Effect of Transcranial Direct Current Stimulation Augmented with Motor Imagery and Upper-Limb Functional Training for Upper-Limb Stroke Rehabilitation: A Prospective Randomized Controlled Trial

Abstract

Background: Combining transcranial direct current stimulation (tDCS) with other therapies is reported to produce promising results in patients with stroke. The purpose of the study was to determine the effect of combining tDCS with motor imagery (MI) and upper-limb functional training for upper-limb rehabilitation among patients with chronic stroke. Methods: A single-center, prospective, randomized controlled trial was conducted among 64 patients with chronic stroke. The control group received sham tDCS with MI, while the experimental group received real tDCS with MI. Both groups performed five different upper-limb functional training exercises coupled with tDCS for 30 min, five times per week for two weeks. Fugl-Meyer’s scale (FMA) and the Action Research Arm Test (ARAT) were used to measure the outcome measures at baseline and after the completion of the 10th session. Results: Analysis of covariance showed significant improvements in the post-test mean scores for FMA (F (414.4) = 35.79, p < 0.001; η2 = 0.37) and ARAT (F (440.09) = 37.46, p < 0.001; η2 = 0.38) in the experimental group compared to the control group while controlling for baseline scores. Conclusions: Anodal tDCS stimulation over the affected primary motor cortex coupled with MI and upper-limb functional training reduces impairment and disability of the upper limbs among patients with chronic stroke.

Transcranial direct current stimulation for upper extremity motor dysfunction in poststroke patients: A systematic review and meta-analysis

“…The included studies 18–61 involved 1555 patients (experimental group: 820, control group: 715) and were published between 2010 and 2024 in 20 countries. The top three countries based on the number of research studies were Italy ( n = 10), China ( n = 9), and the United States ( n = 5).…”

“…Taud et al 53 utilized anodal and bilateral stimulation for the experimental groups, while Qu et al 46 employed 1 and 2 mA of cathodal stimulation for the experimental groups. Fifteen studies 21,22,24–26,29,32,37,38,42,47,50,55,56,61 exclusively utilized anodal stimulation for the experimental group, 19 18–20,23,28,31,34–36,39,41,43,45,51,52,54,57,58,62 exclusively utilized bilateral stimulation for the experimental group, and four 27,40,48,59 exclusively utilized cathodal stimulation for the experimental group (Table 1). Additionally, 39 studies 18–23,26–28,30–40,42…”

“…Approximately 43.2% (n = 19) of the studies applied transcranial direct current stimulation simultaneously with other treatments, and 36.4% (n = 16) applied it prior to other treatments. With the exception of 16 studies, 18,22,24,32,35,37,38,44,46,47,51,52,54,56,59,62 none conducted follow-up assessments from day 3 to month 12 (Table 1). Stimulation parameters: Four studies 30,33,44,49 utilized both anodal and cathodal stimulation for the experimental groups.…”

“…Fifteen studies 21,22,[24][25][26]29,32,37,38,42,47,50,55,56,61 exclusively utilized anodal stimulation for the experimental group, 19 [18][19][20]23,28,31,[34][35][36]39,41,43,45,51,52,54,57,58,62 exclusively utilized bilateral stimulation for the experimental group, and four 27,40,48,59 exclusively utilized cathodal stimulation for the experimental group (Table 1). Additionally, 39 studies [18][19][20][21][22][23][26][27][28][30][31]…”

Effects of neurofeedback training combined with transcranial direct current stimulation on motor imagery: A randomized controlled trial

“…These changes in brain states improve MI performance (Moghadas Tabrizi et al, 2019). In addition, in stroke patients, the combination of MI and tDCS promotes neuroplasticity (Hong et al, 2017) and improves the Fugl-Meyer Assessment score (Chew et al, 2020;Kashoo et al, 2022). While it has been reported that the combinations of MI and NFB as well as MI and tDCS improve MI performance, the effect of combining both NFB and tDCS with MI has not yet been verified, although this combination may provide a new approach to maximizing MI performance.…”