Alashram Anas R, Padua Elvira, Annino Giuseppe
Department of Physiotherapy, Isra University, Amman, Jordan.
Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
Appl Neuropsychol Adult. 2023 Nov-Dec;30(6):814-829. doi: 10.1080/23279095.2022.2091440. Epub 2022 Jun 30.
Traumatic brain injury (TBI) can cause numerous cognitive deficits. These deficits are associated with disability and reduction in quality of life. Noninvasive brain stimulation (NIBS) provides excitatory or inhibitory stimuli to the cerebral cortex. This review aimed to examine the effectiveness of NIBS (i.e., rTMS and tDCS) on cognitive functions in patients with TBI. PubMed, SCOPUS, PEDro, CINAHL, MEDLINE, REHABDATA, and Web of Science were searched from inception to May 2021. The risk of bias in the randomized controlled trials was assessed using the Cochrane Collaboration's instrument. The Physiotherapy Evidence Database (PEDro) scale was applied to evaluate the risk of bias in the non-randomized controlled trials. Ten studies met our inclusion criteria. Six studies used repetitive Transcranial Magnetic Stimulation (rTMS), and four used transcranial Direct Current Stimulation (tDCS) as cognitive rehabilitation interventions. The results showed heterogenous evidence for the effects of rTMS and tDCS on cognitive function outcomes in individuals with TBI. The evidence for the effects of NIBS on cognition following TBI was limited. TDCS and rTMS are safe and well-tolerated interventions post-TBI. The optimal stimulation sites and stimulation parameters remain unknown. Combining NIBS with traditional rehabilitation interventions may contribute to greater enhancements in cognitive functions post-TBI.
创伤性脑损伤（TBI）可导致多种认知缺陷。这些缺陷与残疾和生活质量下降相关。非侵入性脑刺激（NIBS）向大脑皮层提供兴奋性或抑制性刺激。本综述旨在研究NIBS（即重复经颅磁刺激[rTMS]和经颅直流电刺激[tDCS]）对TBI患者认知功能的有效性。检索了PubMed、SCOPUS、PEDro、CINAHL、MEDLINE、REHABDATA和Web of Science数据库，检索时间从建库至2021年5月。使用Cochrane协作组的工具评估随机对照试验中的偏倚风险。应用物理治疗证据数据库（PEDro）量表评估非随机对照试验中的偏倚风险。十项研究符合我们的纳入标准。六项研究使用重复经颅磁刺激（rTMS），四项研究使用经颅直流电刺激（tDCS）作为认知康复干预措施。结果显示，rTMS和tDCS对TBI个体认知功能结局的影响证据存在异质性。NIBS对TBI后认知影响的证据有限。TDCS和rTMS是TBI后安全且耐受性良好的干预措施。最佳刺激部位和刺激参数尚不清楚。将NIBS与传统康复干预相结合可能有助于TBI后认知功能的更大改善。
