Abstract
Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that may enhance motor recovery after stroke. We performed a systematic review and meta-analysis to assess the efficacy of tDCS combined with rehabilitation on arm and hand function after stroke. Electronic databases were searched from their inception to September 2021. We performed a systematic review of selected randomized controlled trials, and methodological qualities were measured using the PEDro (Physiotherapy Evidence Database) scale. We calculated the standardized mean difference for effect size using the Comprehensive Meta-Analysis 3.0 software. We selected 28 studies for the systematic review and 20 studies for the meta-analysis. The overall effect size was 0.480 (95% CI [0.307; 0.653], p < 0.05), indicating a moderate effect size of tDCS combined with rehabilitation for upper extremity function in stroke survivors. The tDCS with occupational therapy/physical therapy (0.696; 95% CI [0.390; 1.003], p < 0.05) or virtual reality therapy (0.510; 95% CI [0.111; 0.909], p < 0.05) was also significantly more effective than other treatments. This meta-analysis of 20 randomized controlled trials provides further evidence that tDCS combined with rehabilitation, especially occupational therapy/physical therapy and virtual reality therapy, may benefit upper extremity function of the paretic upper limb in stroke patients.
Highlights
Non-invasive brain stimulation techniques, such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation, have been used in recent years to enhance neural plasticity, and to improve motor function in the context of post-stroke rehabilitation [1]
The inclusion criteria for the studies are as follows: (1) a randomized control trial (RCT) or pilot-RCT study design; (2) a patient population of adults >18 years old who had experienced any type of stroke; (3) anodal, cathodal, and dual Transcranial direct current stimulation (tDCS) combined with therapeutic interventions that were related to rehabilitation such as occupational therapy, physical therapy, robot-assisted therapy, virtual reality therapy, and constraint-induced movement therapy; and (4) outcome measures that were classified as functional ability or recovery of the upper extremity measured by a validated specific assessment technique, such as the Action Research Arm Test [9] or FuglMeyer Assessment [10]
A: anodal transcranial direct current stimulation, C: cathodal transcranial direct current stimulation, D: dual transcranial direct current stimulation, mA: milliampere. In this meta-analysis, we examined 20 studies comparing the effects of tDCS combined with rehabilitation to those of sham tDCS with rehabilitation or rehabilitation only in stroke patients
Summary
Non-invasive brain stimulation techniques, such as repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have been used in recent years to enhance neural plasticity, and to improve motor function in the context of post-stroke rehabilitation [1]. Recent studies on the application of tDCS combined with rehabilitation have shown positive results regarding arm and hand recovery in stroke patients. These results indicate that tDCS combined with rehabilitation can maximize the effects of rehabilitation training by removing the imbalance in transcallosal inhibition after subcortical stroke [5]. No meta-analysis has previously assessed the efficacy of combination therapy for stroke patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
