Supported by The Lourie Foundation, Inc.

<ol>
	<li>Filmer, H. L., Dux, P. E., Mattingley, J. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Applications+of+transcranial+direct+current+stimulation+for+understanding+brain+function.">Applications of transcranial direct current stimulation for understanding brain function.</a> Trends in neurosciences. 37, 742-753 (2014).</li><li>Brunoni, A. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+research+with+transcranial+direct+current+stimulation+(tDCS):+challenges+and+future+directions.">Clinical research with transcranial direct current stimulation (tDCS): challenges and future directions.</a> Brain stimulation. 5, 175-195 (2012).</li><li>Nitsche, M. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation:+State+of+the+art+2008.">Transcranial direct current stimulation: State of the art 2008.</a> Brain stimulation. 1, 206-223 (2008).</li><li>Iyer, M. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Safety+and+cognitive+effect+of+frontal+DC+brain+polarization+in+healthy+individuals.">Safety and cognitive effect of frontal DC brain polarization in healthy individuals.</a> Neurology. 64, 872-875 (2005).</li><li>Vanneste, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Bilateral+dorsolateral+prefrontal+cortex+modulation+for+tinnitus+by+transcranial+direct+current+stimulation:+a+preliminary+clinical+study.">Bilateral dorsolateral prefrontal cortex modulation for tinnitus by transcranial direct current stimulation: a preliminary clinical study.</a> Experimental brain research. 202, 779-785 (2010).</li><li>Priori, A., Hallett, M., Rothwell, J. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Repetitive+transcranial+magnetic+stimulation+or+transcranial+direct+current+stimulation?.">Repetitive transcranial magnetic stimulation or transcranial direct current stimulation?.</a> Brain stimulation. 2, 241-245 (2009).</li><li>Demirtas-Tatlidede, A., Vahabzadeh-Hagh, A. M., Pascual-Leone, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+noninvasive+brain+stimulation+enhance+cognition+in+neuropsychiatric+disorders.">Can noninvasive brain stimulation enhance cognition in neuropsychiatric disorders.</a> Neuropharmacology. 64, 566-578 (2013).</li><li>Martin, D. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Can+transcranial+direct+current+stimulation+enhance+outcomes+from+cognitive+training?+A+randomized+controlled+trial+in+healthy+participants.">Can transcranial direct current stimulation enhance outcomes from cognitive training? A randomized controlled trial in healthy participants.</a> The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum. 16, 1927-1936 (2013).</li><li>Elmasry, J., Loo, C., Martin, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+systematic+review+of+transcranial+electrical+stimulation+combined+with+cognitive+training.">A systematic review of transcranial electrical stimulation combined with cognitive training.</a> Restorative neurology and neuroscience. 18 (6), 065018 (2015).</li><li>Brunoni, A. R., Vanderhasselt, M. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Working+memory+improvement+with+non-invasive+brain+stimulation+of+the+dorsolateral+prefrontal+cortex:+a+systematic+review+and+meta-analysis.">Working memory improvement with non-invasive brain stimulation of the dorsolateral prefrontal cortex: a systematic review and meta-analysis.</a> Brain and cognition. 86, 1-9 (2014).</li><li>Meesen, R. L., Thijs, H., Leenus, D. J., Cuypers, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+single+session+of+1+mA+anodal+tDCS-supported+motor+training+does+not+improve+motor+performance+in+patients+with+multiple+sclerosis.">A single session of 1 mA anodal tDCS-supported motor training does not improve motor performance in patients with multiple sclerosis.</a> Restorative neurology and neuroscience. 32, 293-300 (2014).</li><li>Shiozawa, P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation+for+major+depression:+an+updated+systematic+review+and+meta-analysis.">Transcranial direct current stimulation for major depression: an updated systematic review and meta-analysis.</a> The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum. 17, 1443-1452 (2014).</li><li>Loo, C. K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation+for+depression:+3-week,+randomised,+sham-controlled+trial.">Transcranial direct current stimulation for depression: 3-week, randomised, sham-controlled trial.</a> The British journal of psychiatry : the journal of mental science. 200, 52-59 (2012).</li><li>Lampit, A., Hallock, H., Valenzuela, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Computerized+cognitive+training+in+cognitively+healthy+older+adults:+a+systematic+review+and+meta-analysis+of+effect+modifiers.">Computerized cognitive training in cognitively healthy older adults: a systematic review and meta-analysis of effect modifiers.</a> PLoS medicine. 11, e1001756 (2014).</li><li>Magalhaes, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Are+cognitive+interventions+for+multiple+sclerosis+effective+and+feasible.">Are cognitive interventions for multiple sclerosis effective and feasible.</a> Restorative neurology and neuroscience. 32, 623-638 (2014).</li><li>Charvet, L. E., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Remotely-supervised+transcranial+direct+current+stimulation+(tDCS)+for+clinical+trials:+guidelines+for+technology+and+protocols.">Remotely-supervised transcranial direct current stimulation (tDCS) for clinical trials: guidelines for technology and protocols.</a> Frontiers in systems neuroscience. 9, 26 (2015).</li><li>Palm, U., Ayache, S. S., Padberg, F., Lefaucheur, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Non-invasive+Brain+Stimulation+Therapy+in+Multiple+Sclerosis:+A+Review+of+tDCS,+rTMS+and+ECT+Results.">Non-invasive Brain Stimulation Therapy in Multiple Sclerosis: A Review of tDCS, rTMS and ECT Results.</a> Brain stimulation. 7, 849-854 (2014).</li><li>Mori, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+anodal+transcranial+direct+current+stimulation+on+chronic+neuropathic+pain+in+patients+with+multiple+sclerosis.">Effects of anodal transcranial direct current stimulation on chronic neuropathic pain in patients with multiple sclerosis.</a> The journal of pain : official journal of the American Pain Society. 11, 436-442 (2010).</li><li>Mori, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation+ameliorates+tactile+sensory+deficit+in+multiple+sclerosis.">Transcranial direct current stimulation ameliorates tactile sensory deficit in multiple sclerosis.</a> Brain stimulation. 6, 654-659 (2013).</li><li>Tecchio, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multiple+sclerosis+fatigue+relief+by+bilateral+somatosensory+cortex+neuromodulation.">Multiple sclerosis fatigue relief by bilateral somatosensory cortex neuromodulation.</a> Journal of neurology. 261, 1552-1558 (2014).</li><li>Saiote, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+transcranial+direct+current+stimulation+on+fatigue+in+multiple+sclerosis.">Impact of transcranial direct current stimulation on fatigue in multiple sclerosis.</a> Restorative neurology and neuroscience. 32, 423-436 (2014).</li><li>Ferrucci, R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transcranial+direct+current+stimulation+(tDCS)+for+fatigue+in+multiple+sclerosis.">Transcranial direct current stimulation (tDCS) for fatigue in multiple sclerosis.</a> NeuroRehabilitation. 34, 121-127 (2014).</li><li>Cuypers, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anodal+tDCS+increases+corticospinal+output+and+projection+strength+in+multiple+sclerosis.">Anodal tDCS increases corticospinal output and projection strength in multiple sclerosis.</a> Neuroscience letters. 554, 151-155 (2013).</li><li>Zanao, T. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Impact+of+two+or+less+missing+treatment+sessions+on+tDCS+clinical+efficacy:+results+from+a+factorial,+randomized,+controlled+trial+in+major+depression.">Impact of two or less missing treatment sessions on tDCS clinical efficacy: results from a factorial, randomized, controlled trial in major depression.</a> Neuromodulation : journal of the International Neuromodulation Society. 17, 737-742 (2014).</li><li>Kurtzke, J. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rating+neurologic+impairment+in+multiple+sclerosis:+an+expanded+disability+status+scale+(EDSS).">Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).</a> Neurology. 33, 1444-1452 (1983).</li></ol>

