Combined transcranial Direct Current Stimulation and robot-assisted arm training in patients with stroke: a systematic review

2021 ◽  
Vol 39 (6) ◽  
pp. 435-446
Author(s):  
Cristina Fonte ◽  
Valentina Varalta ◽  
Arianna Rocco ◽  
Daniele Munari ◽  
Mirko Filippetti ◽  
...  
Keyword(s):  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Cochrane Library ◽  
Motor Deficits ◽  
Robot Assisted ◽  
Robotic Training ◽  
Direct Current Stimulation ◽  
Robotic Therapy ◽  
Mesh Terms

Background: Upper limb motor deficits in patients with severe stroke often remain unresolved over time. Combining transcranial Direct Current Stimulation with robotic therapy is an innovative neurorehabilitation approach that holds promise to improve upper limb impairment after stroke. Objective: To investigate the effects of robotic training in combination with transcranial Direct Current Stimulation for treating poststroke upper limb impairment. Methods: PubMed, MEDLINE, Cochrane Library, and EMBASE electronic databases were searched using keywords, MeSH terms, and strings: “Stroke”[MeSH] AND (“Upper Extremity”[MeSH] OR “upper limb”) AND (“Transcranial Direct Current Stimulation” [MeSH] OR “tDCS”) AND (“robotics” OR “robotic therapy”). Full-text articles published in English up to October 2020 were included. Each was rated for quality according to the Physiotherapy Database (PEDro) score: eight out of eleven scored more than 8 points; their results were considered reliable for this review. Results: Of the total of 171 publications retrieved, 11 met the inclusion criteria. The results of studies that examined the same outcome measures were pooled to draw conclusions on the effectiveness of transcranial Direct Current Stimulation and robot-assisted training in corticomotor excitability, upper limb kinematics, muscle strength and tone, function, disability, and quality of life after stroke. Conclusions: To date, there is insufficient evidence to support the hypothesis that transcranial Direct Current Stimulation enhances the effects of robot-assisted arm training in poststroke patients. Further studies with more accurate, comparable and standardized methodology are needed in order to better define the effects of robotic training in combination with transcranial Direct Current Stimulation on poststroke upper limb impairment. Therefore, given the scarce resources available to rehabilitation researches, other, more promising approaches should be given attention.

scholarly journals The Combined Use of Transcranial Direct Current Stimulation and Robotic Therapy for the Upper Limb

10.3791/58495 ◽  
2018 ◽  
Author(s):  
Marcus Yu Bin Pai ◽  
Thais Tavares Terranova ◽  
Marcel Simis ◽  
Felipe Fregni ◽  
Linamara Rizzo Battistella
Keyword(s):  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Direct Current Stimulation ◽  
Robotic Therapy ◽  
Combined Use

Cathodal transcranial direct current stimulation of the primary motor cortex improves selective muscle activation in the ipsilateral arm

2011 ◽  
Vol 105 (6) ◽  
pp. 2937-2942 ◽  
Author(s):  
Alana B. McCambridge ◽  
Lynley V. Bradnam ◽  
Cathy M. Stinear ◽  
Winston D. Byblow
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Muscle Activation ◽  
Primary Motor Cortex ◽  
Selectivity Ratio ◽  
Direct Current Stimulation ◽  
Antagonist Muscles ◽  
Stimulation Of

Proximal upper limb muscles are represented bilaterally in primary motor cortex. Goal-directed upper limb movement requires precise control of proximal and distal agonist and antagonist muscles. Failure to suppress antagonist muscles can lead to abnormal movement patterns, such as those commonly experienced in the proximal upper limb after stroke. We examined whether noninvasive brain stimulation of primary motor cortex could be used to improve selective control of the ipsilateral proximal upper limb. Thirteen healthy participants performed isometric left elbow flexion by contracting biceps brachii (BB; agonist) and left forearm pronation (BB antagonist) before and after 20 min of cathodal transcranial direct current stimulation (c-tDCS) or sham tDCS of left M1. During the tasks, motor evoked potentials (MEPs) in left BB were acquired using single-pulse transcranial magnetic stimulation of right M1 150–270 ms before muscle contraction. As expected, left BB MEPs were facilitated before flexion and suppressed before pronation. After c-tDCS, left BB MEP amplitudes were reduced compared with sham stimulation, before pronation but not flexion, indicating that c-tDCS enhanced selective muscle activation of the ipsilateral BB in a task-specific manner. The potential for c-tDCS to improve BB antagonist control correlated with BB MEP amplitude for pronation relative to flexion, expressed as a selectivity ratio. This is the first demonstration that selective muscle activation in the proximal upper limb can be improved after c-tDCS of ipsilateral M1 and that the benefits of c-tDCS for selective muscle activation may be most effective in cases where activation strategies are already suboptimal. These findings may have relevance for the use of tDCS in rehabilitation after stroke.

Transcranial direct current stimulation for motor recovery of upper limb function after stroke

2014 ◽  
Vol 47 ◽  
pp. 245-259 ◽  
Author(s):  
Jitka Lüdemann-Podubecká ◽  
Kathrin Bösl ◽  
Sandra Rothhardt ◽  
Geert Verheyden ◽  
Dennis Alexander Nowak
Keyword(s):  
Upper Limb ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Motor Recovery ◽  
Limb Function ◽  
Direct Current Stimulation ◽  
Upper Limb Function

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.

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