Combined non-invasive neuromodulation using transcranial direct current stimulation, motor imagery and action observation for motor, cognitive and functional recovery in cortico-basal degeneration

a single case study

Authors

  • Juan Pablo Romero Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Francisco de Vitoria University, Pozuelo de Alarcón, 28223, Spain; Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223, Spain; Brain Damage Unit, Beata María Ana Hospital, Madrid, 28007, Spain; Cognitive Neuroscience, Pain and Rehabilitation Research Group (NECODOR), Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain https://orcid.org/0000-0002-3190-1296
  • Alexis Martínez-Benito Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Francisco de Vitoria University, Pozuelo de Alarcón, 28223, Spain; Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain https://orcid.org/0009-0003-7245-4343
  • David de Noreña Brain Damage Unit, Beata María Ana Hospital, Madrid, 28007, Spain https://orcid.org/0009-0007-7494-250X
  • Alfonso Hurtado-Martínez Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Francisco de Vitoria University, Pozuelo de Alarcón, 28223, Spain; Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223, Spain https://orcid.org/0009-0008-1927-979X
  • Francisco José Sánchez-Cuesta Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Francisco de Vitoria University, Pozuelo de Alarcón, 28223, Spain; Facultad de Ciencias Experimentales, Universidad Francisco de Vitoria, Pozuelo de Alarcón, 28223, Spain https://orcid.org/0000-0001-6202-7071
  • Yeray González-Zamorano Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Atenas Avenue s/n., 28933 Alcorcón, Spain. Tel: +34 689 10 53 57; E-mail: yeray.gonzalez@urjc.es https://orcid.org/0000-0003-3819-3090
  • Marcos Moreno-Verdú Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Francisco de Vitoria University, Pozuelo de Alarcón, 28223, Spain; Brain, Action and Skill Laboratory (BAS-Lab), Institute of Neuroscience (Cognition and Systems Division), UC Louvain, 1200 Woluwe-Saint-Laimbert, Belgium https://orcid.org/0000-0002-9726-8518

DOI:

https://doi.org/10.17179/excli2024-7027

Keywords:

corticobasal degeneration, non-invasive neuromodulation, transcranial direct current stimulation, motor imagery, action observation

Abstract

This case report presents a comprehensive assessment and therapeutic intervention using non-invasive motor cortex neuromodulation for a 70-year-old female patient diagnosed with corticobasal degeneration (CBD). The study followed the CARE guidelines. The patient meets the criteria for probable CBD, with neuroimaging evidence of exclusively cortical impairment. The patient underwent a non-invasive neuromodulation protocol involving transcranial direct current stimulation (tDCS) and action observation plus motor imagery (AO+MI). The neuromodulation protocol comprised 20 sessions involving tDCS over the primary motor cortex and combined AO+MI. Anodal tDCS was delivered a 2 mA excitatory current for 20 minutes. AO+MI focused on lower limb movements, progressing over four weeks with video observation and gradual execution, both weekly and monthly. The neuromodulation techniques were delivered online (i.e. applied simultaneously in each session). Outcome measures were obtained at baseline, post-intervention and follow-up (1 month later), and included motor (lower limb), cognitive/neuropsychological and functional assessments. Walking speed improvements were not observed, but balance (Berg Balance Scale) and functional strength (Five Times Sit-to-Stand Test) improved post-treatment. Long-term enhancements in attentional set-shifting, inhibitory control, verbal attentional span, and working memory were found. There was neurophysiological evidence of diminished intracortical inhibition. Functional changes included worsening in Cortico Basal Ganglia Functional Scale score. Emotional well-being and general health (SF-36) increased immediately after treatment but were not sustained, while Falls Efficacy Scale International showed only long-term improvement. The findings suggest potential benefits of the presented neuromodulation protocol for CBD patients, highlighting multifaceted outcomes in motor, cognitive, and functional domains.

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Published

2024-05-06

How to Cite

Romero, J. P., Martínez-Benito, A., de Noreña, D., Hurtado-Martínez, A., Sánchez-Cuesta, F. J., González-Zamorano, Y., & Moreno-Verdú, M. (2024). Combined non-invasive neuromodulation using transcranial direct current stimulation, motor imagery and action observation for motor, cognitive and functional recovery in cortico-basal degeneration: a single case study. EXCLI Journal, 23, 714–726. https://doi.org/10.17179/excli2024-7027

Issue

Vol. 23 (2024)

Section

Case reports

Categories

License

Copyright (c) 2024 Juan Pablo Romero, Alexis Martínez-Benito, David de Noreña, Alfonso Hurtado-Martínez, Francisco José Sánchez-Cuesta, Yeray González-Zamorano, Marcos Moreno-Verdú

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