title: Optimizing recovery potential through simultaneous occupational therapy and non-invasive brain-stimulation using tDCS.
abstract: OBJECTIVE
  It is thought that following a stroke the contralesional motor region exerts an undue inhibitory influence on the lesional motor region which might limit recovery. Pilot studies have shown that suppressing the contralesional motor region with cathodal transcranial Direct Current Stimulation (tDCS) can induce a short lasting functional benefit; greater and longer lasting effects might be achieved with combining tDCS with simultaneous occupational therapy (OT) and applying this intervention for multiple sessions.
  
  
  METHODS
  We carried out a randomized, double blind, sham controlled study of chronic stroke patients receiving either 5 consecutive days of cathodal tDCS (for 30 minutes) applied to the contralesional motor region and simultaneous OT, or sham tDCS+OT.
  
  
  RESULTS
  we showed that cathodal tDCS+OT resulted in significantly more improvement in Range-Of-Motion in multiple joints of the paretic upper extremity and in the Upper-Extremity Fugl-Meyer scores than sham tDCS+OT, and that the effects lasted at least one week post-stimulation. Improvement in motor outcome scores was correlated with decrease in fMRI activation in the contralesional motor region exposed to cathodal stimulation.
  
  
  CONCLUSIONS
  This suggests that cathodal tDCS combined with OT leads to significant motor improvement after stroke due to a decrease in the inhibitory effect that the contralesional hemisphere exerts onto the lesional hemisphere.
authors: Department of Neurology, Neuroimaging and Stroke Recovery Laboratories, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA 02215, USA.
authors: Dinesh G
authors: DG
authors: Nair
authors: Vijay
authors: V
authors: Renga
authors: Robert
authors: R
authors: Lindenberg
authors: Lin
authors: L
authors: Zhu
authors: Gottfried
authors: G
authors: Schlaug
mesh_terms: D000328:Adult; D000368:Aged; D004311:Double-Blind Method; D004566:Electrodes; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000098:blood supply / Q000502:physiology*; D009788:Occupational Therapy / Q000379:methods*; D010100:Oxygen / Q000097:blood; D016059:Range of Motion, Articular; D020127:Recovery of Function / Q000502:physiology*; D020521:Stroke / Q000503:physiopathology / Q000628:therapy*; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000502:physiology
chemical_list: D010100:Oxygen