[PA-2-2] Effects of transcranial direct current stimulation with mirror therapy on motor and daily functions in chronic stroke
Introduction
Transcranial direct current stimulation (tDCS) has been extensively studied to promote functional recovery after stroke. Mirror therapy (MT) is potentially effective in improving paretic arm function for stroke patients, and its effect might be augmented by tDCS. However, it is mostly unknown if the timing of tDCS (concurrently or sequentially with MT) would affect the recovery of motor and daily functions. The purpose of this study was to determine whether a combined-mode intervention of tDCS and MT sequentially or concurrently can lead to enhanced rehabilitation outcomes compared to MT protocol without tDCS in chronic stroke patients. We also aimed to identify which combined mode of intervention is more beneficial to improve motor and daily functions.
Methods
A double-blinded randomized controlled trial was conducted in this study. Twenty-eight individuals with chronic stroke were randomly assigned into three groups: (1) sequentially combined tDCS with MT (SEQ), (2) concurrently combined tDCS with MT (CON), and (3) sham tDCS with MT (SHAM). The protocols comprised 90-minute intervention sessions per day and 5 days per week for 4 weeks. Outcome measures were the Fugl-Meyer Assessment Scale for motor function of the upper extremity and the Nottingham Extended Activities of Daily Living Scale for daily function.
Results
All three groups exhibited significant improvement in motor function from pre-intervention to post-intervention. Significant differences among the three groups were demonstrated in daily function. The daily function of the SEQ and CON groups significantly improved while the SHAM group revealed no significant improvement. Moreover, the SEQ group showed more improvement in daily function compared to the CON and SHAM groups.
Conclusion
Our results support the advantage of tDCS with MT to improve motor and daily functions in chronic stroke patients. Sequentially applying tDCS prior to MT seems to be more beneficial for enhancing the motor function of the upper extremity and daily function. The combined mode of tDCS sequentially with MT to facilitate motor and daily functions should be considered in future clinical applications.
Transcranial direct current stimulation (tDCS) has been extensively studied to promote functional recovery after stroke. Mirror therapy (MT) is potentially effective in improving paretic arm function for stroke patients, and its effect might be augmented by tDCS. However, it is mostly unknown if the timing of tDCS (concurrently or sequentially with MT) would affect the recovery of motor and daily functions. The purpose of this study was to determine whether a combined-mode intervention of tDCS and MT sequentially or concurrently can lead to enhanced rehabilitation outcomes compared to MT protocol without tDCS in chronic stroke patients. We also aimed to identify which combined mode of intervention is more beneficial to improve motor and daily functions.
Methods
A double-blinded randomized controlled trial was conducted in this study. Twenty-eight individuals with chronic stroke were randomly assigned into three groups: (1) sequentially combined tDCS with MT (SEQ), (2) concurrently combined tDCS with MT (CON), and (3) sham tDCS with MT (SHAM). The protocols comprised 90-minute intervention sessions per day and 5 days per week for 4 weeks. Outcome measures were the Fugl-Meyer Assessment Scale for motor function of the upper extremity and the Nottingham Extended Activities of Daily Living Scale for daily function.
Results
All three groups exhibited significant improvement in motor function from pre-intervention to post-intervention. Significant differences among the three groups were demonstrated in daily function. The daily function of the SEQ and CON groups significantly improved while the SHAM group revealed no significant improvement. Moreover, the SEQ group showed more improvement in daily function compared to the CON and SHAM groups.
Conclusion
Our results support the advantage of tDCS with MT to improve motor and daily functions in chronic stroke patients. Sequentially applying tDCS prior to MT seems to be more beneficial for enhancing the motor function of the upper extremity and daily function. The combined mode of tDCS sequentially with MT to facilitate motor and daily functions should be considered in future clinical applications.