activation of rehabilitation targets and thus more effective rehabilitation outcomes. This project will design, prototype, and validate the first electrotherapy system optimized for stroke rehabilitation, "Rehabilitation HD-tDCS" (rHD-tDCS); moreover this system is the first to apply advanced software algorithms and existing HD-tDCS technology to leverage the presence of the lesion to guide current to precise targets in an individually optimized fashion. The main goal of this project is the focal and reliable stimulation of peri-lesional cortical targets to improve stroke rehabilitation. The efficacy of the technique will be demonstrated on improved language training in stroke patients with aphasia. Milestones for a successful Phase-1 are: 1. Automated modeling and optimization of current flows in accurate anatomical models of stroke lesions and surrounding areas. 2. Prototype of a programmable stimulation device and electrode montage optimized for targeting these stroke areas. 3. Successful rehabilitation treatment of aphasia with the rHD-tDCS device. The stimulation device and protocols developed in this project are further applicable to motor rehabilitation in stroke and other promising areas of targeted electro-therapy. PUBLIC HEALTH RELEVANCE: Electrical stimulation with small currents trough the scalp produce significant improvements in rehabilitation training, in particular the recovery of language skills after a stroke. This projects aims to developed advanced technology called Rehabilitation High-Definition transcranial Direct Current Stimulation (rHD-tDCS) which can guide therapeutic electrical currents trough multiple electrodes to brain regions involved in functional recovery while sparing the rest of the brain. This is expected to improve safety, reliability, and efficacy of stroke rehabilitation training.