Combination Therapies: Is this the next generation of rehabilitation?

Combining several therapies to build a rehabilitation treatment plan for neurological conditions is nothing new.  However, combining a variety of technologies into a treatment plan to produce functional outcomes is an emerging theme among innovative rehabilitation professionals. The roots of combining the rehabilitation with electrical stimulation to improve motor re-learning come from the pioneering work by Dr. Randolph Nudo and Dr. Alvaro Pascual-Leone in 1990es.

Recently, this approach was applied by combining the robotic therapy with electrical or magnetic stimulation by a team of researchers lead by Dr. Lumy Sawaki at the University of Kentucky in Lexington. This new neural rehabilitation technique capitalizes on “neuroplasticity,” which refers to the brain’s ability to reorganize itself by forming new neural connections to compensate for injury and disease.  Dr. Lumy Sawaki, MD, PhD, an Associate Professor in the Department of Physical Medicine and Rehabilitation at the University of Kentucky, has been exploring how combining technologies in the rehabilitation setting may help her patients regain functional movements. This new therapy is based on previous work she had done involving CIMT, constraint-induced movement therapy.  Dr. Sawaki was the lead author on a CIMT study published in the journal Neurorehabilitation and Neural Repair.   In this study, each of the 30 participants was evaluated using transcranial magnetic stimulation (TMS), a non-invasive method to excite neurons in the primary motor cortex. In the CIMT therapy study, Dr. Sawaki and collaborators used TMS to map the area of the brain that controls a particular muscle and compared this map to previous patterns of activity. As the patient’s ability to perform a certain movement improves, these brain maps confirm the reorganization of the associated area of the brain. Focusing on hand motor function of sub-acute stroke survivors, they observed changes within the functional activity of the brain for those who used CIMT.

Building on this previous work, Dr. Sawaki and her research team are evaluating the combined approach to stimulate the brain with two painless and non-invasive methods: the magnetic stimulation with TMS and the electrical stimulation with transcranial direct current stimulation (tDCS), to develop a new neural rehabilitation therapy for chronic survivors of neurological trauma from stroke, brain and spinal cord injuries. In this new therapy, the TMS and tDCS is applied along with robotic movement therapy, such as body weight supported treadmill training. Dr. Sawaki is using TMS and tDCS to stimulate the area inside the motor cortex that controls movement of a targeted muscle. By applying multiple stimuli and monitoring the muscle response combined with robotic therapy, the investigators are attempting to determine if this combination will result in higher functional benefit.

Conclusive evidence is still lacking but it brings the promise of combined neural rehabilitation therapies paving a new path for how we approach complex neurological conditions in the rehabilitation setting.  Click here to read more about Dr. Lumy Sawaki’s research and new neurorehabilitation therapy.