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

Chia-Lin Koh; Jau-Hong Lin; Jiann-Shing Jeng; Sheau-Ling Huang; Ching-Lin Hsieh

doi:10.1016/j.apmr.2017.05.025

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

Arch Phys Med Rehabil. 2017 Dec;98(12):2477-2484. doi: 10.1016/j.apmr.2017.05.025. Epub 2017 Jun 24.

Authors

Chia-Lin Koh¹, Jau-Hong Lin², Jiann-Shing Jeng³, Sheau-Ling Huang⁴, Ching-Lin Hsieh⁵

Affiliations

¹ School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
² 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.
³ Department of Neurology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
⁴ School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: cathy@ntu.edu.tw.
⁵ School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.

PMID: 28652065
DOI: 10.1016/j.apmr.2017.05.025

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 [η_p²]=.14, P=.07) and moderate long-term effects (3-mo follow-up: η_p²=.17, P=.05; 6-mo follow-up: η_p²=.12, P=.10). Compared with the control group, the tDCS-SM group had a trend of a small immediate effect (η_p²=.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 (η_p²=.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.

Trial registration: ClinicalTrials.gov NCT01847157.

Keywords: Anesthetics; Recovery of function; Rehabilitation; Stroke; Transcranial direct current stimulation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living
Adult
Aged
Chronic Disease
Double-Blind Method
Female
Humans
Male
Middle Aged
Paralysis / rehabilitation*
Recovery of Function
Stroke Rehabilitation / methods*
Transcranial Direct Current Stimulation / methods*
Upper Extremity

Associated data

ClinicalTrials.gov/NCT01847157