Early non-invasive brain stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in stroke patients: Study protocol

2020 ◽  
Vol 83 (8) ◽  
pp. 523-529
Author(s):  
Maricel A Garrido ◽  
Evelyn A Άlvarez ◽  
Fabrizio L Acevedo ◽  
Álvaro I Moyano ◽  
Natalia P Castillo ◽  
...  
Keyword(s):  
Upper Limb ◽  
Functional Recovery ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Movement Therapy ◽  
Functional Independence ◽  
Stroke Patients ◽  
Direct Current Stimulation ◽  
Constraint Induced Movement Therapy ◽  
Subacute Stroke

Introduction Upper limb motor impairment after a stroke is an important sequela. Constraint-induced movement therapy is a rehabilitation approach that has strong evidence. The incorporation of transcranial direct-current stimulation has been proposed; however, there is a lack of studies that confirm its benefits. The principal aim is to compare the effectiveness of 7 days of active versus sham bi-hemispheric transcranial direct-current stimulation, combined with modified constraint-induced movement therapy, for motor and functional recovery of the hemiparetic upper limb in subacute stroke patients. Method/design Randomized, double blind, sham-controlled, parallel group clinical trial in two stroke units. Participants: adults over 18 years, at least 2 days post unihemispheric stroke event, with hemiparesis, and without severe pain, aphasia or cognitive impairment. Intervention: Patients will receive 7 days of continuous therapy and be assigned to one of the treatment groups: active bi-hemispheric transcranial direct-current stimulation or sham bi-hemispheric transcranial direct-current stimulation. Measurement: Evaluations will take place at days 0, 5, 7 and 10, and at 3rd months. The Fugl-Meyer Assessment – Upper Extremity, Wolf Motor Function Test, Functional Independence Measure and Stroke Impact Scale are considered. Discussion Modified constraint-induced movement therapy plus transcranial direct-current stimulation in subacute stroke patients with hemiparesis could maximize motor and functional recovery. Trial registration: ClinicalTrials.gov identifier NCT03452254.

scholarly journals Constraint-Induced Movement Therapy Combined with Transcranial Direct Current Stimulation over Premotor Cortex Improves Motor Function in Severe Stroke: A Pilot Randomized Controlled Trial

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Suellen M. Andrade ◽  
Larissa M. Batista ◽  
Lídia L. R. F. Nogueira ◽  
Eliane A. de Oliveira ◽  
Antonio G. C. de Carvalho ◽  
...  
Keyword(s):  
Motor Function ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Therapy Group ◽  
Premotor Cortex ◽  
Movement Therapy ◽  
Functional Independence ◽  
Direct Current Stimulation ◽  
Constraint Induced Movement Therapy ◽  
Anodal Stimulation

Objective.We compared the effects of transcranial direct current stimulation at different cortical sites (premotor and motor primary cortex) combined with constraint-induced movement therapy for treatment of stroke patients.Design.Sixty patients were randomly distributed into 3 groups: Group A, anodal stimulation on premotor cortex and constraint-induced movement therapy; Group B, anodal stimulation on primary motor cortex and constraint-induced movement therapy; Group C, sham stimulation and constraint-induced movement therapy. Evaluations involved analysis of functional independence, motor recovery, spasticity, gross motor function, and muscle strength.Results.A significant improvement in primary outcome (functional independence) after treatment in the premotor group followed by primary motor group and sham group was observed. The same pattern of improvement was highlighted among all secondary outcome measures regarding the superior performance of the premotor group over primary motor and sham groups.Conclusions.Premotor cortex can contribute to motor function in patients with severe functional disabilities in early stages of stroke. This study was registered in ClinicalTrials.gov database (NCT 02628561).

