The impact of transcranial direct current stimulation (tDCS) combined with modified constraint-induced movement therapy (mCIMT) on upper limb function in chronic stroke: a double-blind randomized controlled trial

Abstract

Purpose: This pilot double-blind sham-controlled randomized trial aimed to determine if the addition of anodal tDCS on the affected hemisphere or cathodal tDCS on unaffected hemisphere to modified constraint-induced movement therapy (mCIMT) would be superior to constraints therapy alone in improving upper limb function in chronic stroke patients. Methods: Twenty-one patients with chronic stroke were randomly assigned to receive 12 sessions of either (i) anodal, (ii) cathodal or (iii) sham tDCS combined with mCIMT. Fugl–Meyer assessment (FMA), motor activity log scale (MAL), and handgrip strength were analyzed before, immediately, and 1 month (follow-up) after the treatment. Minimal clinically important difference (mCID) was defined as an increase of ≥5.25 in the upper limb FMA. Results: An increase in the FMA scores between the baseline and post-intervention and follow-up for active tDCS group was observed, whereas no difference was observed in the sham group. At post-intervention and follow-up, when compared with the sham group, only the anodal tDCS group achieved an improvement in the FMA scores. ANOVA showed that all groups demonstrated similar improvement over time for MAL and handgrip strength. In the active tDCS groups, 7/7 (anodal tDCS) 5/7 (cathodal tDCS) of patients experienced mCID against 3/7 in the sham group. Conclusion: The results support the merit of association of mCIMT with brain stimulation to augment clinical gains in rehabilitation after stroke. However, the anodal tDCS seems to have greater impact than the cathodal tDCS in increasing the mCIMT effects on motor function of chronic stroke patients.

Implications for Rehabilitation

• The association of mCIMT with brain stimulation improves clinical gains in rehabilitation after stroke.

• The improvement in motor recovery (assessed by Fugl–Meyer scale) was only observed after anodal tDCS.

• The modulation of damaged hemisphere demonstrated greater improvements than the modulation of unaffected hemispheres.

• Constraint-induced movement therapy
• interhemispheric competition
• stroke
• transcranial direct current stimulation
• upper limb

Acknowledgements

The authors thank the participants and the Applied Neuroscience Laboratory research team.

Declaration of interest

This research was supported by grant (number 484488/2013-9) from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). Sérgio Rocha Rocha was supported by Fudanção de Amparo a Ciência e Tecnologia do Estado de Pernambuco (FACEPE). Evelyn Silva and Águida Foerster was supported by CNPq.

Supplementary material available online

Supplementary Tables S1 and S2