CUNY has patents with Marom Bikson as inventor. Marom Bikson has equity in Soterix Medical Inc. CUNY has patents with Abhishek Datta as inventor. Abhishek Datta has equity in Soterix Medical Inc.

الخطوات الحاسمة في البروتوكول كما يدار عن بعد تحت إشراف tDCS بعيدا عن إشراف مباشر من الطبيب، فقد تم تصميم معايير الانتقاء والإقصاء لضمان أن المشارك لا يوجد لديه ظروف صحية بطلان أو الانحرافات البيئية، وقادرون تماما على استخدام جهاز كمبيوتر محمول (بما في ذلك مع التكيف التكنولوجيا) للتواصل مع فريق البحث. وبالإضافة إلى ذلك، يجب أن يكون المشاركون قادرين على تحمل جلسة tDCS والالتزام في الوقت الجلسة المقررة لمدة الدراسة. في حين tDCS عن بعد يوفر الراحة للدراسة وإدارة العلاج، ذاتيين استخدام المشاركين ليس من المستحسن على حد سواء بسبب مخاوف تتعلق بالسلامة وعدم القدرة على رصد وتوحيد التحفيز التي يتم تسليمها. بدلا من ذلك، لدينا بروتوكول يتبع المعايير والمبادئ التوجيهية لعن بعد تحت إشراف tDCS 16 إلى تمديد CLمعايير INIC من خلال تسليم في مكان بعيد. تضمن المبادئ التوجيهية التي موظفي البحوث والتدريب المناسب للتفاعل المشاركين، أن المستخدمين لديهم القدرة المناسبة للمشاركة في tDCS عن بعد، وأن هناك مواد تدريبية مستمرة وكذلك التقييمات التي أجريت من المشاركين في كل خطوة من هذه الدراسة. كان التحفيز موحدة وقابلة للتكرار مع بالضبط 20 دقيقة من 1.5 مللي أمبير تسليمها في كل دورة من دون أي انقطاع أو الاختلاف عبر جلسات أو الأفراد. تعديلات على البروتوكول واستكشاف الأخطاء وإصلاحها نصائح ويشمل البروتوكول العديد من التعديلات الصغيرة. أولا، قمنا بتوسيع نطاق استخدام هذا البروتوكول للمشاركين MS التي لها درجة EDSS فوق 6.5 في المقام حيث يوجد وكيل للوصول إلى إدارة كل جرعة. بالإضافة إلى ذلك، قمنا بتنفيذ الإجراء حيث اننا الوصول عن بعد الدراسة المقدمة الكمبيوتر المحمول المشارك للشروع في إجراء الحلقات الدر على شبكة الإنترنتrence لأولئك الذين يحتاجون إلى الدعم ومراجعة تدابير إضافية من التحمل ودراسة الخبرات من خلال وثيقة مشتركة. ويشمل التعديل المستقبلي للبروتوكول الحالي يسمح درجات مختلفة من المراقبة عن بعد بحيث المشاركين الذين يثبت الأكفأ مع تقنية لا تتطلب سوى الإشراف في وقت مبكر لتأكيد تعيين جهاز صعودا وللحصول على رمز فتح. قيود تقنية بينما النتائج الأولية دعمنا جدوى من هذا البروتوكول، وحجم عينة محدودة. مع توسع الالتحاق بالمدارس، وسوف يتم تحليل للثغرات في التدريب، وسبل تبسيط دورات، وتعزيز الفيديو التعليمي، وجعل هذه التقنية في متناول ذوي الإعاقات الحركية (أي الفئران على التكيف لاستخدام الكمبيوتر، والاسفنج جيب / سماعة تعديل لزيادة تخفيف التطبيق). تتراوح بعض المشاركين في EDSS أدناه 6.5 (التي لا تتطلب وكيل)، قد لا تزال تواجه بعض DIFficulty في القضايا ذات الصلة الكمبيوتر إعداد سماعة الرأس واستكشاف الأخطاء وإصلاحها. وعلاوة على ذلك، في حين توصي هذه الدراسة المراقبة عن بعد كامل من المشاركين في جميع الدورات والدراسات المستقبلية قد يراها بعض المشاركين على تدريب كاف لتشغيل الجهاز دون الإشراف على مجمل الدورة. أهمية الأسلوب فيما يتعلق بأساليب القائمة هذه النتائج الأولية تظهر جدوى بروتوكول لدينا لتشرف بعد التسليم tDCS للتجارب السريرية، بعد مجموعة من المبادئ التوجيهية والمعايير التي يجب أن تستخدم لبأمان، وتدير tDCS تحت المراقبة عن بعد على نحو فعال. تم تصميم بروتوكول لدينا سلسلة شجرة القرار من نقاط التفتيش مع معايير &quot;توقف&quot; (القسم 2.5.1 أعلاه) التي يجب أن يتم مسح من أجل المضي قدما في كل خطوة (انظر الشكل 1). وتناولت هذه الحواجز التحمل (تجارب الألم أو أثر سلبيالصورة للعلاج) والامتثال (في الوقت المناسب حضور الدورة والأسلوب السليم). لكل دورة من 1 إلى 10، أكمل المشاركون تقارير حالة السلبية وجيزة قبل وبعد جلسات العمل الخاصة بهم (مع العناصر المستمدة من قائمة الأكثر شيوعا tDCS آثار جانبية في التجارب السابقة). بالإضافة إلى ذلك، أكمل المشاركون تدابير تقرير المصير لمعالجة التحمل (قبل وبعد الدورة) ويمكن إكمال مخزونات أعراض كذلك. هذه الدراسة هي كبيرة في أنه يؤسس تقنية لدراسة العلاج في MS مع السلطة الكافية في الوقت الذي توفر أيضا زيادة فرص الحصول على العلاج tDCS. التطبيقات المستقبلية للتقنية مرة واحدة وقد تم تجريب طريقة ليشرف عن بعد tDCS بالكامل في عدد السكان MS، ويمكن البدء في محاكمة أكبر، عشوائية محكومة لاستهداف إدارة أعراض. من خلال استخدام مواد التدريب التعليمية وهيكل حول INTERA مشارك اليوميctions، tDCS أشرف عن بعد يمكن الوصول إليها من قبل مجموعة واسعة من السكان المريض وتوسيع الدراسة السريرية لهذه التقنية.

