To evaluate the effect of Transcranial direct current stimulation (tDCS) modulation with modified constraint induced movement therapy (mCIMT) in improving affected upper-limb motor recovery and M1 excitability for patients with stroke.
A randomized control trial was conducted among 21 adult patients with stroke. After performing a baseline assessment, the participants were randomly assigned to two groups: the tDCS + mCIMT group (n = 14), and the sham tDCS + mCIMT group (n = 7). All groups received home program as part of the intervention. Inclusion Criteria: adult participants clinically diagnosed and confirmed by imaging of ischemic or hemorrhagic cerebrovascular accident, participant’s age older than 18 years, stroke onset more than 3 months with unilateral motor deficits, Adequate cognitive function is required to follow instructions. The Arabic version of the Mini Mental State Examination (MMSE) should be ≥24, with 10° of active extension to the metacarpophalangeal and interphalangeal joints and 20° at the wrist, and not participating in other clinical or research studies at the same time. Exclusion Criteria: severe muscle spasticity at the affected limb at all joints (the Modified Ashworth Scale scores > 3), contraindications to NIBS, unilateral neglect, other neurologic or orthopedic conditions that may affect hand function, and unstable medical conditions. The total intervention period was performed 3 times a week for 4 weeks. Each participant underwent motor impairment and biophysiological assessments at baseline, during, and after the intervention. Functional outcome measures: Fugl-Meyer Assessment Scale-upper extremity (FMA-UE), Wolf Motor Function Test (WMFT), Nine-Hole Peg Test (NHPT), Arabic version of Stroke Impact Scale (SIS-16), and Motor Activity Log (MAL). Physiological outcome measures: Cortical Excitability Assessment was measured by Transcranial Magnetic Stimulation (TMS) with electromyographic (EMG); task-based functional magnetic resonance imaging (fMRI) was used to assess brain activity that’s associated with hand movement.
A repeated measure ANOVA showed that both groups demonstrated statistically significant improvement over time in FMA, WMFT, MAL, and hand function domain SIS within the group (0.001). However, no significant differences were found between the two groups. In addition, there was no statistically significant overall difference within group in NHPT over time. At the same time, differences in brain activation patterns and cortical excitability were found between the samples of the two groups.
Combining tDCS with mCIMT might have additive potential benefits in improving upper limb recovery in patients with stroke compared to using mCIMT alone.
- Combining tDCS with neurorehabilitation interventions might boost responses of the brain to the interventions and maximize the effects of rehabilitation to improve upper limb function after stroke.
- Learn more about the way the brain controls movement, information that may be helpful to better understand the treatment of patients with stroke
transcranial direct current stimulation
stroke
