Effects of transcranial direct current stimulation on the rehabilitation of painful shoulder following a stroke: protocol for a randomized, controlled, double-blind, clinical trial

Abstract

BackgroundShoulder pain is reported to be one of the major challenges faced in the functional recovery of patients in rehabilitation following a stroke. In such cases, transcranial direct current stimulation (tDCS) has been used as an additional therapeutic tool for improvements in central and peripheral pain. The aim of the proposed study is to evaluate the effect of tDCS when combined with upper limb physical therapy on pain intensity and functional improvement in stroke survivors with shoulder pain in the hemiplegic limb.MethodsA randomized, placebo-controlled, double-blind, clinical trial is proposed. The volunteers will be randomly allocated to receive passive movement on the upper limb, which will be performed by the therapist for 20 min followed by either active tDCS or sham tDCS (current stimulation for 30 s) during simultaneous physical activity of the upper limb (“mini-bike”) for 20 min, totaling 40 min of intervention performed in 10 consecutive sessions. The anode electrode will be positioned over the primary motor cortex with a current of 2 mA and the cathode electrode will be positioned in the supraorbital region contralateral to the anode. The primary outcome will be shoulder pain intensity, which will be measured using the visual analog scale (VAS) on three occasions: 1) pre-intervention; 2) after 10 interventions (5 weekly sessions, for 2 weeks); and 3) 30 days after the end of the interventions. The secondary outcomes will be motor performance, upper limb function, and quality of life.Trial registrationBrazilian Registry of Clinical Trials, RBR-8F5MNY. Registered on June 2, 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-019-3266-y) contains supplementary material, which is available to authorized users.

To Combine or Not to Combine Physical Therapy With tDCS for Stroke With Shoulder Pain? Analysis From a Combination Randomized Clinical Trial for Rehabilitation of Painful Shoulder in Stroke

“…Evaluations were performed on three occasions: pre- and post-intervention and follow-up (30 days after completion of the intervention). The details of the study procedure are shown in Figure 1 and can be seen in the protocol article published by our group ( 23 ).…”

“…The physiotherapeutic treatment was always performed by the same therapist and passive therapy consisted of massage, stretching, and joint mobilization with the patient in the supine position, for 20 min ( 23 ). Then the participant received the tDCS combined with active or active-assisted exercises, using a cycle ergometric (Acte Sports, model E5) for another 20 min.…”

“…Then the participant received the tDCS combined with active or active-assisted exercises, using a cycle ergometric (Acte Sports, model E5) for another 20 min. The cycle ergometer was positioned on a table, in front of the patient ( 23 ). The patient was seated to perform the exercise.…”

Research Hotspots and Frontiers in Post Stroke Pain: A Bibliometric Analysis Study

“…al) interventions (Dyer et al, 2020;Souza et al, 2021). In recent years, noninvasive brain stimulation has been proven as a potentially effective intervention to relieve shoulder pain after stroke (Choi and Chang, 2018;de Souza et al, 2019). CPSP is a type of central neuropathic pain.…”

The Effectiveness of Ultrasound-Guided Subacromial-Subdeltoid Bursa Combined With Long Head of the Biceps Tendon Sheath Corticosteroid Injection for Hemiplegic Shoulder Pain: A Randomized Controlled Trial

“…The main aims of treatment are to reduce pain, restore shoulder mobility, improve functional activities, and prevent progressive degenerative changes. However, although more and more treatment methods are widely used in the treatment of HSP ( 13 ), such as Botulinum toxin type A ( 14 , 15 ), electrical stimulation ( 16 , 17 ), and suprascapular nerve block (SSNB) ( 18 , 19 ), there is no consensus about which treatment method is the best way to manage HSP. As identifying the exact etiology of shoulder pain can be difficult, the management of HSP is challenging.…”