Non-Invasive Brain Stimulation Improves Paretic Limb Force Production: A Systematic Review and Meta-Analysis.
Non-invasive brain stimulation (NIBS) facilitates motor improvements post stroke. Transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) are representative NIBS techniques frequently used in stroke motor rehabilitation. Our primary question is: Do these two techniques improve force production capability in paretic limbs?



The current systematic review and meta-analysis investigated the effects of tDCS and rTMS on paretic limb force production in stroke survivors.



Our comprehensive search identified 23 studies that reported changes in force production following tDCS or rTMS interventions. Each used random assignment and a sham control group. The 23 qualified studies in our meta-analysis generated 29 comparisons: 14 tDCS and 15 rTMS comparisons.



Random effects models indicated improvements in paretic limb force after tDCS and rTMS rehabilitation. We found positive effects on force production in the two sets of stimulation protocols: (a) increasing cortical activity in the ipsilesional hemisphere and (b) decreasing cortical activity in the contralesional hemisphere. Moreover, across acute, subacute, and chronic phases, tDCS and rTMS improved force production.



Cumulative meta-analytic results revealed that tDCS and rTMS rehabilitation protocols successfully improved paretic limb force production capabilities.
Laboratory for Rehabilitation Neuroscience, University of Florida, Gainesville, Florida, USA; Motor Behavior Laboratory, University of Florida, Gainesville, Florida, USA.
Nyeonju
N
Kang
Human Motor Control Laboratory, University of Tasmania, Hobart, Tasmania, Australia; Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK.
Jeffery J
JJ
Summers
Motor Behavior Laboratory, University of Florida, Gainesville, Florida, USA. Electronic address: cauraugh@ufl.edu.
James H
JH
Cauraugh
D001921:Brain / Q000503:physiopathology; D006801:Humans; D010291:Paresis / Q000503:physiopathology / Q000534:rehabilitation*; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation / Q000379:methods*; D065908:Transcranial Direct Current Stimulation; D050781:Transcranial Magnetic Stimulation
Force production; Meta-analysis; Repetitive transcranial magnetic stimulation (rTMS); Stroke; Systematic review; Transcranial direct current stimulation (tDCS)