Using clinical and robotic assessment tools to examine the feasibility of pairing tDCS with upper extremity physical therapy in patients with stroke and TBI: A consideration-of-concept pilot study

Abstract

BACKGROUND: Transcranial direct current stimulation (tDCS) may provide a safe, non-invasive technique for modulating neural excitability during neurorehabilitation. OBJECTIVE: 1) Assess feasibility and potential effectiveness of tDCS as an adjunct to standard upper extremity (UE) physical therapy (PT) for motor impairments resulting from neurological insult. 2) Determine sustainability of improvements over a six month period. METHODS: Five participants with chronic neurologic insult (stroke or traumatic brain injury > 6 months prior) completed 24 sessions (40 minutes, three times/week) of UE-PT combined with bihemispheric tDCS delivered at 1.5 mA over the motor cortex during the first 15 minutes of each PT session. Outcomes were assessed using clinical (UE Fugl-Meyer, Purdue Pegboard, Box and Block, Stroke Impact Scale) and robotic (unimanual and bimanual motor control) measures. Change in scores and associated effects sizes from Pre-test to Post-test and a six month Follow-up were calculated for each participant and group as a whole. RESULTS: Scores on UE Fugl-Meyer, Box and Block, Purdue Pegboard, Stroke Impact Scale, and robotic measures improved from Pre-to Post-test. Improvements on UE Fugl-Meyer, Box and Block, and robotic measures were largely sustained at six months. CONCLUSIONS: Combining bihemispheric tDCS with UE-PT in individuals with neurological insult warrants further investigation.

Clinical utility of brain stimulation modalities following traumatic brain injury: current evidence

“…Table 2 details seven tDCS studies. 39 – 45 Six clinical studies were found in the chronic phase of TBI, and there was only one study 39 in the subacute phase. In contrast to TMS studies, most tDCS studies were randomized controlled trials or crossover studies.…”

“…All patients received bihemispheric tDCS over M1 paired with standard upper extremity physical therapy (24 sessions of 40 minutes, three times per week). They monitored lasting motor function improvement 45 and reported positive results 6 months after tDCS stimulation.…”

“… 52 This enzymatic restoration improves cellular activity of brain tissue that has been damaged by TBI. 45 Thereby, transcranial LLLT may become a novel therapy to enhance cognitive performance; emotional functions; and neurological conditions 47 , 56 linked to mitochondrial dysfunction, 47 a ubiquitous finding in brain injury due to TBI.…”

The contribution of interindividual factors to variability of response in transcranial direct current stimulation studies

“…There has been similar variability in the reports of combined rehabilitative training and tDCS in the injured population. Several studies have reported greater behavioral improvement with combined tDCS and training, compared with training alone, in motor function (Middleton et al, 2014 ; Kasashima-shindo et al, 2015 ), motor function associated electrophysiology measures (Kim and Ko, 2013 ), aphasia (Wu et al, 2015 ), neglect (single case report) (Brem et al, 2014 ), and attention (Park et al, 2013b ). However, some of the positive studies were conducted on extremely small numbers ( n < 10).…”

Métodos para la evaluación motora objetiva de pacientes con daño cerebral adquirido en neurorrehabilitación funcional

“…Los métodos de evaluación del movimiento de la ES convencionales dependen de la experiencia y la subjetividad de los médicos o terapeutas evaluadores. Las evaluaciones de la función motora de la ES se centran en pruebas clínicas que dependen en gran medida de los criterios del examinador (Middleton et al, 2014) y requieren que un terapeuta califique a los pacientes mientras estos realizan tareas y actividades específicas.…”