Combining transcranial direct current stimulation with robot therapy for the impaired upper limb after sub-acute stroke

Tedesco Triccas, Lisa, Burridge, Jane, Hughes, Ann-Marie, Verheyden, Geert and Rothwell, John (2011) Combining transcranial direct current stimulation with robot therapy for the impaired upper limb after sub-acute stroke. Clinical Neurophysiology, 122 (S1), supplement Abstracts of the 14th European Congress of Clinical Neurophysiology and 4th International Conference on Transcranial Magnetic and Direct Current Stimulation, S149-S150.

Abstract

Introduction: About 65 percent of stroke survivors cannot involve their affected upper limb (UL) into their activities of daily living (Bruce & Dobkin 2005). Robot Therapy (RT) is one technique that can increase the intensity of rehabilitation and evidence shows that robot-assisted arm training results in reduction of UL motor impairments (Lo et al. 2010). Recently, RT has also been combined with a non-invasive method of brain stimulation, transcranial Direct Current Stimulation (tDCS) (Hesse et al. 2011). When comparing real to sham tDCS in addition with RT, non- significant differences in UL motor recovery of people with sub-acute stroke were demonstrated. A possible reason for this was that the robot used in the study was a one-dimensional wrist robot which did not allow the impaired UL to move in different dimensions. Thus, the main objective of this research is to explore whether combining tDCS with unilateral three-dimensional robot therapy for people with stroke leads to better outcomes in impairment, function and corticospinal neurophysiology measures than robot therapy alone.

Methods: A systematic literature review was conducted to investigate different methodologies used for applying tDCS and RT. The evidence was synthesized to generate the final protocol.

Results: A pilot, double-blinded randomised controlled trial is underway using a three-dimensional Armeo® robot with tDCS. The trial involves two groups of participants with sub-acute stroke: 1) Armeo RT and real tDCS, and 2) Armeo RT and sham tDCS. Each participant will receive an intervention programme involving 18 sessions over 8 weeks. Each session will consist of twenty minutes of real or sham tDCS during 1 hour of RT. Clinical and neurophysiological measures using Transcranial Magnetic Stimulation will be utilised pre- and post- intervention and at the 3 month follow-up.

Conclusions: Research into non-invasive brain stimulation and RT seems promising but to translate research findings into clinical stroke practice, further research is needed. This study will add to the body of knowledge of neurorehabilitation research.

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Contributors

Author: Jane Burridge

Author: Ann-Marie Hughes

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