Timing-dependent effects of transcranial direct current stimulation with mirror therapy on daily function and motor control in chronic stroke: a randomized controlled pilot study

Wan-Wen Liao, Wei-Chi Chiang, Keh-Chung Lin, Ching-Yi Wu, Chien-Ting Liu, Yu-Wei Hsieh, Yun-Chung Lin, Chia-Ling Chen, Wan-Wen Liao, Wei-Chi Chiang, Keh-Chung Lin, Ching-Yi Wu, Chien-Ting Liu, Yu-Wei Hsieh, Yun-Chung Lin, Chia-Ling Chen

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Trial registration: ClinicalTrials.gov Identifier: NCT02827864 . Registered on 29th June, 2016.

Keywords: Activities of daily living; Mirror therapy; Stroke; Timing-dependent effect; Transcranial direct current stimulation; Upper extremity kinematics.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The CONSORT flow diagram
Fig. 2
Fig. 2
Experimental flow of the three intervention groups. Note: a-tDCS, anodal tDCS; MT, mirror therapy; tDCS, transcranial direct current stimulation
Fig. 3
Fig. 3
Changes of NEADL, FMA and index MT in the three intervention groups. Note: NEADL, Nottingham Extended Activities of Daily Living scale; FMA, Fugl-Meyer Assessment scale of Upper Extremity; MT, movement time (seconds). Data is presented as mean ± standard error. SEQ, Sequential group; CON, Concurrent group; SHAM, Sham group

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