Constraint-Induced Movement Therapy Combined with Transcranial Direct Current Stimulation over Premotor Cortex Improves Motor Function in Severe Stroke: A Pilot Randomized Controlled Trial

Abstract

Objective. We compared the effects of transcranial direct current stimulation at different cortical sites (premotor and motor primary cortex) combined with constraint-induced movement therapy for treatment of stroke patients. Design. Sixty patients were randomly distributed into 3 groups: Group A, anodal stimulation on premotor cortex and constraint-induced movement therapy; Group B, anodal stimulation on primary motor cortex and constraint-induced movement therapy; Group C, sham stimulation and constraint-induced movement therapy. Evaluations involved analysis of functional independence, motor recovery, spasticity, gross motor function, and muscle strength. Results. A significant improvement in primary outcome (functional independence) after treatment in the premotor group followed by primary motor group and sham group was observed. The same pattern of improvement was highlighted among all secondary outcome measures regarding the superior performance of the premotor group over primary motor and sham groups. Conclusions. Premotor cortex can contribute to motor function in patients with severe functional disabilities in early stages of stroke. This study was registered in ClinicalTrials.gov database (NCT 02628561).

Fronto-parietal involvement in chronic stroke motor performance when corticospinal tract integrity is compromised

“…Based on the current study, we hypothesize increased fronto-parietal network connectivity in MEP− stroke survivors would be behaviorally beneficial in those with some residual CST integrity, quantified with FA AI at the level of the cerebral peduncle. There is some preliminary evidence to support the hypothesis that increasing fronto-parietal network connectivity with facilitatory transcranial direct current stimulation to the ipsilesional premotor cortex could benefit motor performance ( Andrade et al, 2017 , Cunningham et al, 2015 ). If upregulation of the ipsilesional fronto-parietal network did promote greater upper-limb behavior, this could suggest a role for interventions such as non-invasive brain stimulation treatments or cognitive strategies to engage the fronto-parietal network during training ( Olesen et al, 2004 , Violante et al, 2017 ).…”

Premotor dorsal white matter integrity for the prediction of upper limb motor impairment after stroke

“…We hypothesized that several sub-pathways within the CST would be associated with motor impairment both in the acute and chronic phase. Specifically, we hypothesized that the integrity of fibres descending from primary motor cortex, premotor dorsal cortex and supplementary motor area would show consistent associations with motor impairments, given their functional role and concurrent activation during the execution of voluntary movements 28 .…”

Contralesional Cathodal Transcranial Direct Current Stimulation Does Not Enhance Upper Limb Function in Subacute Stroke: A Pilot Randomized Clinical Trial

“…Until now, there is limited information about the effects of ctDCSM1 UH during the first weeks after stroke when mechanisms of neuroplasticity are more active. Effective rehabilitation strategies delivered in this early phase are deemed pivotal to enhance recovery [11][12][13][14][15][16][17]. Meta-analyses concluded that ctDCSM1 UH may be beneficial for improvement of upper limb function when delivered in the chronic phase, but not at earlier stages after stroke [8,18].…”