scholarly journals Effects of Cerebellar Transcranial Direct Current Stimulation on Upper Limb Motor Function After Stroke: Study Protocol for the Pilot of a Randomized Controlled Trial

2021 ◽  
Author(s):  
Akiko Yuasa ◽  
Shintaro Uehara ◽  
Kazuki Ushizawa ◽  
Takamichi Toyama ◽  
Jose Gomez-Tames ◽  
...  
Keyword(s):  
Pilot Study ◽  
Motor Function ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Intensive Training ◽  
Direct Current Stimulation ◽  
Randomized Controlled ◽  
Cerebellar Tdcs ◽  
Motor Improvement

Abstract Background: Transcranial direct current stimulation (tDCS) is a technique that can noninvasively modulate neural states in a targeted brain region. As cerebellar activity levels are associated with upper limb motor improvement after stroke, the cerebellum is a plausible target of tDCS. However, the effect of tDCS remains unclear. Here, we designed a pilot study to assess: 1) the feasibility of a study that aims to examine the effects of cerebellar tDCS combined with an intensive rehabilitation approach based on the concept of constraint-induced movement therapy (CIMT), and 2) the preliminary outcome of the combined approach on upper limb motor function in patients with stroke in the chronic stage.Methods: This pilot study has a double-blind randomized controlled design. Twenty-four chronic stroke patients with mild to moderate levels of upper limb motor impairment will be randomly assigned to an active or sham tDCS group. The participants will receive 20 min of active or sham tDCS to the contralesional cerebellum at the commencement of 4 hours of daily intensive training, repeatedly for 5 days per week for 2 weeks. The primary outcome is upper limb motor function which will be evaluated using the Action Research Arm Test. Secondary outcomes comprise scores of the Fugl-Meyer Assessment for the upper extremity and the Motor Activity Log. Additionally, neurophysiological and neuroanatomical assessments of the cerebellum will be performed using transcranial magnetic stimulation and magnetic resonance imaging. These assessments will be conducted before, at the middle, and after the 2-week intervention, and finally 1 month after the intervention. Any adverse events that occur during the study will be recorded.Discussion: Cerebellar tDCS combined with intensive upper limb training may increase the gains of motor improvement when compared to the sham condition. The present study should provide valuable evidence regarding the feasibility of the design and the efficacy of cerebellar tDCS for upper limb motor function in patients with stroke before a future large trial is conducted.Trial registration: This study has been registered at the Japan Registry of Clinical Trials (jRCTs042200078; https://jrct.niph.go.jp/en-latest-detail/jRCTs042200078). Registered 17 December 2020

scholarly journals Transcranial Direct Current Stimulation (tDCS) in Unilateral Cerebral Palsy: A Pilot Study of Motor Effect

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Emanuela Inguaggiato ◽  
Nadia Bolognini ◽  
Simona Fiori ◽  
Giovanni Cioni
Keyword(s):  
Cerebral Palsy ◽  
Pilot Study ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Primary Motor Cortex ◽  
Controlled Study ◽  
Anodal Tdcs ◽  
Direct Current Stimulation ◽  
Unilateral Cerebral Palsy

Transcranial Direct Current Stimulation (tDCS) is an emerging tool to improve upper limb motor functions after stroke acquired in adulthood; however, there is a paucity of reports on its efficacy for upper limb motor rehabilitation in congenital or early-acquired stroke. In this pilot study we have explored, for the first time, the immediate effects, and their short-term persistence, of a single application of anodal tDCS on chronic upper limb motor disorders in children and young individuals with Unilateral Cerebral Palsy (UCP). To this aim, in a crossover sham-controlled study, eight subjects aged 10-28 years with UCP underwent two sessions of active and sham tDCS. Anodal tDCS (1.5 mA, 20 min) was delivered over the primary motor cortex (M1) of the ipsilesional hemisphere. Results showed, only following the active stimulation, an immediate improvement in unimanual gross motor dexterity of hemiplegic, but not of nonhemiplegic, hand in Box and Block test (BBT). Such improvement remained stable for at least 90 minutes. Performance of both hands in Hand Grip Strength test was not modified by anodal tDCS. Improvement in BBT was unrelated to participants’ age or lesion size, as revealed by MRI data analysis. No serious adverse effects occurred after tDCS; some mild and transient side effects (e.g., headache, tingling, and itchiness) were reported in a limited number of cases. This study provides an innovative contribution to scientific literature on the efficacy and safety of anodal tDCS in UCP. This trial is registered with NCT03137940.

scholarly journals Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Roberto Llorens ◽  
María Antonia Fuentes ◽  
Adrián Borrego ◽  
Jorge Latorre ◽  
Mariano Alcañiz ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Physical Therapy ◽  
Motor Function ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Sensorimotor Function ◽  
Meaningful Improvement ◽  
Direct Current Stimulation ◽  
Post Stroke

Abstract Background Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS). Preliminary studies in mildly impaired individuals in the acute phase post-stroke show intensified effects when action is facilitated by tDCS and mediated by virtual reality (VR) but the effectiveness in cases of severe impairment and chronic stroke is unknown. This study investigated the effectiveness of a combined tDCS and VR-based intervention in the sensorimotor function of chronic individuals post-stroke with persistent severe hemiparesis compared to conventional physical therapy. Methods Twenty-nine participants were randomized into an experimental group, who received 30 minutes of the combined tDCS and VR-based therapy and 30 minutes of conventional physical therapy, or a control group, who exclusively received conventional physical therapy focusing on passive and active assistive range of motion exercises. The sensorimotor function of all participants was assessed before and after 25 one-hour sessions, administered three to five times a week, using the upper extremity subscale of the Fugl-Meyer Assessment, the time and ability subscales of the Wolf Motor Function Test, and the Nottingham Sensory Assessment. Results A clinically meaningful improvement of the upper limb motor function was consistently revealed in all motor measures after the experimental intervention, but not after conventional physical therapy. Similar limited effects were detected in the sensory function in both groups. Conclusion The combined tDCS and VR-based paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy.

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