Effects of cerebellar transcranial direct current stimulation on rehabilitation of upper limb motor function after stroke

Abstract

BackgroundThe cerebellum is involved in the control and coordination of movements but it remains unclear whether stimulation of the cerebellum could improve the recovery of upper limb motor function. Therefore, this study aimed to explore whether cerebellar transcranial direct current stimulation (tDCS) therapy could promote the recovery of upper limb motor function in patients who suffered a stroke.MethodsIn this randomized, double-blind, and sham-controlled prospective study, 77 stroke patients were recruited and randomly assigned to the tDCS group (n = 39) or the control group (n = 38). The patients received anodal (2 mA, 20 min) or sham tDCS therapy for 4 weeks. The primary outcome was the change in the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) score from baseline to the first day after 4 weeks of treatment (T1) and 60 days after 4 weeks of treatment (T2). The secondary outcomes were the FMA-UE response rates assessed at T1 and T2. Adverse events (AEs) related to the tDCS treatment were also recorded.ResultsAt T1, the mean FMA-UE score increased by 10.7 points [standard error of the mean (SEM) = 1.4] in the tDCS group and by 5.8 points (SEM = 1.3) in the control group (difference between the two groups was 4.9 points, P = 0.013). At T2, the mean FMA-UE score increased by 18.9 points (SEM = 2.1) in the tDCS group and by 12.7 points (SEM = 2.1) in the control group (the difference between the two groups was 6.2 points, P = 0.043). At T1, 26 (70.3%) patients in the tDCS group had a clinically meaningful response to the FMA-UE score compared to 12 (34.3%) patients in the control group (the difference between the two groups was 36.0%, P =0.002). At T2, 33 (89.2%) patients in the tDCS group had a clinically meaningful response to the FMA-UE score compared with 19 (54.3%) patients in the control group (the difference between the two groups was 34.9%, P = 0.001). There was no statistically significant difference in the incidence of adverse events between the two groups. In the subgroup analysis of different hemiplegic sides, the rehabilitation effect of patients with right hemiplegia was better than that of patients with left hemiplegia (P < 0.05); in the age subgroup analysis, different age groups of patients did not show a significant difference in the rehabilitation effect (P > 0.05).ConclusionCerebellar tDCS can be used as an effective and safe treatment to promote recovery of upper limb motor function in stroke patients.Trial registrationChiCTR.org.cn, identifier: ChiCTR2200061838.

Effects of Cerebellar Non-Invasive Stimulation on Neurorehabilitation in Stroke Patients: An Updated Systematic Review

“…The review included twenty-one randomized controlled trials (RCTs) and one pilot study [ 35 ]. Among the RCTs, fifteen were parallel-design [ 29 , 30 , 31 , 32 , 34 , 36 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 ], while six were crossover-design [ 33 , 48 , 49 , 50 , 51 , 52 ]. Except for the pilot study, all RCT experiments utilized random assignment and allocation concealment.…”

“…Except for the pilot study, all RCT experiments utilized random assignment and allocation concealment. Fifteen RCTs blinded both participants and outcome assessors [ 29 , 30 , 32 , 33 , 34 , 36 , 39 , 40 , 41 , 43 , 44 , 46 , 47 , 48 , 51 ], while two RCTs, focusing on aphagia, were single-blinded examiner studies [ 27 , 33 ]. In two studies, blinding was applied to participants, but the blinding status of the outcome assessors was not mentioned in the articles [ 49 , 52 ].…”

“…The pilot study focusing on aphasia did not employ blinding [ 35 ]. In terms of attrition bias, six studies reported no dropouts [ 35 , 39 , 42 , 48 , 49 , 50 ], eleven studies had dropouts below 10% [ 29 , 30 , 32 , 33 , 34 , 40 , 41 , 44 , 45 , 46 , 47 ], and five studies had dropouts exceeding 10% [ 31 , 36 , 43 , 51 , 52 ].…”

“…The number of participants randomized in each individual trial ranged from 16 to 143. With the exception of three studies (two focusing on gait and one on dysarthria) that included subjects with infratentorial infarcts [ 31 , 39 , 50 ]; all other studies included patients with supratentorial infarcts [ 29 , 30 , 32 , 33 , 34 , 35 , 36 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 51 , 52 ]. All post-stroke aphasia (PSA) patients included in the current review were right-handed patients with left hemispheric infarcts [ 35 , 48 , 51 ].…”

“…All post-stroke aphasia (PSA) patients included in the current review were right-handed patients with left hemispheric infarcts [ 35 , 48 , 51 ]. Eight studies were conducted in the acute to early subacute stroke phase (0–3 months) [ 29 , 30 , 31 , 32 , 39 , 41 , 43 , 45 ], thirteen studies were conducted in the chronic phase (>3 months) [ 33 , 34 , 35 , 40 , 42 , 44 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ], and one study did not specify the timing of cerebellar NIBS treatment [ 36 ]. In total, fourteen studies examined the effects of cerebellar NIBS on motor recovery following stroke, focusing on gait and balance, muscle spasticity, and hand function.…”