Burke-Cornell Medical Research Institute, White Plains, NY, US.
NeuroRehabilitation. 2013;33(1):49-56. doi: 10.3233/NRE-130927.
Combining tDCS with robotic therapy is a new and promising form of neurorehabilitation after stroke, however the effectiveness of this approach is likely to be influenced by the relative timing of the brain stimulation and the therapy.
To measure the kinematic and neurophysiological effects of delivering tDCS before, during and after a single session of robotic motor practice (wrist extension).
We used a within-subjects repeated-measurement design in 12 chronic (>6 months) stroke survivors. Twenty minutes of anodal tDCS was delivered to the affected hemisphere before, during, or after a 20-minute session of robotic practice. Sham tDCS was also applied during motor practice. Robotic motor performance and corticomotor excitability, assessed through transcranial magnetic stimulation (TMS), were evaluated pre- and post-intervention.
Movement speed was increased after motor training (sham tDCS) by ∼20%. Movement smoothness was improved when tDCS was delivered before motor practice (∼15%). TDCS delivered during practice did not offer any benefit, whereas it reduced speed when delivered after practice (∼10%). MEPs were present in ∼50% of patients at baseline; in these subjects motor practice increased corticomotor excitability to the trained muscle.
In a cohort of stroke survivors, motor performance kinematics improved when tDCS was delivered prior to robotic training, but not when delivered during or after training. The temporal relationship between non-invasive brain stimulation and neurorehabilitation is important in determining the efficacy and outcome of this combined therapy.
经颅直流电刺激（tDCS）与机器人疗法相结合是一种新的、有前途的中风后神经康复形式，然而这种方法的有效性可能受到大脑刺激与治疗的相对时间的影响。
测量在机器人运动练习（腕伸展）单次治疗前后给予 tDCS 的运动学和神经生理学效果。
我们在 12 名慢性（>6 个月）中风幸存者中使用了一种单组内重复测量设计。在机器人练习的 20 分钟期间或之前，对患侧半球给予 20 分钟的阳极 tDCS。在运动练习期间也给予假 tDCS。在干预前后评估通过经颅磁刺激（TMS）评估机器人运动表现和皮质运动兴奋性。
运动训练（假 tDCS）后运动速度增加了约 20%。运动平滑度在 tDCS 在运动练习前给予时得到改善（约 15%）。在练习期间给予的 tDCS 没有提供任何益处，而在练习后给予时会降低速度（约 10%）。在基线时，约有 50%的患者存在 MEP；在这些患者中，运动练习增加了对训练肌肉的皮质运动兴奋性。
在一组中风幸存者中，当 tDCS 在机器人训练之前给予时，运动表现的运动学得到改善，但在训练期间或之后给予时则没有改善。非侵入性脑刺激与神经康复之间的时间关系对于确定这种联合治疗的疗效和结果很重要。