scholarly journals Different Therapeutic Effects of Transcranial Direct Current Stimulation on Upper and Lower Limb Recovery of Stroke Patients with Motor Dysfunction: A Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-13 ◽  
Author(s):  
Xi Bai ◽  
Zhiwei Guo ◽  
Lin He ◽  
Long Ren ◽  
Morgan A. McClure ◽  
...  
Keyword(s):  
Upper Limb ◽  
Direct Current ◽  
Effect Size ◽  
Transcranial Direct Current Stimulation ◽  
Lower Limb ◽  
Meta Analysis ◽  
Motor Dysfunction ◽  
Stroke Patients ◽  
Direct Current Stimulation ◽  
Subacute Stroke

Objective. To explore the effects of transcranial direct current stimulation (tDCS) on the motor recovery of stroke patients and the effect differences between the upper limb and lower limb. Methods. Randomized control trials published until January 2019 were searched from PubMed, Embase, ScienceDirect, and Cochrane Library databases. The standardized mean difference (SMD) with 95% confidence interval (CI) was estimated separately for upper and lower limb motor outcomes to understand the mean effect size. Results. Twenty-nine studies with 664 subjects were included in this meta-analysis. The overall analyses of tDCS demonstrated significant effect size both for the upper limb (SMD=0.26, P=0.002) and the lower limb (SMD=0.47, P=0.002). Compared with acute and subacute stroke patients, chronic stroke patients obtained significant effects after tDCS (SMD=0.25, P=0.03) in upper limb function. Furthermore, both anode and cathode stimulations produced significant effect size for stroke patients after ≤10 sessions of tDCS (anode: SMD=0.40, P=0.001; cathode: SMD=0.79, P<0.0001) with >0.029 mA/cm2 of density (anode: SMD=0.46, P=0.002; cathode: SMD=0.79, P<0.0001). But for lower limb function, more prominent effects were found in subacute stroke patients (SMD=0.56, P=0.001) with bilateral tDCS (SMD=0.59, p=0.009). Conclusion. tDCS is effective for the recovery of stroke patients with motor dysfunction. In addition, upper limb and lower limb functions obtain distinct effects from different therapeutic parameters of tDCS at different stages, respectively.

scholarly journals The Effects of Transcranial Direct Current Stimulation on Balance and Gait in Stroke Patients: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Ke Dong ◽  
Shifeng Meng ◽  
Ziqi Guo ◽  
Rufang Zhang ◽  
Panpan Xu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Meta Analysis ◽  
Functional Independence ◽  
Berg Balance Scale ◽  
Cochrane Central Register ◽  
Stroke Patients ◽  
Timed Up And Go ◽  
Direct Current Stimulation

Objective: Balance dysfunction after stroke often results in individuals unable to maintain normal posture, limits the recovery of gait and functional independence. We explore the short-term effects of transcranial direct current stimulation (tDCS) on improving balance function and gait in stroke patients.Methods: We systematically searched on PubMed, Web of Science, EMBASE, Cochrane Central Register of Controlled Trials, and Google Scholar for studies that explored the effects of tDCS on balance after stroke until August 2020. All involved studies used at least one measurement of balance, gait, or postural control as the outcome.Results: A total of 145 studies were found, of which 10 (n = 246) met the inclusion criteria and included in our studies. The present meta-analysis showed that active tDCS have beneficial effects on timed up and go test (TUGT) [mean difference (MD): 0.35; 95% confidence interval (CI): 0.11 to 0.58] and Functional Ambulation Category (FAC) (MD: −2.54; 95% CI: −3.93 to −1.15) in stroke patients. However, the results were not significant on the berg balance scale (BBS) (MD: −0.20; 95% CI: −1.44 to 1.04), lower extremity subscale of Fugl-Meyer Assessment (FMA-LE) (MD: −0.43; 95% CI: −1.70 to 0.84), 10-m walk test (10 MWT) (MD: −0.93; 95% CI: −2.68 to 0.82) and 6-min walking test (6 MWT) (MD: −2.55; 95% CI: −18.34 to 13.23).Conclusions: In conclusion, we revealed that tDCS might be an effective option for restoring walking independence and functional ambulation for stroke patients in our systematic review and meta-analysis.Systematic Review Registration: CRD42020207565.

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