Abstract
BackgroundNon-invasive brain stimulation techniques have been shown in several studies to improve the motor recovery of the affected upper-limbs in stroke patients. This study aims to investigate whether or not cathodal transcranial direct current stimulation (c-tDCS), combined with virtual reality (VR), is superior to VR alone in reducing motor impairment and improving upper limb function and quality of life in stroke patients.MethodsForty patients who suffered ischemic stroke between 2 weeks to 12 months were recruited for this single-blind randomized control trial. The patients were randomly assigned either to an experimental group who receiving c-tDCS and VR, or a control group receiving sham stimulation and VR. The cathodal electrode was positioned over the primary motor cortex (M1) of the unaffected hemisphere. The treatment session consisted of 20 min of daily therapy, for 10 sessions over a 2-week period. The outcome measures were the Fugl-Meyer Upper Extremity (FM-UE), the Action Research Arm Test (ARAT) and the Barthel Index (BI).ResultsThe two groups were comparable in demographic characteristic and motor impairment. After 2 weeks of intervention, both groups demonstrated significant improvement in FM-UE, ARAT and BI scores (P<0.05).The experiment group demonstrated more improvement in FM-UE than the control group (10.1 vs. 6.4, p = 0.003) and, ARAT (7.0 vs 3.6, p = 0.026) and BI (12.8 vs 8.5, p = 0.043).ConclusionsThe findings from our study support that c-tDCS, along with VR, can facilitate a stronger beneficial effect on upper limb motor impairment, function and quality of life than VR alone in patients with ischemic stroke.Trial registrationThe study was registered in the Chinese Clinical Trial Registry (ChiCTR1800019386) in November 8, 2018-Retrospectively registered.
Highlights
IntroductionMotor impairment is the most common complication after stroke. Despite rehabilitation, the recovery of the affected upper limb is typically more limited than the affected lower limb [1]
Zimerman et al Observed that the use of c-Transcranial direct current stimulation (tDCS) during training could increase Short Interval Intracortical Inhibition (SICI) in M1 of the contralesional hemisphere, on the contrary, decrease of SICI in M1 of the ipsilesional hemisphere
It was observed that the cathodal transcranial direct current stimulation (c-tDCS) improved the motor function of the hemiplegic hands, suggesting that there was a significant correlation between the improvement of tDCS-induced motor function and the intracortical inhibition induced by c-tDCS [7]
Summary
Motor impairment is the most common complication after stroke. Despite rehabilitation, the recovery of the affected upper limb is typically more limited than the affected lower limb [1]. New therapeutic approaches including non-invasive brain stimulation, functional electrical stimulation, robotic therapies, and virtual reality (VR) have been investigated for stroke rehabilitation [2]. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique which has the capability of modulating motor cortex excitability by the application of weak direct current through the scalp [3]. TDCS has shown great promise in improving motor function during rehabilitative training of patients who have suffered from subacute ischemic stroke in several proof-ofconcept stroke studies [9–11]. Non-invasive brain stimulation techniques have been shown in several studies to improve the motor recovery of the affected upper-limbs in stroke patients. This study aims to investigate whether or not cathodal transcranial direct current stimulation (c-tDCS), combined with virtual reality (VR), is superior to VR alone in reducing motor impairment and improving upper limb function and quality of life in stroke patients
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