tDCS is a relatively recent therapy that operates through the use of low amplitude (2.0 mA or less) direct current to modulate cortical excitability 1. Hundreds of clinical trials have demonstrated tDCS to be safe and well-tolerated2-4. tDCS is easier to use, lower in cost, and better tolerated when compared to other methods such as transcranial magnetic stimulation (e.g., tDCS has not been associated with the development of seizures 5,6). Multiple tDCS sessions are required for benefit, especially when administered with the goal of enhancing rehabilitation outcomes.7-10
It is not yet known how many tDCS sessions are necessary or optimal, but the effects are cumulative with little evidence that tDCS over a single session produces behaviorally meaningful changes.2,11 For example, studies of depression have found 30 or more sessions needed for full benefit in some participants. 12,13 Multiple sessions are especially important when pairing tDCS with a behavioral therapy, which only occurs with rigorous repetition across many sessions. 14
For many patients and caregivers, traveling to the outpatient facility to receive repeated tDCS treatment sessions is a major obstacle in terms of time, cost and travel arrangements. This real-world limitation has resulted in studies with small sample sizes and without adequate power or design to draw conclusions that can lead to clinical use.15 Remote tDCS delivery would allow for participation in study protocols from home or other locations, and reach those patients who otherwise would not have access to these trials. Further, it allows the possibility for testing "on-demand" application for indications such as epilepsy and migraines. 
We have worked with a diverse group of clinical investigators interested in remotely-supervised tDCS to develop guidelines and standards for remotely-supervised tDCS delivery including specialized equipment and specific training requirements both for staff and study participants16. Here, we developed a protocol to follow these guidelines and test for feasibility in patients with multiple sclerosis (MS), a disorder where tDCS may be a useful tool for the management of its symptoms. 11,17-23

<table border="0" cellpadding="0" cellspacing="0" width="793">
	<tbody>
		<tr height="42">
			<td height="42" style="height:42px;width:184px;">Mini-CT transcranial direct current stimulation device</td>
			<td style="width:71px;">Soterix</td>
			<td style="width:119px;"></td>
			<td style="width:419px;">Device to deliver direct current stimultion in a remote manner</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:184px;">Study Kit&#160;</td>
			<td style="width:71px;">NA</td>
			<td style="width:119px;"></td>
			<td>Provided to participant with all required setup items - device, headset, sponge pockets, pre-filled syringes, Kleenex, handheld mirro, spare batteries&#160;</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:184px;">Laptop&#160;</td>
			<td style="width:71px;">NA</td>
			<td style="width:119px;"></td>
			<td>Provided to allow secure video conferecing during device setup and headset placement</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:184px;">Instruction Manual&#160;</td>
			<td style="width:71px;">NA</td>
			<td style="width:119px;"></td>
			<td>Transcription of instructional video and detailed instructions for protocol&#160;</td>
		</tr>
	</tbody>
</table>

a protocol for the use of remotely-supervised transcranial direct current stimulation (tdcs) in multiple sclerosis (ms)

