Abstract
Background: Upper limb function recovery is of vital importance for stroke patients. However, it is difficult to get ideal recovery, especially for patients with severe chronic stroke. As the first randomized controlled long-term trial combining bilateral transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) therapy, this study examined the efficacy of a novel protocol that included applying tDCS as an add-on treatment prior to FES therapy over the course of a 4-week program.Methods: Thirty subjects with severe chronic stroke were randomized to either Group A (active tDCS+FES) (N = 15) or Group B (sham tDCS+FES) (N = 15). Five assessments including 3 behavioral outcome measurement scales [the Fugl-Meyer scale (cFMA), the Wolf motor function test (WMFT) and the modified Ashworth scale (MAS)], the surface electromyography (sEMG) evaluation and the transcranial magnetic stimulation (TMS) assessment were performed to evaluate subjects before and after the overall therapy.Results: In Group A, the combined protocol was well tolerated by all patients and induced significant improvements in upper extremity motor abilities in terms of the assessments of cFMA [t(14) = −5.658, p < 0.05], WMFT [t(14) = −3.746, p < 0.05], MAS [t(14) = 5.236, p < 0.05], sEMG and TMS. The results of between-group comparisons showed there was a significant difference between Group A and Group B in terms of the assessments of cFMA [t(28) = 2.223, p < 0.05], WMFT [t(28) = −2.152, p < 0.05] and sEMG [F(1, 196) = 0.918, p < 0.05].Conclusion: The proposed protocol can facilitate improvements in upper extremity motor abilities in severe chronic stroke patients and is more beneficial than the protocol with FES therapy alone. Our results showed efficacy of the new paradigm with combined intervention in both the central nervous system and the peripheral nervous system.Trial registration: ChiCTR-ICR-15006108
Highlights
As one of the most devastating neurological conditions, stroke results in approximately 5.5 million deaths annually worldwide (Prentice et al, 2004)
We aimed to examine the long-term efficacy of this combined protocol over upper extremity motor abilities in severe chronic stroke patients
To assess the within-group difference of the combined Fugl-Meyer assessment (cFMA) score, a paired sample t-test between the pre-intervention cFMA scores and the post-intervention cFMA scores was conducted for each group
Summary
As one of the most devastating neurological conditions, stroke results in approximately 5.5 million deaths annually worldwide (Prentice et al, 2004). About 65% of the patients experience upper-limb function impairment after 6 months of the stroke onset (Dobkin, 2005). Upper limb function accounts for approximately 60% of the whole body function, indicating that the self-managing ability and independence of patients after stroke mainly depends on upper limb recovery levels (Veerbeek et al, 2011). Limb motor function recovery usually reaches a plateau 6 months after the onset of the stroke (Stinear, 2010; Stinear et al, 2012). It is important to choose effective evidence-based interventions to further promote the recovery of hand function of chronic stroke patients. Upper limb function recovery is of vital importance for stroke patients. It is difficult to get ideal recovery, especially for patients with severe chronic stroke. As the first randomized controlled long-term trial combining bilateral transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) therapy, this study examined the efficacy of a novel protocol that included applying tDCS as an add-on treatment prior to FES therapy over the course of a 4-week program
Sign-in/Register to view highlights & summary 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 callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
