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THERAPY AT THE SPEED OF LIGHT TR ANSCR ANIAL MAGNETIC STIMULATION (TMS) is far from the only technology being explored for its potential to improve stroke recovery. Researchers at Stanford University School of Medicine have enhanced brain chemistry and motor control in post-stroke mice by using light-based therapy to activate cell-to-cell communication. Like TMS, optogenetic therapy works by manipulating cells in the motor cortex. However, optogenetics allows researchers to target certain types of cells by precisely implanting a light-sensitive protein. The mice maintained improvements dur- ing two weeks of post-therapy follow-up. a precursor to other therapies and doesn't necessarily make the therapy already being done more complex." RIC is involved in a 12-site national study to ascertain the reproducibility of the pilot study's fi ndings. ■ Noninvasive Stimulation Shows Promise for Stroke Recovery By Valerie Lauer T HE RESEARCH, CONDUCTED at the Rehabilitation Institute of Chicago (RIC), sheds new light on possible applications of brain stimulation to target and help correct brain damage caused by stroke. Mapping the Mind The research team at RIC used TMS to map the unique location in each participant's motor cortex that con- trols upper-extremity mobility and that sustained damaged from the stroke. What they found was an imbalance of excitability — areas that were either less responsive or more responsive than normal to stimulation. "We probe the cortical system, we get output from the muscle, and we get some idea of how that connection from brain to muscle is working," says Lynn Rogers, PhD, Director of the Neuralplasticity Laboratory at RIC. "We're coming to understand that we … can actually change the system with TMS. We can create a system that is more responsive or less responsive than it was before by using these trained repetitive stimulations." The team used stereotactic MRI to guide TMS therapy to the exact point of imbalance. During thrice-weekly sessions over a six-week period, pre-functional OT was followed by repeated TMS and then by an hour of task-oriented OT. Follow-up was then conducted at one week, one month and six months. Long-term Results While researchers did observe slightly more progress in the group receiving TMS during the study and at the one- week follow-up, the difference became more pronounced as time passed. By the six-month follow-up, participants in the experimental group showed an average of 14.4 points of improvement on the upper-extremity Fugl-Meyer scale compared with 4.1 points of improvement for the control group. Rogers and her colleagues hope navi- gated TMS, as an adjunct to an existing therapeutic practice, will become part of an improved standard of post-stroke care. "I can see it being the type of tech- nolog y that can fairly seamlessly be integrated into the system," she says. "It's STROKE PATIENTS WHO RECEIVED NAVIGATED, REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (TMS) IN ADDITION TO STANDARD OCCUPATIONAL THERAPY (OT) WERE ABLE TO REGAIN AND MAINTAIN MORE UPPER-EXTREMITY MOBILITY THAN THOSE WHO COMPLETED OT ALONE, A 2014 STUDY FOUND. 1 4 | San Antonio MD NEWS ■ M D N E W S . CO M