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses low amplitude direct currents to alter cortical excitability. With well-established safety and tolerability, tDCS has been found to have the potential to ameliorate symptoms such as depression and pain in a range of conditions as well as to enhance outcomes of cognitive and physical training. However, effects are cumulative, requiring treatments that can span weeks or months and frequent, repeated visits to the clinic. The cost in terms of time and travel is often prohibitive for many participants, and ultimately limits real-world access. 
Following guidelines for remote tDCS application, we propose a protocol that would allow remote (in-home) participation that uses specially-designed devices for supervised use with materials modified for patient use, and real-time monitoring through a telemedicine video conferencing platform. We have developed structured training procedures and clear, detailed instructional materials to allow for self- or proxy-administration while supervised remotely in real-time. The protocol is designed to have a series of checkpoints, addressing attendance and tolerability of the session, to be met in order to continue to the next step. The feasibility of this protocol was then piloted for clinical use in an open label study of remotely-supervised tDCS in multiple sclerosis (MS). This protocol can be widely used for clinical study of tDCS.

تكيفنا هذا البروتوكول للاستخدام في MS. استهدفنا تسليم إيصال عشر جلسات التحفيز tDCS أكثر من أسبوعين، وكانت 9،10 جلسات الأولين من عشر دورات تدريبية في شخص واصيب ثمانية التالية تحت إشراف عن بعد (الشكل 3). وتتألف الدورة الثانية لملاءمة البيئة تقييم حيث زار الفنيين الدراسة المنزلية المشارك لتأكيد المناسب مجموعة المتابعة. لاستكمال الدورات يشرف من بعيد التالية، وقدمت للمشاركين الجهاز tDCS المصممة خصيصا للاستخدام عن بعد وسماعة الرأس التي تم تعديلها لسهولة الاستخدام لتوجيه دقيق وضع قطب كهربائي. تم توفير عدة الجهاز وشملت الجهاز وسماعة، لمرة واحدة جيوب استخدام اسفنجة لأقطاب والمحاقن المعبأة مع الكمية المقاسة من المياه المالحة المطلوبة لكل الاسفنج، مع جميع البنود وصفت بشكل فردي بعد يوم والأعضاءأوتوماتيكية لسهولة الاستخدام. وضعت أقطاب في الثنائية الظهرية الوحشية قشرة الفص الجبهي (DLPC) موقف مع القطب مصعدي وضعت على الجانب الأيسر. 10 وهذا يوفر سهولة موثوق وضع قطب كهربائي، تطبيقات علاجية واسعة. 9،10 بناء على الدراسات السابقة استهدفنا 1.5 مللي أمبير لمدة 20 دقيقة جلسات. بروتوكول 9،10 يسمح للحد من الحالي إلى 1.0 مللي أمبير في الأساس إذا كان هذا يحسن التحمل الموضوع العام. وتلقى المشاركون كمبيوتر محمول المقدمة دراسة تكوينه من أجل الدراسة، بما في ذلك الفيديو التعليمي يسهل الوصول إليه وصلة لتأمين اتصال بالفيديو مع فني الدراسة. وشمل الكمبيوتر المحمول أيضا برنامج للمراقبة عن بعد من كل نشاط الكمبيوتر، وبرنامج الوصول عن بعد إلى جهاز الكمبيوتر للحصول على الدعم التقني. استخدمت أدلة مفصلة لعملية من قبل كل من المشاركين والدراسة فني، والموثق لص الذاتي<html> وقدمت تدابير eport. ما مجموعه ن = قد أكملت 20 مشاركا MS الدراسة. معايير الاختيار المحددة على الموسع الإعاقة مركز مقياس (EDSS) 25 * 6.0 أو أقل أو 6.5 أو أعلى مع وكيل لضمان الحد الأدنى من متطلبات المحرك لتشغيل الجهاز. وقد تم التحاق ممثل مجموعة من انخفاض في MS (إعاقة حركية وضعف الإدراك، أو كليهما). كل 20 مشاركا، ن = 4 مع الوكيل، تم تدريب بنجاح في تقرير المصير، تطبيق جلسة tDCS وتم الانتهاء من مجموع 192 جلسات. كما هو مبين في الشكل 4، 40 من جلسات the192 شمل التدريب؛ 152 المتبقية كانت جلسات حصرا تحت إشراف عن بعد. الدورات يشرف عن بعد، أعدم 100٪ بشكل صحيح مع بنجاح وضع أقطاب كهربائية، تشغيل الجهاز وجيد التحمل التسليم من التحفيز. تحميل / 53542 / 53542fig1.jpg &quot;/&gt; الشكل 1. إيقاف معايير مخطط انسيابي. الرسم البياني تفاصيل مختلف المعايير التي تشير إلى أحد المشاركين لم تعد قادرة على المضي قدما أو المشاركة في دراسة أشرف tDCS عن بعد. <a href="https://www.jove.com/files/ftp_upload/53542/53542fig1large.jpg" target="_blank">الرجاء انقر هنا لعرض نسخة أكبر من هذا الرقم.</a> <img alt="الرقم 2" src="/files/ftp_upload/53542/53542fig2.jpg" /> الشكل 2. كيت الأجهزة. يوضح هذا الرأي عدة الجهاز مع جيوب الاسفنج ملفوفة بشكل فردي، واحدة مليئة المالحة حقنة في الاسفنج في اليوم الواحد، مرآة المحمولة حامل الجهاز، محلول ملحي الفراغ، والجهاز مع غطاء الرأس. <a href="https://www.jove.com/files/ftp_upload/53542/53542fig2large.jpg" target="_blank">الرجاء انقر هنا لعرض نسخة أكبر من هذا الرقم.</a> <imgALT = &quot;الشكل 3&quot; SRC = &quot;/ ملفات / ftp_upload / 53542 / 53542fig3.jpg&quot; /&gt; الشكل 3. مشارك دراسة جدول زمني. هذا جدول زمني يوضح طريقة لمجموعات دراسة دورة والأجهزة من خلال كل التحاق المشاركين 10 يوم في الدراسة. <a href="https://www.jove.com/files/ftp_upload/53542/53542fig3large.jpg" target="_blank">الرجاء انقر هنا لعرض نسخة أكبر من هذا الرقم.</a> <img alt="الرقم 4" src="/files/ftp_upload/53542/53542fig4.jpg" /> الرقم 4. جلسات tDCS التطبيقية الذاتي عبر ن = 20 مشاركا. وهذا الرقم يدل على جلسات الانتهاء، المطبقة الذاتي عبر ن = التحق 20 مشاركا في الدراسة. اكتمال الدورة الأولية في عيادة حين الانتهاء من الدورات التسع المتبقية من خلال المراقبة عن بعد في المنزل المشارك. <a href="https://www.jove.com/files/ftp_upload/53542/53542fig4large.jpg" target="_blank">الرجاء انقر هنا لعرض أكبر الخامس</a>ersion من هذا الرقم.

