tDCS and Robotics on Upper Limb Stroke Rehabilitation: Effect Modification by Stroke Duration and Type of Stroke.
Objective. The aim of this exploratory pilot study is to test the effects of bilateral tDCS combined with upper extremity robot-assisted therapy (RAT) on stroke survivors. Methods. We enrolled 23 subjects who were allocated to 2 groups: RAT + real tDCS and RAT + sham-tDCS. Each patient underwent 10 sessions (5 sessions/week) over two weeks. Outcome measures were collected before and after treatment: (i) Fugl-Meyer Assessment-Upper Extremity (FMA-UE), (ii) Box and Block Test (BBT), and (iii) Motor Activity Log (MAL). Results. Both groups reported a significant improvement in FMA-UE score after treatment (p < 0.01). No significant between-groups differences were found in motor function. However, when the analysis was adjusted for stroke type and duration, a significant interaction effect (p < 0.05) was detected, showing that stroke duration (acute versus chronic) and type (cortical versus subcortical) modify the effect of tDCS and robotics on motor function. Patients with chronic and subcortical stroke benefited more from the treatments than patients with acute and cortical stroke, who presented very small changes. Conclusion. The additional use of bilateral tDCS to RAT seems to have a significant beneficial effect depending on the duration and type of stroke. These results should be verified by additional confirmatory studies.
Neuroscience and Rehabilitation Department, Ferrara University Hospital, 44100 Ferrara, Italy.
Sofia
S
Straudi
Center of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA 02129, USA.
Felipe
F
Fregni
Neuroscience and Rehabilitation Department, Ferrara University Hospital, 44100 Ferrara, Italy.
Carlotta
C
Martinuzzi
Neuroscience and Rehabilitation Department, Ferrara University Hospital, 44100 Ferrara, Italy.
Claudia
C
Pavarelli
School of Physiotherapy, University of Ferrara, 44100 Ferrara, Italy.
Stefano
S
Salvioli
Neuroscience and Rehabilitation Department, Ferrara University Hospital, 44100 Ferrara, Italy.
Nino
N
Basaglia
D001132:Arm / Q000503:physiopathology*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012371:Robotics / Q000379:methods*; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D013997:Time Factors; D065908:Transcranial Direct Current Stimulation / Q000009:adverse effects / Q000379:methods*