Kubota M1, Matsumura M1, Matsuo H1, Mae Y1, Hamazuka Y1, Shimada S1, Takahashi A2, Yamaguchi T3, Ikawa M4, Matsumine A2
1Fukui University Hospital, Division of Physical Therapy and Rehabilitation, Eiheiji, Fukui, Japan, 2Faculty of Medical Sciences, University of Fukui, Department of Orthopaedics and Rehabilitation Medicine, Fukui, Japan, 3Faculty of Medical Sciences, University of Fukui, Division of Promotion of Community Medicine, Fukui, Japan, 4Faculty of Medical Sciences, University of Fukui, Second Department of Internal Medicine (Neurology), Fukui, Japan
Background: The efficacy of rehabilitation interventions to facilitate recovery in severe acute stroke patients remains controversial. Although Non-invasive brain stimulation with transcranial direct current stimulation (tDCS) modulates cortical excitability, the effects for stroke patients in acute phase are still debatable. Functional electrical stimulation therapy (FES) with upper extremity training also might be an efficacious intervention in the rehabilitation of reaching and grasping function for stroke patients. Both tDCS and FES therapy have been regarded as promising techniques for stroke rehabilitation, a combination of them may induce significant improvements compared with either one alone. However, the long-term efficacy of combining both therapies for severe acute stroke patients, to our knowledge, has never been investigated.
Purpose: We investigated the effect of combined bilateral tDCS and FES on motor recovery of hands performance in the acute/subacute phase after stroke.
Methods: Subjects were three acute stroke patients who had severe upper limb paralysis (Brunnstrom recovery stage 1 or 2). A multiple baseline single case design was used, and baseline phase was more than five days after onset to reduce the impact of unpredictable improvement or worsening. After baseline assessment, they completed 10-day sessions of tDCS combined FES for two weeks. Bilateral tDCS was performed at 2.0mA for 20 minutes. The anodal electrode was positioned in the primary motor cortex area in the contralateral affected hemisphere according to the International classification system of EEG electrodes placement. And cathodal electrode was positioned in the primary motor cortex area in the ipsilateral affected hemisphere. At the same time of tDCS, patients received FES training for 20 minutes. The electrodes were positioned over the extensor digitorum or flexor digitorum superficialis muscle. Patients was instructed to add volitional movement as much as feasible during electrical stimulation on time. Electrical stimulation was set as 40Hz and 200µsec pulse width. The training session following brain stimulation was that conventionally performed as part of inpatient daily rehabilitation of upper limb. Blinded evaluator assessed upper limb motor impairment and global functional state with the Fugl-Meyer Assessment Score after daily rehabilitation. To evaluate upper limb functional abilities or activities of daily living, we applied box and block test, Stroke Impairment Assessment Set (SIAS) and functional independent measure (FIM). This protocol was approved by the local independent ethics committee.
Results: All of three patients, Fugel-Meyer Assessment Score of intervention phase became better improvement compared with each patient baseline phase. Also box and block test and SIAS upper motor function was improved after intervention phase.
Conclusion(s): This single case multiple baseline design indicated that combined bilateral tDCS and FES might be effective for patients with severe acute stroke patients.
Implications: Combined bilateral tDCS and FES might be effective to facilitate motor recovery in severe acute stroke patients.
Keywords: stroke, transcranial direct current stimulation, Functional electrical stimulation
Funding acknowledgements: This work was supported by JSPS KAKENHI Grant Number J160000908.
Purpose: We investigated the effect of combined bilateral tDCS and FES on motor recovery of hands performance in the acute/subacute phase after stroke.
Methods: Subjects were three acute stroke patients who had severe upper limb paralysis (Brunnstrom recovery stage 1 or 2). A multiple baseline single case design was used, and baseline phase was more than five days after onset to reduce the impact of unpredictable improvement or worsening. After baseline assessment, they completed 10-day sessions of tDCS combined FES for two weeks. Bilateral tDCS was performed at 2.0mA for 20 minutes. The anodal electrode was positioned in the primary motor cortex area in the contralateral affected hemisphere according to the International classification system of EEG electrodes placement. And cathodal electrode was positioned in the primary motor cortex area in the ipsilateral affected hemisphere. At the same time of tDCS, patients received FES training for 20 minutes. The electrodes were positioned over the extensor digitorum or flexor digitorum superficialis muscle. Patients was instructed to add volitional movement as much as feasible during electrical stimulation on time. Electrical stimulation was set as 40Hz and 200µsec pulse width. The training session following brain stimulation was that conventionally performed as part of inpatient daily rehabilitation of upper limb. Blinded evaluator assessed upper limb motor impairment and global functional state with the Fugl-Meyer Assessment Score after daily rehabilitation. To evaluate upper limb functional abilities or activities of daily living, we applied box and block test, Stroke Impairment Assessment Set (SIAS) and functional independent measure (FIM). This protocol was approved by the local independent ethics committee.
Results: All of three patients, Fugel-Meyer Assessment Score of intervention phase became better improvement compared with each patient baseline phase. Also box and block test and SIAS upper motor function was improved after intervention phase.
Conclusion(s): This single case multiple baseline design indicated that combined bilateral tDCS and FES might be effective for patients with severe acute stroke patients.
Implications: Combined bilateral tDCS and FES might be effective to facilitate motor recovery in severe acute stroke patients.
Keywords: stroke, transcranial direct current stimulation, Functional electrical stimulation
Funding acknowledgements: This work was supported by JSPS KAKENHI Grant Number J160000908.
Topic: Neurology: stroke; Electrophysical & isothermal agents; Neurology
Ethics approval required: Yes
Institution: University of Fukui
Ethics committee: the Ethics Review Board
Ethics number: 20138018
All authors, affiliations and abstracts have been published as submitted.