Watch this Scientific Journal Video about A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation tDCS in Multiple Sclerosis MS at JoVE.com

A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation tDCS in Multiple Sclerosis MS

The goal of this pilot study is to describe a protocol for the remotely-supervised delivery of transcranial direct current stimulation (tDCS) so that the procedure maintains standards of in-clinic practice, including safety, reproducibility, and tolerability. The feasibility of this protocol was tested in participants with multiple sclerosis (MS).

بروتوكول لاستخدام الإشراف عن بعد، عبر الجمجمة مباشرة الحالي تحفيز (tDCS) في التصلب المتعدد (MS)

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that uses low amplitude direct currents to alter cortical ...

a-protocol-for-use-remotely-supervised-transcranial-direct-current

Research

JoVE Journal

Medicine

A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation (tDCS) in Multiple Sclerosis (MS)

17.1K Views.  NYU Langone Medical Center. The goal of this pilot study is to describe a protocol for the remotely-supervised delivery of transcranial direct current stimulation (tDCS) so that the procedure maintains standards of in-clinic practice, including safety, reproducibility, and tolerability. The feasibility of this protocol was tested in participants with multiple sclerosis (MS). 

Video: A Protocol for the Use of Remotely-Supervised Transcranial Direct Current Stimulation tDCS in Multiple Sclerosis MS

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis (ALS)

Improved methods for assessing bulbar impairment are necessary for expediting diagnosis of bulbar dysfunction in ALS, for predicting disease progression across speech subsystems, and for addressing the critical need for sensitive outcome measures for ongoing experimental treatment trials. To address this need, we are obtaining longitudinal profiles of bulbar impairment in 100 individuals based on a comprehensive instrumentation-based assessment that yield objective measures. Using instrumental approaches to quantify speech-related behaviors is very important in a field that has primarily relied on subjective, auditory-perceptual forms of speech assessment1. Our assessment protocol measures performance across all of the speech subsystems, which include respiratory, phonatory (laryngeal), resonatory (velopharyngeal), and articulatory. The articulatory subsystem is divided into the facial components (jaw and lip), and the tongue. Prior research has suggested that each speech subsystem responds differently to neurological diseases such as ALS. The current protocol is designed to test the performance of each speech subsystem as independently from other subsystems as possible. The speech subsystems are evaluated in the context of more global changes to speech performance. These speech system level variables include speaking rate and intelligibility of speech.
The protocol requires specialized instrumentation, and commercial and custom software. The respiratory, phonatory, and resonatory subsystems are evaluated using pressure-flow (aerodynamic) and acoustic methods. The articulatory subsystem is assessed using 3D motion tracking techniques. The objective measures that are used to quantify bulbar impairment have been well established in the speech literature and show sensitivity to changes in bulbar function with disease progression. The result of the assessment is a comprehensive, across-subsystem performance profile for each participant. The profile, when compared to the same measures obtained from healthy controls, is used for diagnostic purposes. Currently, we are testing the sensitivity and specificity of these measures for diagnosis of ALS and for predicting the rate of disease progression. In the long term, the more refined endophenotype of bulbar ALS derived from this work is expected to strengthen future efforts to identify the genetic loci of ALS and improve diagnostic and treatment specificity of the disease as a whole. The objective assessment that is demonstrated in this video may be used to assess a broad range of speech motor impairments, including those related to stroke, traumatic brain injury, multiple sclerosis, and Parkinson disease.

A Protocol for Comprehensive Assessment of Bulbar Dysfunction in Amyotrophic Lateral Sclerosis ALS

Objective assessments of the physiological mechanisms that support speech are needed to monitor disease onset and progression in persons with ALS and to quantify treatment effects in clinical trials. In this video, we present a comprehensive, instrumentation-based protocol for quantifying speech motor performance in clinical populations.

بروتوكول لتقييم شامل لبصلي الضعف في التصلب الوحشي الضموري (ALS)

Improved methods for assessing bulbar impairment are necessary for expediting diagnosis of bulbar dysfunction in ALS, for predicting disease progression ...

