Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, 259 Wen-hwa 1st Road, Taoyuan City, Taiwan.
Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan.
J Neuroeng Rehabil. 2020 Jul 20;17(1):101. doi: 10.1186/s12984-020-00722-1.
The timing of transcranial direct current stimulation (tDCS) with neurorehabilitation interventions may affect its modulatory effects. Motor function has been reported to be modulated by the timing of tDCS; however, whether the timing of tDCS would also affect restoration of daily function and upper extremity motor control with neurorehabilitation in stroke patients remains largely unexplored. Mirror therapy (MT) is a potentially effective neurorehabilitation approach for improving paretic arm function in stroke patients. This study aimed to determine whether the timing of tDCS with MT would influence treatment effects on daily function, motor function and motor control in individuals with chronic stroke.
This study was a double-blinded randomized controlled trial. Twenty-eight individuals with chronic stroke received one of the following three interventions: (1) sequentially combined tDCS with MT (SEQ), (2) concurrently combined tDCS with MT (CON), and (3) sham tDCS with MT (SHAM). Participants received interventions for 90 min/day, 5 days/week for 4 weeks. Daily function was assessed using the Nottingham Extended Activities of Daily Living Scale. Upper extremity motor function was assessed using the Fugl-Meyer Assessment Scale. Upper extremity motor control was evaluated using movement kinematic assessments.
There were significant differences in daily function between the three groups. The SEQ group had greater improvement in daily function than the CON and SHAM groups. Kinematic analyses showed that movement time of the paretic hand significantly reduced in the SEQ group after interventions. All three groups had significant improvement in motor function from pre-intervention to post-intervention.
The timing of tDCS with MT may influence restoration of daily function and movement efficiency of the paretic hand in chronic stroke patients. Sequentially applying tDCS prior to MT seems to be advantageous for enhancing daily function and hand movement control, and may be considered as a potentially useful strategy in future clinical application.
ClinicalTrials.gov Identifier: NCT02827864 . Registered on 29th June, 2016.
经颅直流电刺激（tDCS）与神经康复干预的时间可能会影响其调节作用。已有研究报道 tDCS 的时间可调节运动功能；但是，tDCS 的时间是否也会影响脑卒中患者神经康复后的日常功能和上肢运动控制的恢复，目前仍知之甚少。镜像治疗（MT）是一种改善脑卒中患者患侧上肢功能的有效神经康复方法。本研究旨在确定 MT 联合 tDCS 的时间是否会影响慢性脑卒中患者的日常功能、运动功能和运动控制的治疗效果。
这是一项双盲随机对照试验。28 名慢性脑卒中患者接受以下三种干预措施之一：（1）经颅直流电刺激与镜像治疗序贯联合（SEQ），（2）经颅直流电刺激与镜像治疗同时联合（CON），和（3）假经颅直流电刺激与镜像治疗（SHAM）。患者每天接受干预 90 分钟，每周 5 天，共 4 周。采用诺丁汉扩展日常生活活动量表评估日常功能。采用 Fugl-Meyer 评估量表评估上肢运动功能。采用运动运动学评估评估上肢运动控制。
三组间日常功能存在显著差异。SEQ 组的日常功能改善程度大于 CON 组和 SHAM 组。运动学分析表明，干预后 SEQ 组患手的运动时间明显缩短。三组患者上肢运动功能均较干预前显著改善。
MT 联合 tDCS 的时间可能会影响慢性脑卒中患者日常功能和患手运动效率的恢复。MT 前序贯应用 tDCS 似乎有利于增强日常功能和手部运动控制，可考虑作为未来临床应用的一种潜在有用策略。
ClinicalTrials.gov 标识符：NCT02827864。注册于 2016 年 6 月 29 日。
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