title: Using clinical and robotic assessment tools to examine the feasibility of pairing tDCS with upper extremity physical therapy in patients with stroke and TBI: a consideration-of-concept pilot study.
abstract: BACKGROUND
  Transcranial direct current stimulation (tDCS) may provide a safe, non-invasive technique for modulating neural excitability during neurorehabilitation.
  
  
  OBJECTIVE
  1) Assess feasibility and potential effectiveness of tDCS as an adjunct to standard upper extremity (UE) physical therapy (PT) for motor impairments resulting from neurological insult. 2) Determine sustainability of improvements over a six month period.
  
  
  METHODS
  Five participants with chronic neurologic insult (stroke or traumatic brain injury > 6 months prior) completed 24 sessions (40 minutes, three times/week) of UE-PT combined with bihemispheric tDCS delivered at 1.5 mA over the motor cortex during the first 15 minutes of each PT session. Outcomes were assessed using clinical (UE Fugl-Meyer, Purdue Pegboard, Box and Block, Stroke Impact Scale) and robotic (unimanual and bimanual motor control) measures. Change in scores and associated effects sizes from Pre-test to Post-test and a six month Follow-up were calculated for each participant and group as a whole.
  
  
  RESULTS
  Scores on UE Fugl-Meyer, Box and Block, Purdue Pegboard, Stroke Impact Scale, and robotic measures improved from Pre- to Post-test. Improvements on UE Fugl-Meyer, Box and Block, and robotic measures were largely sustained at six months.
  
  
  CONCLUSIONS
  Combining bihemispheric tDCS with UE-PT in individuals with neurological insult warrants further investigation.
authors.affiliation: University of South Carolina, Department of Exercise Science, Division of Rehabilitation Sciences, Columbia, SC, USA.
authors.forename: Addie
authors.initials: A
authors.lastname: Middleton
authors.affiliation: University of South Carolina, Department of Exercise Science, Division of Rehabilitation Sciences, Columbia, SC, USA.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Fritz
authors.affiliation: University of South Carolina, Department of Exercise Science, Division of Rehabilitation Sciences, Columbia, SC, USA.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Liuzzo
authors.affiliation: University of South Carolina, Department of Exercise Science, Division of Rehabilitation Sciences, Columbia, SC, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Newman-Norlund
authors.affiliation: University of South Carolina, Department of Exercise Science, Division of Rehabilitation Sciences, Columbia, SC, USA.
authors.forename: Troy M
authors.initials: TM
authors.lastname: Herter
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D026741:Physical Therapy Modalities / Q000009:adverse effects*; D010865:Pilot Projects; D020127:Recovery of Function; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D000071939:Stroke Rehabilitation; D065908:Transcranial Direct Current Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D034941:Upper Extremity / Q000502:physiology*
keywords: TBI; rehabilitation; stroke; tDCS; upper extremity