A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke

Article type: Research Article

Authors: Triccas, L. Tedesco^{a; *} | Burridge, J.H.^a | Hughes, A.^a | Verheyden, G.^b | Desikan, M.^c | Rothwell, J.^c

Affiliations: [a] Faculty of Health Sciences, University of Southampton, Southampton, UK | [b] KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium | [c] Sobell Department of Motor Neuroscience, Institute of Neurology, University College of London, London, UK

Correspondence: [*] Address for correspondence: Lisa Tedesco Triccas, Building 45, Faculty of Health Sciences, University of Southampton, SO17 1BJ Southampton, UK. Tel.: +44 (0) 1603 591686; E-mail: [email protected]

Abstract: BACKGROUND:Neurorehabilitation technologies such as robot therapy (RT) and transcranial Direct Current Stimulation (tDCS) can promote upper limb (UL) motor recovery after stroke. OBJECTIVE:To explore the effect of anodal tDCS with uni-lateral and three-dimensional RT for the impaired UL in people with sub-acute and chronic stroke. METHODS:A pilot randomised controlled trial was conducted. Stroke participants had 18 one-hour sessions of RT (Armeo®Spring) over eight weeks during which they received 20 minutes of either real tDCS or sham tDCS during each session. The primary outcome measure was the Fugl-Meyer assessment (FMA) for UL impairments and secondary were: UL function, activities and stroke impact collected at baseline, post-intervention and three-month follow-up. RESULTS:22 participants (12 sub-acute and 10 chronic) completed the trial. No significant difference was found in FMA between the real and sham tDCS groups at post-intervention and follow-up (p = 0.123). A significant ‘time’ x ‘stage of stroke’ was found for FMA (p = 0.016). A higher percentage improvement was noted in UL function, activities and stroke impact in people with sub-acute compared to chronic stroke. CONCLUSIONS:Adding tDCS did not result in an additional effect on UL impairment in stroke. RT may be of more benefit in the sub-acute than chronic phase.

Keywords: Transcranial direct current stimulation, robot therapy, stroke, rehabilitation, upper limb, motor recovery

DOI: 10.3233/NRE-151251

Journal: NeuroRehabilitation, vol. 37, no. 2, pp. 181-191, 2015