Traumatic brain injuries (TBIs) are alterations in brain function or other brain pathology induced by external forces. The location of the injury as well as its severity is what today allows us to identify and further understand the cognitive deficits and symptoms resulting from damage to the brain structure. Considering that all TBI patients present their own unique set of functional impairments and symptoms, the development of a safe and personalized framework of treatment that targets these is crucial for rehabilitation interventions.
In the research article titled Neuromodulatory Interventions for Traumatic Brain Injury, Dr. Pape and colleagues emphasize the importance of understanding the mechanism behind neuromodulation and improving this technique for the future of TBI rehabilitation. In the TBI treatment field, neuromodulation has been recognized as a promising tool due to its potential to facilitate the recovery of somatosensory and higher-order skills damaged in TBI. Neuromodulation is the alteration of nerve activity through targeted stimulation that aids in modulating neuronal pathways in order to support repair and alteration. In other words, this intervention is the result of inducing plasticity as well as engaging mechanisms of metaplasticity (long-term potentiation (LTP) or depression (LTD) mechanisms).
One of the most noninvasive techniques used in rehabilitation is called repetitive transcranial magnetic stimulation (rTMS). The effects of this technique can be optimized by the precise manipulation of strength and focality of stimuli, which in turn induces a greater or slower neuronal depolarization, or induces a secondary activation or other brain networks outside of the stimuli radius. According to Dr. Pape, the adoption of techniques like TMS paired with a learning-based intervention is a good step toward the future of rehabilitation in enhancing the functional recovery of each unique TBI patient.
Similarly, in the research article Repetitive transcranial magnetic stimulation promotes neurological functional recovery in rats with traumatic brain injury by upregulating synaptic plasticity-related proteins by Dr. Qian and colleagues, the study closely examines and further expounds on the use of rTMS and its mechanism of action in the brain. With the use of rat models with moderate TBI, the researchers measured mRNA and protein levels of those involved in synaptic plasticity like NMDAR1 and CREB, brain-derived neurotrophic factor (BDNF) known as a long-term potentiation (LTP) regulator, BDNF-tropomyosin receptor kinase B (TrkB), and synaptophysin (SYN). Their findings showed that rTMS increased these protein levels and their mRNA expression which are linked to long-term potentiation. In addition, rTMS seemed to invert the deficit of the protein SYN as well as support the restoration and reorganization of the synaptic brain structure. With this in mind, it is this production of these proteins that leads to the function of the metaplastic mechanism of LTP that results in the neuromodulatory effects observed after rTMS treatment on TBI.
Ultimately, both studies illustrate the importance of understanding rTMS and its neuromodulatory effectiveness in order to treat TBI. Now that the scientific field has started to recognize repetitive transcranial magnetic stimulation (rTMS) to be a promising tool for the future of rehabilitation in TBI, there needs to be more research developed to further understand this tool and its limitations, and create a framework of neuromodulatory treatment that works across all TBI patients.
References:
Pape, T. L., Herrold, A. A., Guernon, A., Aaronson, A. & Rosenow, J. M. (2020). Neuromodulatory interventions for traumatic brain injury. Journal of Head Trauma Rehabilitation, 35(6), 365-370. https://doi.org/10.1097/HTR.0000000000000643
Qian, F. F., He, Y. H., Du, X. H., Lu, H. X., He, R. H., & Fan, J. Z. (2023). Repetitive transcranial magnetic stimulation promotes neurological functional recovery in rats with traumatic brain injury by upregulating synaptic plasticity-related proteins. Neural Regeneration Research, 18(2), 368. https://doi.org/10.4103/1673-5374.346548
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