Abstract
In this study, we investigated the effects of dual-hemisphere transcranial direct current stimulation (dual-tDCS) of both the affected (anodal tDCS) and non-affected (cathodal tDCS) primary motor cortex, combined with peripheral neuromuscular electrical stimulation (PNMES), on the effectiveness of constraint-induced movement therapy (CIMT) as a neurorehabilitation intervention in chronic stroke. We conducted a randomized controlled trial of feasibility, with a single blind assessor, with patients recruited from three outpatient clinics. Twenty chronic stroke patients were randomly allocated to the control group, receiving conventional CIMT, or the intervention group receiving dual-tDCS combined with PNMES before CIMT. Patients in the treatment group first underwent a 20-min period of dual-tDCS, followed immediately by PNMES, and subsequent CIMT for 2 h. Patients in the control group only received CIMT (with no pretreatment stimulation). All patients underwent two CIMT sessions, one in the morning and one in the afternoon, each lasting 2 h, for a total of 4 h of CIMT per day. Upper extremity function was assessed using the Fugl-Meyer Assessment (primary outcome), as well as the amount of use (AOU) and quality of movement (QOM) scores, obtained via the Motor Activity Log (secondary outcome). Nineteen patients completed the study, with one patient withdrawing after allocation. Compared to the control group, the treatment improvement in upper extremity function and AOU was significantly greater in the treatment than control group (change in upper extremity score, 9.20 ± 4.64 versus 4.56 ± 2.60, respectively, P < 0.01, η2 = 0.43; change in AOU score, 1.10 ± 0.65 versus 0.62 ± 0.85, respectively, P = 0.02, η2 = 0.52). There was no significant effect of the intervention on the QOM between the intervention and control groups (change in QOM score, 1.00 ± 0.62 versus 0.71 ± 0.72, respectively, P = 0.07, η2 = 0.43; treatment versus control). Our findings suggest a novel pretreatment stimulation strategy based on dual-tDCS and PNMES may enhance the therapeutic benefit of CIMT.
Highlights
15–30% of stroke survivors experience longlasting upper extremity hemiparesis [1], with poststroke motor deficits of the upper extremity being a serious clinical concern
Our present findings indicate that, compared with patients who undergo behavioral and motor treatment alone, those who undergo behavioral and motor treatment after receiving dual-tDCS and peripheral neuromuscular electrical stimulation (PNMES) recovered motor function (FMA upper extremity) and real-world (AOU in Motor Activity Log (MAL)) to a greater extent than
On the Fugl-Meyer Assessment (FMA) upper extremity scale, the improvement was 4.64 points higher in the treatment than in the control group, and this between-group difference was above the threshold for a clinically meaningful change. These findings suggest that behavioral motor treatment, combined with tDCS and PNMES, can provide meaningful improvement in upper limb function chronic stroke patients
Summary
15–30% of stroke survivors experience longlasting upper extremity hemiparesis [1], with poststroke motor deficits of the upper extremity being a serious clinical concern. Treatments for upper extremity motor deficits are a critical component of stroke rehabilitation. In the 1980s, Taub et al developed constraint-induced movement therapy (CIMT) as an intensive treatment for upper extremity motor deficit in chronic stroke patients [2]. CIMT consists of task-oriented training for the affected upper extremity and a “transfer package” representing a behavioral method for enhancing adherence to treatment. Many previous studies have confirmed the effectiveness of CIMT for improving upper extremity function in chronic stroke patients [2,3,4]. CIMT has been recommended by several guidelines for the improvement of the affected upper extremity function in chronic stroke patients [5, 6]. The plasticity of the primary motor cortex is important for the improvement in upper extremity motor function
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