Combination transcranial direct current stimulation and virtual reality therapy for upper extremity training in patients with subacute stroke.
OBJECTIVE
To investigate the effects of combination cathodal transcranial direct current stimulation (tDCS) and virtual reality (VR) therapy for upper extremity (UE) training in patients with subacute stroke.


METHODS
Pilot randomized controlled trial. Patients were randomly assigned to 1 of 3 groups: group A received cathodal tDCS, group B received VR, and group C received combination therapy (cathodal tDCS was simultaneously applied during VR therapy).


METHODS
University hospital.


METHODS
Patients (N=59) with impaired unilateral UE motor function after stroke.


METHODS
Fifteen sessions of treatment over a 3-week period.


METHODS
The Modified Ashworth Scale, manual muscle test (MMT), Manual Function Test (MFT), Fugl-Meyer Scale (FMS), and Box and Block Test were used to assess UE function. To evaluate activities of daily living, the Korean-Modified Barthel Index (K-MBI) was used. All outcomes were measured before and immediately after treatment.


RESULTS
After treatment, all groups demonstrated significant improvements in MMT, MFT, FMS, and K-MBI scores. The change in MFT and FMS scores was different between the 3 groups. Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups.


CONCLUSIONS
In the present pilot study, the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone. This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke.
Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan Ulsan Regional Cardiocerebrovascular Center, Dong-A University Hospital, Busan, Republic of Korea.
Sook Joung
SJ
Lee
Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address: mhchun@amc.seoul.kr.
Min Ho
MH
Chun
D000203:Activities of Daily Living; D000368:Aged; D003198:Computer Simulation; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020127:Recovery of Function; D056910:Republic of Korea; D000071939:Stroke Rehabilitation; D034941:Upper Extremity; D014584:User-Computer Interface
Combined modality therapy; Rehabilitation; Stroke; Virtual reality exposure therapy