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  4. Novel personalized treatment strategy for patients with chronic stroke with severe upper-extremity impairment: The first patient of the AVANCER trial
 
research article

Novel personalized treatment strategy for patients with chronic stroke with severe upper-extremity impairment: The first patient of the AVANCER trial

Bigoni, Claudia  
•
Beanato, Elena  
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Harquel, Sylvain  
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September 8, 2023
Med

Background: Around 25% of patients who have had a stroke suffer from severe upper-limb impairment and lack effective rehabilitation strategies. The AVANCER proof-of-concept clinical trial (NCT04448483) tackles this issue through an intensive and personalized-dosage cumulative inter-vention that combines multiple non-invasive neurotechnologies. Methods: The therapy consists of two sequential interventions, lasting until the patient shows no further motor improvement, for a minimum of 11 sessions each. The first phase involves a brain-computer interface governing an exoskeleton and multi-channel functional electrical stim-ulation enabling full upper-limb movements. The second phase adds anodal transcranial direct current stimulation of the motor cortex of the lesioned hemisphere. Clinical, electrophysiological, and neuroi-maging examinations are performed before, between, and after the two interventions (T0, T1, and T2). This case report presents the results from the first patient of the study. Findings: The primary outcome (i.e., 4-point improvement in the Fugl-Meyer assessment of the upper extremity) was met in the first patient, with an increase from 6 to 11 points between T0 and T2. This improvement was paralleled by changes in motor-network structure and function. Resting-state and transcranial magnetic stimulation -evoked electroencephalography revealed brain functional changes, and magnetic resonance imaging (MRI) measures detected structural and task-related functional changes. Conclusions: These first results are promising, pointing to feasibility, safety, and potential efficacy of this personalized approach acting syn-ergistically on the nervous and musculoskeletal systems. Integrating multi-modal data may provide valuable insights into underlying mech-anisms driving the improvements and providing predictive information regarding treatment response and outcomes.

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Type
research article
DOI
10.1016/j.medj.2023.06.006
Web of Science ID

WOS:001074159600001

Author(s)
Bigoni, Claudia  
•
Beanato, Elena  
•
Harquel, Sylvain  
•
Herve, Julie  
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Oflar, Meltem  
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Crema, Andrea  
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Espinosa, Arnau
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Evangelista, Giorgia G.  
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Koch, Philipp
•
Bonvin, Christophe
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Date Issued

2023-09-08

Publisher

CELL PRESS

Published in
Med
Volume

4

Issue

9

Start page

591

End page
Subjects

Medicine, Research & Experimental

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Research & Experimental Medicine

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corticospinal tract

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motor recovery

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brain

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reliability

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neurorehabilitation

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stimulation

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cortex

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scale

Editorial or Peer reviewed

REVIEWED

Written at

EPFL

EPFL units
TNE  
Available on Infoscience
October 23, 2023
Use this identifier to reference this record
https://infoscience.epfl.ch/handle/20.500.14299/201844
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