Insights into Stroke Rehabilitation Research at the University of Massachusetts Medical School

At Brainbox, we are extremely proud of the exciting research that our equipment and expertise helps to support around the world. Earlier this year, our partners at Jali Medical had the opportunity to meet with Dr Gottfried Schlaug and Dr Anante Shinde at the University of Massachusetts Medical School to carry out the installation of some brand new TMS and Neuronavigation systems, and to learn a little about the research being carried out there in the field of stroke rehabilitation.

Dr Schlaug explains that, before the trial begins, his group will first employ navigated transcranial magnetic stimulation (TMS) to help screen their pool of proposed patients and create a shortlist of those best suited for inclusion in the trial. Using individual MRI data gathered from each patient, Schlaug’s group will use the DuoMAG MP-Dual system as a diagnostic tool, examining the integrity of the corticospinal tract in each group member. The results of this trial will allow the researchers both to ascertain which of the patients might respond best to the proposed treatment, and, through repeated TMS applications, will help to evaluate the ongoing effects of the treatment over time.

With the aid of the Brainsight TMS Navigation system, researchers will be able to precisely and safely position the TMS coil over the specific brain areas that they wish to stimulate, and will have the ability to fine-tune these measurements to the individual anatomies of each patient through the use of unique MRI scans imported into the system.

Due to the inherent multi-centred nature of the trial too, the procedures and measurements required for this research must be kept as simple and straightforward as possible to help standardise the data collection across all patients — the ability to precisely target and deliver TMS pulses in Brainsight will provide a much-needed aid in guaranteeing the necessary reproducibility of TMS sessions.

When the trial begins proper, Dr Schlaug explains, the group will combine transcranial direct current stimulation (tDCS) with constraint-induced movement therapy — a form of rehabilitation therapy wherein the functional limb of a stroke patient is constrained, thus forcing the patient to use the impaired limb in its place with the ultimate goal of improving upper-extremity function.

Subjects in this trial will then receive ten sessions of intervention across three dosage levels of tDCS. Across these sessions, patients will be tested at baseline, post-intervention, and again three months after the trial. It may be the case, he explains, that multiple sessions of intervention are necessary to create and maintain a therapeutic effect in the patients.

As the trial progresses, the group will keep the corticospinal tract’s integrity under constant review: through administering further sessions of TMS to the brain regions identified in the first phase of the study, Dr Schlaug hopes that his group will be able to fully evaluate the effects of tDCS application and constraint-induced therapy over time.

We’re very excited to see the results of this study as it progresses, and we’re very proud to see our systems supporting even more groundbreaking research being carried out worldwide.

Interested in learning carrying out your own navigated TMS study? Find out more about our stimulators and the Brainsight TMS Navigation system - or get in touch directly to design your own integrated multimodal setup.