Investigating the Efficacy of Combining Virtual Reality-Based Mirror Therapy and tDCS to Improve Upper Limb Recovery in Patients with Stroke

Ahmad Alokaily, Rahaf Altowairqi, Alaa Albishi, Fahad Alsubaie, Saja Alhadlaq, Mohammed Alotaibi, Lahbib Soualmi, Nehal Almodarra, Abdullah Alotaibi, Manal alosimi, Saad Alrafiah
Purpose:

To investigate whether combining VRMT with tDCS alongside conventional physical therapy (CPT) will lead to a significant improvement in hand function for patients with stroke compared to using VRMT alone.

Methods:

A randomized control trial was conducted among 21 adult patients with chronic stroke. Participants were randomly assigned to two groups: tDCS combined with VRMT (n = 11) and VRMT with Sham tDCS (n = 10). The VRMT group received game-based training using a Leap Motion tracker with their non-affected upper limb. Each session lasted approximately 45 minutes and comprised six games, each lasting 6 minutes with 90 seconds of rest between each game. The anodal tDCS with a continuous, direct current of 2 mA was used during the sessions for 20 minutes. All groups received CPT for 45 minutes as part of the treatment. Functional scales were used before and after the intervention to assess upper motor functions. These measures include the Fugl-Meyer Assessment, Wolf Motor Function Test, Box and Block Test, the Nine-Hole Pegboard Test, and Stroke Impact Scale-16 (SIS-16). In addition, physiological measures such as transcranial magnetic stimulation (TMS) and task-based fMRI were obtained from several subjects to assess the brain changes associated with these interventions.

Results:

Both groups have shown significant improvements post-interventions in all functional outcome measures (p = 0.001). However, no significant differences were found between the two groups except for SIS-16. The tDCS+VRMT group showed greater improvement in the SIS-16 scale compared to VRMT with sham tDCS (p = 0.030). Meanwhile, differences in brain activation patterns and cortical excitability were found between the samples of the two groups.

Conclusion(s):

Combining tDCS with VRMT might have slightly additive potential benefits in improving upper limb functions in patients with stroke compared to using VRMT alone.

Implications:

tDCS might play a significant role in increasing neuroplasticity when it is combined with physical therapy interventions.

Funding acknowledgements:
تم دعم هذا البحث الوارد بواسطة [ المعهد الوطني لأبحاث الصحة] بموجب المشروع رقم [SNIH-RO-HRT01-2302-KSU-36532664]
Keywords:
Virtual Reality, Mirror Therapy
Transcranial Direct Current Stimulation
Stroke
Primary topic:
Neurology: stroke
Second topic:
Neurology
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
institutional review board, Sub-Committee for Health Sciences Colleges on Human Subjects. King Saud University, Riyadh.
Provide the ethics approval number:
E-23-7496
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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