Utilizing Transcranial Magnetic Stimulation to Study the Human Neuromuscular System

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade. While the use of TMS has expanded to the study of many systems and processes during this time, the original application and perhaps one of the most common uses of TMS involves studying the physiology, plasticity and function of the human neuromuscular system. Single pulse TMS applied to the motor cortex excites pyramidal neurons transsynaptically 2 (Figure 1) and results in a measurable electromyographic response that can be used to study and evaluate the integrity and excitability of the corticospinal tract in humans 3. Additionally, recent advances in magnetic stimulation now allows for partitioning of cortical versus spinal excitability 4,5. For example, paired-pulse TMS can be used to assess intracortical facilitatory and inhibitory properties by combining a conditioning stimulus and a test stimulus at different interstimulus intervals 3,4,6-8. In this video article we will demonstrate the methodological and technical aspects of these techniques. Specifically, we will demonstrate single-pulse and paired-pulse TMS techniques as applied to the flexor carpi radialis (FCR) muscle as well as the erector spinae (ES) musculature. Our laboratory studies the FCR muscle as it is of interest to our research on the effects of wrist-hand cast immobilization on reduced muscle performance6,9, and we study the ES muscles due to these muscles clinical relevance as it relates to low back pain8. With this stated, we should note that TMS has been used to study many muscles of the hand, arm and legs, and should iterate that our demonstrations in the FCR and ES muscle groups are only selected examples of TMS being used to study the human neuromuscular system.

Transcranial magnetic stimulation (TMS) is a non-invasive tool to gain insight on the physiology and function of the human nervous system. Here, we present our TMS techniques to study cortical excitability of the upper limb and lumbar musculature.

استخدام التنشيط المغناطيسي عبر الجمجمة لدراسة النظام العصبي العضلي الإنسان

Transcranial magnetic stimulation (TMS) has been in use for more than 20 years 1, and has grown exponentially in popularity over the past decade.  While ...

Clinical Testing and Spinal Cord Removal in a Mouse Model for Amyotrophic Lateral Sclerosis (ALS)

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder resulting in progressive degeneration of motoneurons. Peak of onset is around 60 years for the sporadic disease and around 50 years for the familial disease. Due to its progressive course, 50% of the patients die within 30 months of symptom onset. In order to evaluate novel treatment options for this disease, genetic mouse models of ALS have been generated based on human familial mutations in the SOD gene, such as the SOD1 (G93A) mutation. Most important aspects that have to be evaluated in the model are overall survival, clinical course and motor function. Here, we demonstrate the clinical evaluation, show the conduction of two behavioural motor tests and provide quantitative scoring systems for all parameters. Because an in depth analysis of the ALS mouse model usually requires an immunohistochemical examination of the spinal cord, we demonstrate its preparation in detail applying the dorsal laminectomy method. Exemplary histological findings are demonstrated. The comprehensive application of the depicted examination methods in studies on the mouse model of ALS will enable the researcher to reliably test future therapeutic options which can provide a basis for later human clinical trials.

Clinical Testing and Spinal Cord Removal in a Mouse Model for Amyotrophic Lateral Sclerosis ALS

A mouse model for amyotrophic lateral sclerosis (ALS) is examined clinically and behaviorally. As a prerequisite for an accompanying immunohistological analysis the preparation of the spinal cord is depicted in detail.

السريرية اختبار وإزالة العمود الفقري الحبل في الفأر نموذج لتصلب الأنسجة العضلية الجانبية (ALS)

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder resulting in progressive degeneration of motoneurons. Peak of onset is around 60 ...

Utilizing Repetitive Transcranial Magnetic Stimulation to Improve Language Function in Stroke Patients with Chronic Non-fluent Aphasia

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this experiment, we demonstrate the administration of low-frequency repetitive TMS (rTMS) to an optimal stimulation site in the right hemisphere in patients with chronic non-fluent aphasia. A battery of standardized language measures is administered in order to assess baseline performance. Patients are subsequently randomized to either receive real rTMS or initial sham stimulation. Patients in the real stimulation undergo a site-finding phase, comprised of a series of six rTMS sessions administered over five days; stimulation is delivered to a different site in the right frontal lobe during each of these sessions. Each site-finding session consists of 600 pulses of 1 Hz rTMS, preceded and followed by a picture-naming task. By comparing the degree of transient change in naming ability elicited by stimulation of candidate sites, we are able to locate the area of optimal response for each individual patient. We then administer rTMS to this site during the treatment phase. During treatment, patients undergo a total of ten days of stimulation over the span of two weeks; each session is comprised of 20 min of 1 Hz rTMS delivered at 90% resting motor threshold. Stimulation is paired with an fMRI-naming task on the first and last days of treatment. After the treatment phase is complete, the language battery obtained at baseline is repeated two and six months following stimulation in order to identify rTMS-induced changes in performance. The fMRI-naming task is also repeated two and six months following treatment. Patients who are randomized to the sham arm of the study undergo sham site-finding, sham treatment, fMRI-naming studies, and repeat language testing two months after completing sham treatment. Sham patients then cross over into the real stimulation arm, completing real site-finding, real treatment, fMRI, and two- and six-month post-stimulation language testing.

We explore the use of repetitive transcranial magnetic stimulation (rTMS) to improve language abilities in patients with chronic stroke and non-fluent aphasia. After identifying a site in the right frontal gyrus for each patient that responds optimally to stimulation, we target this site during ten days of rTMS treatment.

