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

Abstract

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.

Literature Review on the Effects of tDCS Coupled with Robotic Therapy in Post Stroke Upper Limb Rehabilitation

“…The analysis of the literature presented in this paper has strengthened the efficacy of RT in stroke rehabilitation (Lo et al, 2010; Hesse et al, 2011; Ochi et al, 2013; Klamroth-Marganska et al, 2014; Triccas et al, 2015; Straudi et al, 2016). …”

“…The eight retrieved journal studies are Hesse et al (2007), Hesse et al (2011), Giacobbe et al (2013), Ochi et al (2013), Ang et al (2015), Triccas et al (2015), Powell et al (2016), and Straudi et al (2016). …”

“…The number of patients in the groups treated with real tDCS ranged from a minimum of 4 (Powell et al, 2016) to a maximum of 32 (Hesse et al, 2011) for a total of 148 patients; the control group has been used by Hesse et al (2011) (32 patients), Triccas et al (2015) (11 patients), Ang et al (2015) (9 patients), Straudi et al (2016) (11 patients). More details on the enrolled patients and the experimental groups are reported in Tables 1A,B.…”

“…Five different robotic devices have been used for delivering therapy across the analyzed studies: the RehaStim BiManu Track, used in three studies (Hesse et al, 2007, 2011; Ochi et al, 2013), the InMotion3 adopted in one study (Giacobbe et al, 2013), the InMotion 2 employed in two studies (Ang et al, 2015; Powell et al, 2016) the Armeo®Spring used by Triccas et al (2015), and the REO Therapy System, Motorika, LTD, Israel used in Straudi et al (2016). …”

“…The other three works, Hesse et al (2011), Triccas et al (2015), and Straudi et al (2016) performed randomized controlled trials with a larger sample of patients. However, they have shown that the adjunct of tDCS to RT only lead to small significant changes in FMS adjusting statistical analysis for the lesion site (cortical vs. subcortical), the timing from the stroke onset (chronic vs. subacute) and the type of stroke (ischemic vs. hemorrhagic) (Tables 2A–C).…”