Abstract
BackgroundThe timing of transcranial direct current stimulation (tDCS) with neurorehabilitation interventions may affect its modulatory effects. Motor function has been reported to be modulated by the timing of tDCS; however, whether the timing of tDCS would also affect restoration of daily function and upper extremity motor control with neurorehabilitation in stroke patients remains largely unexplored. Mirror therapy (MT) is a potentially effective neurorehabilitation approach for improving paretic arm function in stroke patients. This study aimed to determine whether the timing of tDCS with MT would influence treatment effects on daily function, motor function and motor control in individuals with chronic stroke.MethodsThis study was a double-blinded randomized controlled trial. Twenty-eight individuals with chronic stroke received one of the following three interventions: (1) sequentially combined tDCS with MT (SEQ), (2) concurrently combined tDCS with MT (CON), and (3) sham tDCS with MT (SHAM). Participants received interventions for 90 min/day, 5 days/week for 4 weeks. Daily function was assessed using the Nottingham Extended Activities of Daily Living Scale. Upper extremity motor function was assessed using the Fugl-Meyer Assessment Scale. Upper extremity motor control was evaluated using movement kinematic assessments.ResultsThere were significant differences in daily function between the three groups. The SEQ group had greater improvement in daily function than the CON and SHAM groups. Kinematic analyses showed that movement time of the paretic hand significantly reduced in the SEQ group after interventions. All three groups had significant improvement in motor function from pre-intervention to post-intervention.ConclusionThe timing of tDCS with MT may influence restoration of daily function and movement efficiency of the paretic hand in chronic stroke patients. Sequentially applying tDCS prior to MT seems to be advantageous for enhancing daily function and hand movement control, and may be considered as a potentially useful strategy in future clinical application.Trial registrationClinicalTrials.gov Identifier: NCT02827864. Registered on 29th June, 2016.
Highlights
Stroke remains one of the leading causes of long-term disability [1]
Applying transcranial direct current stimulation (tDCS) prior to Mirror therapy (MT) seems to be advantageous for enhancing daily function and hand movement control, and may be considered as a potentially useful strategy in future clinical application
We found greater improvements in overall activities of daily living (ADL)/instrumental ADL (IADL) function in the sequentially combined tDCS with MT (SEQ) group compared to the combined tDCS with MT (CON) and sham tDCS with MT (SHAM) groups, indicating that the timing of tDCS may affect restoration of basic and complex ADL abilities for independent living in the community
Summary
Stroke remains one of the leading causes of long-term disability [1]. Most stroke patients have difficulties performing every day activities due to paresis of upper limbs, which results in impaired activities of daily living (ADL) and reduced quality of life [2, 3]. Noninvasive brain simulation aims to maximize brain plasticity by externally applying electrical stimulation to modulate cortical excitability [7]. Since these two types of approaches individually have been shown to improve stroke recovery, it has been proposed that a synergistic approach that combines both of them may further augment overall treatment effects [8, 9]. Motor function has been reported to be modulated by the timing of tDCS; whether the timing of tDCS would affect restoration of daily function and upper extremity motor control with neurorehabilitation in stroke patients remains largely unexplored. This study aimed to determine whether the timing of tDCS with MT would influence treatment effects on daily function, motor function and motor control in individuals with chronic stroke
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