title: The impact of transcranial direct current stimulation (tDCS) combined with modified constraint-induced movement therapy (mCIMT) on upper limb function in chronic stroke: a double-blind randomized controlled trial.
abstract: OBJECTIVE
  This pilot double-blind sham-controlled randomized trial aimed to determine if the addition of anodal tDCS on the affected hemisphere or cathodal tDCS on unaffected hemisphere to modified constraint-induced movement therapy (mCIMT) would be superior to constraints therapy alone in improving upper limb function in chronic stroke patients.
  
  
  METHODS
  Twenty-one patients with chronic stroke were randomly assigned to receive 12 sessions of either (i) anodal, (ii) cathodal or (iii) sham tDCS combined with mCIMT. Fugl-Meyer assessment (FMA), motor activity log scale (MAL), and handgrip strength were analyzed before, immediately, and 1 month (follow-up) after the treatment. Minimal clinically important difference (mCID) was defined as an increase of ≥5.25 in the upper limb FMA.
  
  
  RESULTS
  An increase in the FMA scores between the baseline and post-intervention and follow-up for active tDCS group was observed, whereas no difference was observed in the sham group. At post-intervention and follow-up, when compared with the sham group, only the anodal tDCS group achieved an improvement in the FMA scores. ANOVA showed that all groups demonstrated similar improvement over time for MAL and handgrip strength. In the active tDCS groups, 7/7 (anodal tDCS) 5/7 (cathodal tDCS) of patients experienced mCID against 3/7 in the sham group.
  
  
  CONCLUSIONS
  The results support the merit of association of mCIMT with brain stimulation to augment clinical gains in rehabilitation after stroke. However, the anodal tDCS seems to have greater impact than the cathodal tDCS in increasing the mCIMT effects on motor function of chronic stroke patients.
  
  
  CONCLUSIONS
  The association of mCIMT with brain stimulation improves clinical gains in rehabilitation after stroke. The improvement in motor recovery (assessed by Fugl-Meyer scale) was only observed after anodal tDCS. The modulation of damaged hemisphere demonstrated greater improvements than the modulation of unaffected hemispheres.
authors.affiliation: a Department of Physical Therapy , Applied Neuroscience Laboratory, Universidade Federal de Pernambuco , Recife , Brazil.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Rocha
authors.affiliation: a Department of Physical Therapy , Applied Neuroscience Laboratory, Universidade Federal de Pernambuco , Recife , Brazil.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Silva
authors.affiliation: a Department of Physical Therapy , Applied Neuroscience Laboratory, Universidade Federal de Pernambuco , Recife , Brazil.
authors.forename: Águida
authors.initials: Á
authors.lastname: Foerster
authors.affiliation: a Department of Physical Therapy , Applied Neuroscience Laboratory, Universidade Federal de Pernambuco , Recife , Brazil.
authors.forename: Carine
authors.initials: C
authors.lastname: Wiesiolek
authors.affiliation: a Department of Physical Therapy , Applied Neuroscience Laboratory, Universidade Federal de Pernambuco , Recife , Brazil.
authors.forename: Anna Paula
authors.initials: AP
authors.lastname: Chagas
authors.affiliation: a Department of Physical Therapy , Applied Neuroscience Laboratory, Universidade Federal de Pernambuco , Recife , Brazil.
authors.forename: Giselle
authors.initials: G
authors.lastname: Machado
authors.affiliation: a Department of Physical Therapy , Applied Neuroscience Laboratory, Universidade Federal de Pernambuco , Recife , Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Baltar
authors.affiliation: a Department of Physical Therapy , Applied Neuroscience Laboratory, Universidade Federal de Pernambuco , Recife , Brazil.
authors.forename: Katia
authors.initials: K
authors.lastname: Monte-Silva
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D000071939:Stroke Rehabilitation; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D034941:Upper Extremity / Q000503:physiopathology*
keywords: Constraint-induced movement therapy; interhemispheric competition; stroke; transcranial direct current stimulation; upper limb