Bigoni, Claudia; Beanato, Elena; Harquel, Sylvain; Hervé, Julie; Oflar, Meltem; Crema, Andrea; Espinosa, Arnau; Evangelista, Giorgia G; Koch, Philipp; Bonvin, Christophe; Turlan, Jean-Luc; Guggisberg, Adrian; Morishita, Takuya; Wessel, Maximilian J; Zandvliet, Sarah B; Hummel, Friedhelm C (2023). Novel personalized treatment strategy for patients with chronic stroke with severe upper-extremity impairment: The first patient of the AVANCER trial. Med (N Y), 4(9), 591-599.e3. Cell Press 10.1016/j.medj.2023.06.006
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BACKGROUND
Around 25% of patients who have had a stroke suffer from severe upper-limb impairment and lack effective rehabilitation strategies. The AVANCER proof-of-concept clinical trial (NCT04448483) tackles this issue through an intensive and personalized-dosage cumulative intervention that combines multiple non-invasive neurotechnologies.
METHODS
The therapy consists of two sequential interventions, lasting until the patient shows no further motor improvement, for a minimum of 11 sessions each. The first phase involves a brain-computer interface governing an exoskeleton and multi-channel functional electrical stimulation enabling full upper-limb movements. The second phase adds anodal transcranial direct current stimulation of the motor cortex of the lesioned hemisphere. Clinical, electrophysiological, and neuroimaging examinations are performed before, between, and after the two interventions (T0, T1, and T2). This case report presents the results from the first patient of the study.
FINDINGS
The primary outcome (i.e., 4-point improvement in the Fugl-Meyer assessment of the upper extremity) was met in the first patient, with an increase from 6 to 11 points between T0 and T2. This improvement was paralleled by changes in motor-network structure and function. Resting-state and transcranial magnetic stimulation-evoked electroencephalography revealed brain functional changes, and magnetic resonance imaging (MRI) measures detected structural and task-related functional changes.
CONCLUSIONS
These first results are promising, pointing to feasibility, safety, and potential efficacy of this personalized approach acting synergistically on the nervous and musculoskeletal systems. Integrating multi-modal data may provide valuable insights into underlying mechanisms driving the improvements and providing predictive information regarding treatment response and outcomes.
FUNDING
This work was funded by the Wyss-Center for Bio and Neuro Engineering (WCP-030), the Defitech Foundation, PHRT-#2017-205, ERA-NET-NEURON (Discover), and SNSF (320030L_197899, NiBS-iCog).
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology |
UniBE Contributor: |
Guggisberg, Adrian (A) |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2666-6340 |
Publisher: |
Cell Press |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
13 Jul 2023 13:29 |
Last Modified: |
11 Sep 2023 00:14 |
Publisher DOI: |
10.1016/j.medj.2023.06.006 |
PubMed ID: |
37437575 |
Uncontrolled Keywords: |
Translation to patients brain stimulation brain-computer interface neurorehabilitation personalized therapy stroke |
BORIS DOI: |
10.48350/184733 |
URI: |
https://boris.unibe.ch/id/eprint/184733 |
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