Date Presented 03/27/20
This review examines the efficacy of NIBS coupled with OT interventions. Sixty studies utilizing OT along with NIBS were included. Results support the use of NIBS as an add-on to OT interventions. Identifying the efficacy of NIBS as an adjuvant to existing therapies assists in characterizing interventions that may be useful in those clinical populations in which high-intensity therapy is not tolerable or feasible.
Primary Author and Speaker: Ghazala Saleem
Additional Authors and Speakers: Carly Goldberg
Contributing Authors: Stacy Suskauer
PURPOSE: Currently, there are limited occupational therapy interventions with sufficient evidence to recommend implementation into practice. Occupational therapy interventions that have strong evidence such as repetitive task practice or constraint-induced movement therapy require high intensity beyond that feasible in many clinical settings. Thus, identifying evidence-based treatment approaches that can enhance the efficacy of existing neurorehabilitative therapies is critical. One of the potential mechanisms of non-invasive brain stimulation (NIBS) is to prime brain regions to enhance response to concurrent treatment. The pairing of NIBS, transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS), with occupational therapy interventions shows promising results in neurorehabilitation. However, the usefulness of NIBS as an adjuvant to occupational therapy needs to be comprehensively investigated. This scoping review examines the efficacy of the combined use of NIBS and occupational therapy interventions. We asked the following research questions:
a) Can non-invasive brain stimulation (tDCS) be used in preparation for or in conjunction with occupational therapy interventions to enhance functional performance and participation?
b) What are the barriers and/or scientific gaps that hinder the translation of non-invasive brain stimulation into broader occupational therapy practice?
DESIGN: Descriptive review
METHODS: PubMed, EMBASE, Cochrane, CINAHL, and Web of Science were searched from the first date available to August 23, 2018. All English-language studies utilizing occupational therapy or related interventions (e.g., constraint-induced movement therapy) along with NIBS in both adults and children were included. Two reviewers independently screened literature and extracted and compiled data.
RESULTS: Of the initial 316 references identified, 60 full-texts were included. Twenty-three percent of studies were randomized controlled trials. Most studies were controlled using either occupational therapy or occupational-therapy related interventions. Eighty percent of studies were conducted in adult patients with stroke. Forty-six studies used TMS while 14 studies used tDCS along with occupational therapy or related intervention. Ninety percent of studies using tDCS and 78% of studies using TMS along with occupational therapy reported improved upper limb functioning. Two studies using TMS coupled with occupational therapy reported improvement in spatial neglect. One study each reported improvement in depression or functional mobility with combined tDCS and occupational therapy. No effects were seen on cognitive functioning with TMS along with occupational therapy interventions.
CONCLUSION: Overall, results support the use of NIBS as an add-on to occupational therapy or related interventions. Controlled studies comparing the efficacy of occupational therapy versus combined NIBS and occupational therapy are needed to integrate NIBS as an adjuvant to occupational therapy interventions.
IMPACT STATEMENT: Identifying efficacy of NIBS coupled with occupational therapy will likely assist in characterizing interventions that may serve as a potential adjunct to existing therapies and may be useful in those clinical populations in which high-intensity therapy is not tolerable and/or feasible.
References
Stoykov, M. E., & Madhavan, S. (2015). Motor priming in neurorehabilitation. Journal of neurologic physical therapy: JNPT, 39(1), 33. doi: 10.1097/NPT.0000000000000065.
Kakuda, W., Abo, M., Kobayashi, K., Momosaki, R., Yokoi, A., Fukuda, A., & Umemori, T. (2011). Application of combined 6-Hz primed low-frequency rTMS and intensive occupational therapy for upper limb hemiparesis after stroke. NeuroRehabilitation, 29(4), 365-371. doi: 10.3233/NRE-2011-0714.
Mortensen, J., Figlewski, K., & Andersen, H. (2016). Combined transcranial direct current stimulation and home-based occupational therapy for upper limb motor impairment following intracerebral hemorrhage: a double-blind randomized controlled trial. Disability and rehabilitation, 38(7), 637-643. doi: 10.3109/09638288.2015.1055379.
