Novel Non-invasive Brain Stimulation Techniques in Neurological Rehabilitation: Cross-modal Paired Associative Stimulation (PAS) Protocols to Promote Plastic Reorganization in Stroke and Phantom Limb Pain Patients
Paired associative stimulation (PAS) is a non-invasive brain stimulation protocol, where two stimuli (a peripheral and a cortical one, the latter delivered with transcranial magnetic stimulation - TMS) are repeatedly associated to enhance plasticity in the brain. In the present study, a new cross-modal, visuo-motor PAS protocol - called mirror-PAS- will be tested as a possible non-invasive brain stimulation treatment in neurological rehabilitation to promote motor recovery and pain reduction. Participants will perform the standard PAS targeting the motor system and the recently developed mirror-PAS in two separate sessions. The investigators will compare the possible effect of the protocols in terms of neurophysiological and behavioral outcomes to identify the optimal PAS method to enhance plasticity and promote sensory-motor function.
• age from 18 to 85 years
• single, unilateral, hemispheric stroke (cortical or sub-cortical areas)
• stroke confirmed by neuroimaging (CT or MRI)
• stroke at least 4 months before enrollment
• hemiparesis of the upper limb resulting from stroke or hemianesthesia clinically documented
• age from 18 to 90 years
• amputation of one part of the upper limb at least 2 months before enrollment
• presence of stable phantom limb pain at least 2 months prior to enrollment