استخدام المتكرر تحفيز المغناطيسي عبر الجمجمة لتحسين وظيفة اللغة في مرضى السكتة الدماغية المزمنة مع فقدان القدرة على الكلام غير بطلاقة

Transcranial magnetic stimulation (TMS) has been shown to significantly improve language function in patients with non-fluent aphasia1. In this ...

Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation (HD-tDCS)

High-definition transcranial direct current stimulation (HD-tDCS) has recently been developed as a noninvasive brain stimulation approach that increases the accuracy of current delivery to the brain by using arrays of smaller "high-definition" electrodes, instead of the larger pad-electrodes of conventional tDCS. Targeting is achieved by energizing electrodes placed in predetermined configurations. One of these is the 4x1-ring configuration. In this approach, a center ring electrode (anode or cathode) overlying the target cortical region is surrounded by four return electrodes, which help circumscribe the area of stimulation. Delivery of 4x1-ring HD-tDCS is capable of inducing significant neurophysiological and clinical effects in both healthy subjects and patients. Furthermore, its tolerability is supported by studies using intensities as high as 2.0 milliamperes for up to twenty minutes.
Even though 4x1 HD-tDCS is simple to perform, correct electrode positioning is important in order to accurately stimulate target cortical regions and exert its neuromodulatory effects. The use of electrodes and hardware that have specifically been tested for HD-tDCS is critical for safety and tolerability. Given that most published studies on 4x1 HD-tDCS have targeted the primary motor cortex (M1), particularly for pain-related outcomes, the purpose of this article is to systematically describe its use for M1 stimulation, as well as the considerations to be taken for safe and effective stimulation. However, the methods outlined here can be adapted for other HD-tDCS configurations and cortical targets.

Technique and Considerations in the Use of 4x1 Ring High-definition Transcranial Direct Current Stimulation HD-tDCS

High-definition transcranial direct current stimulation (HD-tDCS), with its 4x1-ring montage, is a noninvasive brain stimulation technique that combines both the neuromodulatory effects of conventional tDCS with increased focality. This article provides a systematic demonstration of the use of 4x1 HD-tDCS, and the considerations needed for safe and effective stimulation.

تقنية واعتبارات في استخدام 4X1 خاتم عالي الوضوح عبر الجمجمة مباشر تحفيز الحالي (HD-tDCS)

High-definition transcranial direct current stimulation (HD-tDCS) has recently been developed as a noninvasive brain stimulation approach that increases ...

The Multiple Sclerosis Performance Test (MSPT): An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the Multiple Sclerosis Performance Test (MSPT), which represents a new approach to quantifying MS related disability. The MSPT takes advantage of advances in computer technology, information technology, biomechanics, and clinical measurement science. The resulting MSPT represents a computer-based platform for precise, valid measurement of MS severity. Based on, but extending the Multiple Sclerosis Functional Composite (MSFC), the MSPT provides precise, quantitative data on walking speed, balance, manual dexterity, visual function, and cognitive processing speed. The MSPT was tested by 51 MS patients and 49 healthy controls (HC). MSPT scores were highly reproducible, correlated strongly with technician-administered test scores, discriminated MS from HC and severe from mild MS, and correlated with patient reported outcomes. Measures of reliability, sensitivity, and clinical meaning for MSPT scores were favorable compared with technician-based testing. The MSPT is a potentially transformative approach for collecting MS disability outcome data for patient care and research. Because the testing is computer-based, test performance can be analyzed in traditional or novel ways and data can be directly entered into research or clinical databases. The MSPT could be widely disseminated to clinicians in practice settings who are not connected to clinical trial performance sites or who are practicing in rural settings, drastically improving access to clinical trials for clinicians and patients. The MSPT could be adapted to out of clinic settings, like the patient&#8217;s home, thereby providing more meaningful real world data. The MSPT represents a new paradigm for neuroperformance testing. This method could have the same transformative effect on clinical care and research in MS as standardized computer-adapted testing has had in the education field, with clear potential to accelerate progress in clinical care and research.

The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report methodologic details on a new test, the Multiple Sclerosis Performance Test (MSPT). This new approach to the objective of quantification of MS related disability provides a computer-based platform for precise, valid measurement of MS severity.

والتصلب المتعدد اختبار الأداء (MSPT): أداة تقييم الإعاقة باد المستندة

Precise measurement of neurological and neuropsychological impairment and disability in multiple sclerosis is challenging. We report a new test, the ...

A Method of Trigonometric Modelling of Seasonal Variation Demonstrated with Multiple Sclerosis Relapse Data

This report describes a novel Stata-based application of trigonometric regression modelling to 55 years of multiple sclerosis relapse data from 46 clinical centers across 20 countries located in both hemispheres. Central to the success of this method was the strategic use of plot analysis to guide and corroborate the statistical regression modelling. Initial plot analysis was necessary for establishing realistic hypotheses regarding the presence and structural form of seasonal and latitudinal influences on relapse probability and then testing the performance of the resultant models. Trigonometric regression was then necessary to quantify these relationships, adjust for important confounders and provide a measure of certainty as to how plausible these associations were. Synchronization of graphing techniques with regression modelling permitted a systematic refinement of models until best-fit convergence was achieved, enabling novel inferences to be made regarding the independent influence of both season and latitude in predicting relapse onset timing in MS. These methods have the potential for application across other complex disease and epidemiological phenomena suspected or known to vary systematically with season and/or geographic location.

Combining plot analysis with trigonometric regression is a robust method for exploring complex, cyclical phenomena such as relapse onset timing in multiple sclerosis (MS). This method enabled unbiased characterisation of seasonal trends in relapse onset permitting novel inferences around the influence of seasonal variation, ultraviolet radiation (UVR) and latitude.

