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 η2 [ηp2]=.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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: June 24, 2017
Footnotes
Supported by the Ministry of Science and Technology (grant no. NSC 101-2314-B-002-194-MY3), Taiwan.
Clinical Trial Registration No.: NCT01847157.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
