Effects of the addition of transcranial direct current stimulation to virtual reality therapy after stroke: a pilot randomized controlled trial.
BACKGROUND
Upper limb (UL) impairment is the most common disabling deficit following a stroke. Previous studies have suggested that transcranial direct current stimulation (tDCS) enhances the effect of conventional therapies.


OBJECTIVE
This pilot double-blind randomized control trial aimed to determine whether or not tDCS, combined with Wii virtual reality therapy (VRT), would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals.


METHODS
Twenty participants were randomly assigned either to an experimental group that received VRT and tDCS, or a control group that received VRT and sham tDCS. The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS, and one hour of virtual reality therapy. The outcomes included were determined using the Fugl-Meyer scale, the Wolf motor function test, the modified Ashworth scale (MAS), grip strength, and the stroke specific quality of life scale (SSQOL). Minimal clinically important differences (MCID) were observed when assessing outcome data.


RESULTS
Both groups demonstrated gains in all evaluated areas, except for the SSQOL-UL domain. Differences between groups were only observed in wrist spasticity levels in the experimental group, where more than 50% of the participants achieved the MCID.


CONCLUSIONS
These findings support that tDCS, combined with VRT therapy, should be investigated and clarified further.
Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
R T
RT
Viana
Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
G E C
GE
Laurentino
Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
R J P
RJ
Souza
Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
J B
JB
Fonseca
Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
E M
EM
Silva Filho
Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
S N
SN
Dias
Department of Physical Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
L F
LF
Teixeira-Salmela
Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
K K
KK
Monte-Silva
D000203:Activities of Daily Living; D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000534:rehabilitation; D010865:Pilot Projects; D011788:Quality of Life; D020127:Recovery of Function / Q000502:physiology; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D034941:Upper Extremity; D063367:Virtual Reality Exposure Therapy
Virtual reality therapy; non-invasive brain stimulation; rehabilitation; stroke; transcranial stimulation; wii gaming system