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Effects of Transcranial Direct Current Stimulation With Sensory Modulation on Stroke Motor Rehabilitation: A Randomized Controlled Trial

  • Chia-Lin Koh
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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  • Jau-Hong Lin
    Affiliations
    Department of Physical Therapy, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan

    Department and Graduate Institute of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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  • Jiann-Shing Jeng
    Affiliations
    Department of Neurology, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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  • Sheau-Ling Huang
    Correspondence
    Corresponding author Sheau-Ling Huang, MS, School of Occupational Therapy, College of Medicine, National Taiwan University, Rm 420, F4, No.17, Xuzhou Rd, Zhongzheng Dist, Taipei City 100, Taiwan.
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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  • Ching-Lin Hsieh
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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      Abstract

      Objective

      To test whether a multistrategy intervention enhanced recovery immediately and longitudinally in patients with severe to moderate upper extremity (UE) paresis.

      Design

      Double-blind, randomized controlled trial with placebo control.

      Setting

      Outpatient department of a local medical center.

      Participants

      People (N=25) with chronic stroke were randomly assigned to 1 of 2 groups: a transcranial direct current stimulation with sensory modulation (tDCS-SM) group (n=14; mean age ± SD, 55.3±11.4y) or a control group (n=11; mean age ± SD, 56.9±13.5y).

      Interventions

      Eight-week intervention. The tDCS-SM group received bilateral tDCS, bilateral cutaneous anesthesia, and high repetitions of passive movements on the paretic hand. The control group received the same passive movements but with sham tDCS and sham anesthesia. During the experiment, all participants continued their regular rehabilitation.

      Main Outcome Measures

      Voluntary UE movement, spasticity, UE function, and basic activities of daily living. Outcomes were assessed at baseline, at postintervention, and at 3- and 6-month follow-ups.

      Results

      No significant differences were found between groups. However, there was a trend that the voluntary UE movement improved more in the tDCS-SM group than in the control group, with a moderate immediate effect (partial η2p2]=.14, P=.07) and moderate long-term effects (3-mo follow-up: ηp2=.17, P=.05; 6-mo follow-up: ηp2=.12, P=.10). Compared with the control group, the tDCS-SM group had a trend of a small immediate effect (ηp2=.02–.04) on reducing spasticity, but no long-term effect. A trend of small immediate and long-term effects in favor of tDCS-SM was found on UE function and daily function recovery (ηp2=.02–.09).

      Conclusions

      Accompanied with traditional rehabilitation, tDCS-SM had a nonsignificant trend of having immediate and longitudinal effects on voluntary UE movement recovery in patients with severe to moderate UE paresis after stroke, but its effects on spasticity reduction and functional recovery may be limited.

      Keywords

      List of abbreviations:

      ANCOVA (analysis of covariance), ARAT (Action Research Arm Test), BI (Barthel Index), FMA-UE (Fugl-Meyer Motor Assessment–Upper Extremity), MAS (Modified Ashworth Scale), NNT (number needed to treat), tDCS (transcranial direct current stimulation), tDCS-SM (tDCS with sensory modulation), UE (upper extremity)
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