Transcranial direct current stimulation associated with physical-therapy in acute stroke patients-A randomized, triple blind, sham-controlled study.pdf
[en] Background: Transcranial Direct Current Stimulation has been increasing in popularity in the last few
years. Despite vast amounts of articles on the use of tDCS on stroke patients, very little has been done during the acute phase. Objectives: Measure the effects of tDCS on functional and sensory outcomes throughout the first year post onset of stroke.
Methods: 50 acute stroke patients were randomized and placed into either the treatment or sham group. Anodal tDCS was applied (2 mA, 20min) 5 times a week during the first month post stroke. Patients were evaluated with the Wolf Motor Function Test, the Semmes Weinstein Monofilament Test, the Upper Extremity section (UEFM), the Lower Extremity section (LEFM) and the Somatosensory section of the Fugl Meyer Test, the Tardieu Spasticity Scale, the Stroke Impact Scale (SIS), the Hospital Anxiety and Depression Scale (HADS) and the Barthel Index. Evaluations were held at 48 h post stroke, week 1, 2, 3, 4, 3 months, 6 months and 1 year.
Results: There were statistically and clinically significant improvements after tDCS in all functional motor outcomes, and somatosensory functions. Differences between both groups for the main outcome (WMFT time) were 51% (p=0.04) at one month, and 57% (p=0.02) at one year.
Conclusion: tDCS seems to be an effective adjuvant to conventional rehabilitation techniques. If applied in the acute stages of stroke, functional recovery is not only accelerated, but improved, and results are maintained up to one-year post stroke.
Disciplines :
Orthopedics, rehabilitation & sports medicine
Author, co-author :
Bornheim, Stephen ; Université de Liège - ULiège > Département des sciences de la motricité > Kinésithérapie générale et réadaptation
Croisier, Jean-Louis ; Université de Liège - ULiège > Département des sciences de la motricité > Kinésithérapie générale et réadaptation
MAQUET, Pierre ; Centre Hospitalier Universitaire de Liège - CHU > Département de médecine interne > Service de neurologie
Kaux, Jean-François ; Université de Liège - ULiège > Département des sciences de la motricité > Médecine physique, réadaptation et traumatologie du sport
Language :
English
Title :
Transcranial direct current stimulation associated with physical-therapy in acute stroke patients - A randomized, triple blind, sham-controlled study
Bikson, M., Grossman, P., Thomas, C., Zannou, A.L., Jiang, J., Adnan, T., et al. Safety of transcranial direct current stimulation: evidence based update 2016. Brain Stimul 9 (2016), 641–661.
Marquez, J., van Vliet, P., McElduff, P., Lagopoulos, J., Parsons, M., Transcranial direct current stimulation (tDCS): does it have merit in stroke rehabilitation? A systematic review. Int J Stroke 10 (2015), 306–316.
Nitsche, M a, Nitsche, M a, Paulus, W., Paulus, W., Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol 527:Pt 3 (2000), 633–639.
Nowak, D.A., Grefkes, C., Ameli, M., Fink, G.R., Interhemispheric competition after stroke: brain stimulation to enhance recovery of function of the affected hand. Neurorehabilitation Neural Repair 23 (2009), 641–656.
Zheng, X., Alsop, D.C., Schlaug, G., Effects of transcranial direct current stimulation (tDCS) on human regional cerebral blood flow. Neuroimage 58 (2011), 26–33.
Peruzzotti-Jametti, L., Cambiaghi, M., Bacigaluppi, M., Gallizioli, M., Gaude, E., Mari, S., et al. Safety and efficacy of transcranial direct current stimulation in acute experimental ischemic stroke. Stroke 44 (2013), 3166–3174.
Kronberg, G., Bridi, M., Abel, T., Bikson, M., Parra, L.C., Direct current stimulation modulates LTP and LTD: activity dependence and dendritic effects. Brain Stimul 10 (2017), 51–58.
Braun, R., Klein, R., Walter, H.L., Ohren, M., Freudenmacher, L., Getachew, K., et al. Transcranial direct current stimulation accelerates recovery of function, induces neurogenesis and recruits oligodendrocyte precursors in a rat model of stroke. Exp Neurol 279 (2016), 127–136.
Polania, R., Nitsche, M.A., Paulus, W., Modulating functional connectivity patterns and topological functional organization of the human brain with transcranial direct current stimulation. Hum Brain Mapp 32 (2011), 1236–1249.
Bornheim, S., Thibaut, A., Beaudart, C., Maquet, P., Croisier, J., Kaux, J., Evaluating the effects of tDCS in stroke patients using functional outcomes: a systematic review. 2019, Submitt Publ.
