scholarly journals Transcranial electrostimulation with special waveforms enhances upper-limb motor function in patients with chronic stroke: a pilot randomized controlled trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Shih-Ching Chen ◽  
Ling-Yu Yang ◽  
Muhammad Adeel ◽  
Chien-Hung Lai ◽  
Chih-Wei Peng
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Controlled Trial ◽  
Rehabilitation Program ◽  
Chronic Stroke ◽  
Therapeutic Effects ◽  
The Real ◽  
Therapeutic Benefits ◽  
Transcranial Electrostimulation

Abstract Background Transcranial direct current stimulation (tDCS) and intermittent theta burst stimulation (iTBS) were both demonstrated to have therapeutic potentials to rapidly induce neuroplastic effects in various rehabilitation training regimens. Recently, we developed a novel transcranial electrostimulation device that can flexibly output an electrical current with combined tDCS and iTBS waveforms. However, limited studies have determined the therapeutic effects of this special waveform combination on clinical rehabilitation. Herein, we investigated brain stimulation effects of tDCS-iTBS on upper-limb motor function in chronic stroke patients. Methods Twenty-four subjects with a chronic stroke were randomly assigned to a real non-invasive brain stimulation (NIBS; who received the real tDCS + iTBS output) group or a sham NIBS (who received sham tDCS + iTBS output) group. All subjects underwent 18 treatment sessions of 1 h of a conventional rehabilitation program (3 days a week for 6 weeks), where a 20-min NIBS intervention was simultaneously applied during conventional rehabilitation. Outcome measures were assessed before and immediately after the intervention period: Fugl-Meyer Assessment-Upper Extremity (FMA-UE), Jebsen-Taylor Hand Function Test (JTT), and Finger-to-Nose Test (FNT). Results Both groups showed improvements in FMA-UE, JTT, and FNT scores after the 6-week rehabilitation program. Notably, the real NIBS group had greater improvements in the JTT (p = 0. 016) and FNT (p = 0. 037) scores than the sham NIBS group, as determined by the Mann–Whitney rank-sum test. Conclusions Patients who underwent the combined ipsilesional tDCS-iTBS stimulation with conventional rehabilitation exhibited greater impacts than did patients who underwent sham stimulation-conventional rehabilitation in statistically significant clinical responses of the total JTT time and FNT after the stroke. Preliminary results of upper-limb functional recovery suggest that tDCS-iTBS combined with a conventional rehabilitation intervention may be a promising strategy to enhance therapeutic benefits in future clinical settings. Trial registration: ClinicalTrials.gov Identifier: NCT04369235. Registered on 30 April 2020.

scholarly journals Effectiveness of the addition of rhythmic or discrete aiming movements training of the upper limbs on motor function and participation after stroke: protocol of a randomized controlled trial

2019 ◽  
Author(s):  
Renata Morales Banjai ◽  
Leonardo Oliveira Pena Costa ◽  
Sandra Maria Sbeghen Freitas ◽  
Vivian Farahte Giangiardi ◽  
Maria Liliane da Silva ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Motor Function ◽  
Upper Limb ◽  
Controlled Trial ◽  
Chronic Stroke ◽  
Upper Limbs ◽  
Discrete Movements ◽  
Randomized Controlled ◽  
Movement Training ◽  
Usual Therapy

Abstract Background Upper limb disabilities after a stroke compromise the activities of daily living. Several approaches to improve motor control and reduce disability are proposed, including specific unilateral training of the contralesional limb or bilateral training with appropriate equipment and/or robotic assistance. These approaches can be used with rhythmic or discrete movements along with usual therapy, but the most effective approach has never been determined. The objective of this study will be to verify the effect of training with rhythmic or discrete movements in conjunction with the usual therapy on motor function and participation regarding the patients’ upper limbs after chronic stroke. Methods/Design This is a 3-arm, assessor-blinded, randomized controlled trial. Seventy-five patients with chronic stroke (> 6 months) and upper limb paresis will be included. Participants will be randomly allocated into 3 groups: 1) discrete movement training and usual therapy (n = 25), 2) rhythmic movement training and usual therapy (n = 25) and 3) a control group, (n = 25) which will only receive the usual therapy. A five-week intervention period (10 sessions) with two sessions per week will be carried out. Outcome measures include participation, activity and motor function measured by the Stroke Impact Scale (SIS), Motor Activity Log (MAL) and Fugl-Meyer Scale, respectively; other measures are aiming movement performance, grip strength and spasticity, which will be obtained at follow-up assessments 5 weeks and 3 months after randomization. Discussion The results of this trial can support allied health professionals’ decision-making processes in the treatment of motor impairment and disability after chronic stroke and reduce this condition’s health-related costs.

Abstract T P123: Non-invasive Brain Stimulation for Motor Function of Chronic Stroke Patients

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Eunhee Park ◽  
Tae Gun Kwon ◽  
Won Hyuk Chang ◽  
Yun-Hee Kim
Keyword(s):  
Motor Function ◽  
Brain Stimulation ◽  
Movement Time ◽  
Motor Task ◽  
Chronic Stroke ◽  
Stroke Patients ◽  
Dual Mode ◽  
Simultaneous Application ◽  
Corticomotor Excitability ◽  
Cathodal Tdcs

Objective: The purpose of this study was to investigate the effect of dual-mode noninvasive brain stimulation (NBS) by combining transcranial direct current stimulation (tDCS) over the unaffected primary motor cortex (uM1) and high-frequency repetitive transcranial magnetic stimulation (rTMS) over the affected M1 (aM1) on motor functions and corticomotor excitability in chronic stroke patients. Methods: Seventeen chronic stroke patients (12 men; mean age 58.7 years; 12 infarctions and 5 hemorrhages) participated in this double blinded random-order crossover study. All participants received three randomly arranged, dual-mode stimulations with 24 hours of washout period; Condition 1, simultaneous application of 10 Hz rTMS over the aM1 and cathodal tDCS over the uM1; Condition 2, simultaneous application of 10 Hz rTMS over the M1a and anodal tDCS over the uM1; Condition 3, 10 Hz rTMS over the aM1 and sham tDCS over the uM1. Corticomotor excitability using motor evoked potential (MEP) amplitude and hand motor functions using the sequential motor task were assessed before and after stimulation. Results: MEP amplitude was significantly increased after condition 1 and 3, respectively (p<0.05). The changes of MEP amplitude were significantly higher in condition 1 than condition 2 (p<0.05). In sequential motor task, the movement time was significantly decreased after condition 1 and 3, respectively (p<0.05). The change of movement time was significantly larger in condition 1 than the other conditions (p<0.05). Conclusions: Simultaneous stimulation of cathodal tDCS over the uM1 produced enhancement of 10 Hz rTMS effect over the aM1 in patients with stroke. These results suggest the dual-mode NBS as a method of enhancing motor function probably by inducing interhemispheric interaction of bilateral primary motor cortices in chronic stroke patients (Supported by the National Research Foundation of Korea grant (No.2011-0016960) and a KOSEF grant (M10644000022-06N4400-02210)).

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