Developing a new approach to stroke rehabilitation for the upper limb based on TMS neurofeedback

Today in Ireland, most people who experience a stroke survive, but more than half are left with long-term disabilities due to paralysis of one arm. In the proposed research, we aim to push the boundaries of standard stroke rehabilitation, by introducing a technique that promises to boost the brain's recovery mechanisms, stimulating growth of new physical connections to carry information to the paralysed muscles. We will use a novel brain-computer interface, based on applying magnetic pulses (Transcranial Magnetic Stimulation, TMS) to the damaged area in the brain, causing twitches in the paralysed muscles. The size of these twitches are then displayed to the patient on a computer screen in the form of a game. In the game, the patient is encouraged to learn how to make the twitches bigger or smaller, by engaging appropriate mental imagery to re-activate the damaged brain region. We have named this approach TMS-neurofeedback (NF). Over the course of the four-year project, we will first demonstrate that stroke patients are capable of learning to self-regulate the size of the twitches, despite the fact that the limb is immobile. We will then test over an extended 3 month period whether priming the brain with TMS-NF once per week prior to their standard movement therapy, has positive effects on the speed and extent of recovery of the limb. Finally, we will examine MRI scans of the brains of stroke patients before and after TMS-NF to investigate whether changes have occurred in the brain's structure and function as a result. This will form part of a detailed investigation into how TMS-NF works, and how patients experience it. Upon completion of the project, we will release the software for TMS-NF to the scientific and clinical community to make it available for others to use for research or therapeutic purposes.

Award Date

15 May 2019

Award Value

€€711,945.80

Principal Investigator

Dr Kathy Ruddy

Host Institution

Trinity College Dublin

Scheme

Emerging Investigator Awards