A طريقة المثلثية نمذجة الموسمية التغيير تظاهر مع التصلب المتعدد الانتكاس البيانات

This report describes a novel Stata-based application of trigonometric regression modelling to  55 years of multiple sclerosis relapse data from 46 ...

Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis

Hip weakness is a common symptom affecting walking ability in people with multiple sclerosis (MS). It is known that resistance strength training (RST) can improve strength in individuals with MS, however; it remains unclear the duration of RST that is needed to make strength gains and how to adapt hip strengthening exercises for individuals of varying strength using only resistance bands. This paper describes the methodology to set up and implement an adapted resistance strength training program, using resistance bands, for individuals with MS. Directions for pre- and post-strength tests to evaluate efficacy of the strength-training program are included. Safety features and detailed instructions outline the weekly program content and progression. Current evidence is presented showing that significant strength gains can be made within 8 weeks of starting a RST program. Evidence is also presented showing that resistance strength training can be successfully adapted for individuals with MS of varying strength with little equipment.

Hip weakness is a common symptom affecting walking ability in people with multiple sclerosis. Isolated muscle strengthening is a useful method to target specific weaknesses. This protocol describes a progressive resistance-training program using exercise bands to increase hip muscle strength.

التدريب تكييفها المقاومة يحسن قوة في ثمانية أسابيع في الأفراد الذين يعانون من مرض التصلب العصبي المتعدد

Hip weakness is a common symptom affecting walking ability in people with multiple sclerosis (MS). It is known that resistance strength training (RST) can ...

Bioluminescence and Near-infrared Imaging of Optic Neuritis and Brain Inflammation in the EAE Model of Multiple Sclerosis in Mice

Experimental autoimmune encephalomyelitis (EAE) in SJL/J mice is a model for relapsing-remitting multiple sclerosis (RRMS). Clinical EAE scores describing motor function deficits are basic readouts of the immune-mediated inflammation of the spinal cord. However, scores and body weight do not allow for an in vivo assessment of brain inflammation and optic neuritis. The latter is an early and frequent manifestation in about 2/3 of MS patients. Here, we show methods for bioluminescence and near-infrared live imaging to assess EAE evoked optic neuritis, brain inflammation, and blood-brain barrier (BBB) disruption in living mice using an in vivo imaging system. A bioluminescent substrate activated by oxidases primarily showed optic neuritis. The signal was specific and allowed the visualization of medication effects and disease time courses, which paralleled the clinical scores. Pegylated fluorescent nanoparticles that remained within the vasculature for extended periods of time were used to assess the BBB integrity. Near-infrared imaging revealed a BBB leak at the peak of the disease. The signal was the strongest around the eyes. A near-infrared substrate for matrix metalloproteinases was used to assess EAE-evoked inflammation. Auto-fluorescence interfered with the signal, requiring spectral unmixing for quantification. Overall, bioluminescence imaging was a reliable method to assess EAE-associated optic neuritis and medication effects and was superior to the near-infrared techniques in terms of signal specificity, robustness, ease of quantification, and cost.

We show a technique for in vivo live bioluminescence and near-infrared imaging of optic neuritis and encephalitis in the experimental autoimmune encephalomyelitis (EAE) model for multiple sclerosis in SJL/J mice.

تلألؤ بيولوجي والقريبة من تحت الحمراء التصوير من التهاب العصب البصري والمخ التهاب في نموذج EAE من مرض التصلب العصبي المتعدد في الفئران

Experimental autoimmune encephalomyelitis (EAE) in SJL/J mice is a model for relapsing-remitting multiple sclerosis (RRMS). Clinical EAE scores describing ...

Home-Based Transcranial Direct Current Stimulation Device Development: An Updated Protocol Used at Home in Healthy Subjects and Fibromyalgia Patients

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation (NIBS) method, which modulates the membrane potential of neurons in the cerebral cortex by a low-intensity direct current. tDCS is a low-cost technique with minimal adverse effects and easy application. This neurostimulation method has a promising future to improve pain therapy, treatment of neuropsychiatric disorders, and physical rehabilitation.
Current studies demonstrate the benefits of using tDCS over consecutive multiple sessions. However, the daily displacement to the specialized centers, travel costs, and disruptions to daily activities are some of the difficulties faced by patients. Thus, to be more comfortable, easy-to-use, and not disrupt daily commitments, a home-based tDCS was designed. Therefore, the objective of this study was to evaluate the feasibility of a portable tDCS device for home use in healthy subjects and fibromyalgia patients.
Despite increased tDCS use and a reasonably large body of research on the effects across a range of clinical conditions, there is a limited amount of research on developing secure devices that guarantee the dose and contain a block system to avoid excessive use. Therefore, we used a tDCS device with a security system to permit daily use for 20 minutes with a minimal interval of 12 hours between sessions. A programmer preconfigures the equipment, which has a neoprene cap that allows the electrode positions in any assembly, according to individualized protocols for treatments or research. After, researchers can assess the effectiveness of treatment, and its adherence using information kept in the device software.
Results suggest that the device is feasible for home use, with proper monitoring of adherence and contact impedance. There were reports of a few adverse effects, which do not differ from those reported in the literature in studies with the treatment under direct supervision.

This study provides an updated home-based tDCS protocol that enables subjects to receive the beneficial effects of tDCS at home with an easy to use device with settings to control the use and dosage, enhancing the feasibility for long-term use at home.

المنزلية مباشرة Transcranial جهاز تحفيز التنمية الحالية: بروتوكولا حدثت المستخدمة في المنزل في صحة مرضى فيبروميالغيا والمواضيع

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation (NIBS) method, which modulates the membrane potential of neurons in the ...