Lee, K.B., Lim, S.H., Kim, K.H., Kim, K.J., Kim, Y.R., Chang, W.N., et al. Six-month functional recovery of stroke patients: a multi-time-point study. Int J Rehabil Res 38 (2015), 173–180.
Keith, R.A., Wilson, D.B., Gutierrez, P., Acute and subacute rehabilitation for stroke: a comparison. Arch Phys Med Rehabil 76 (1995), 495–500.
Andrade, S.M., Ferreira, JJ. de A., Rufino, T.S., Medeiros, G., Brito, J.D., da Silva, M.A., et al. Effects of different montages of transcranial direct current stimulation on the risk of falls and lower limb function after stroke. Neurol Res 39 (2017), 1037–1043.
Sattler, V., Acket, B., Raposo, N., Albucher, J.-F., Thalamas, C., Loubinoux, I., et al. Anodal tDCS combined with radial nerve stimulation promotes hand motor recovery in the acute phase After ischemic stroke. Neurorehabilitation Neural Repair 29 (2015), 743–754.
Rossi, C., Sallustio, F., Di Legge, S., Stanzione, P., Koch, G., Transcranial direct current stimulation of the affected hemisphere does not accelerate recovery of acute stroke patients. Eur J Neurol 20 (2013), 202–204.
Di Lazzaro, V., Dileone, M., Capone, F., Pellegrino, G., Ranieri, F., Musumeci, G., et al. Immediate and late modulation of interhemipheric imbalance with bilateral transcranial direct current stimulation in acute stroke. Brain Stimul 7 (2014), 841–848.
Bornheim, S., Croisier, J.-L., Maquet, P., Kaux, J.-F., Proposal of a new transcranial direct current stimulation safety screening tool. Am J Phys Med Rehabil 98 (2019), e77–e78.
Gandiga, P.C., Hummel, F.C., Cohen, L.G., Transcranial DC stimulation (tDCS): a tool for double-blind sham-controlled clinical studies in brain stimulation. Clin Neurophysiol 117 (2006), 845–850.
Brunoni, A.R., Amadera, J., Berbel, B., Volz, M.S., Rizzerio, B.G., Fregni, F., A systematic review on reporting and assessment of adverse effects associated with transcranial direct current stimulation. Int J Neuropsychopharmacol, 14, 2011, 1133—1145.
Bornheim, S., Croisier, J., Elkebir, K., Lachi, L., Radermecker, M., Taieb, L., et al. La tDCS en phase aiguë d'un AVC : un outil rééducatif. Kinésithérapie, La Rev, 19, 2019, 83.
Lin, K.C., Hsieh, Y.W., Wu, C.Y., Chen, C.L., Jang, Y., Liu, J Sen, Minimal detectable change and clinically important difference of the wolf motor function test in stroke patients. Neurorehabilitation Neural Repair 23 (2009), 429–434.
Noordzij, M., Tripepi, G., Dekker, F.W., Zoccali, C., Tanck, M.W., Jager, K.J., CME Series Sample size calculations: basic principles and common pitfalls. Nephrol Dial Transplant 25 (2010), 1388–1393.
Putaala, J., Curtze, S., Hiltunen, S., Tolppanen, H., Kaste, M., Tatlisumak, T., Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke the helsinki young stroke registry. 2009.
Rabadi, M.H., Aston, C.E., Effect of transcranial direct current stimulation on severely affected arm-hand motor function in patients after an acute ischemic stroke. Am J Phys Med Rehabil 96 (2017), S178–S184.
Kessler, S.K., Turkeltaub, P.E., Benson, J.G., Hamilton, R.H., Differences in the experience of active and sham transcranial direct current stimulation. Brain Stimul 5 (2012), 155–162.
Boggio, P.S., Nunes, A., Rigonatti, P.S., Nitsche, M.A., Pascual-Leone, A., Fregni, F., Repeated sessions of noninvasive brain DC stimulation is associated with motor function improvement in stroke patients. Restor Neurol Neurosci 25 (2007), 123–129.
Kim, D.Y., Lim, J.-Y., Kang, E.K., You, D.S., Oh, M.-K., Oh, B.-M., et al. Effect of transcranial direct current stimulation on motor recovery in patients with subacute stroke. Am J Phys Med Rehabil 89 (2010), 879–886.
Utarapichat, S., Kitisomprayoonkul, W., Effects of transcranial direct current stimulation on motor activity of lower limb muscles in chronic stroke. J Med Assoc Thail 101 (2018), 131–136.
Meinzer, M., Lindenberg, R., Sieg, M.M., Nachtigall, L., Ulm, L., Flöel, A., Transcranial direct current stimulation of the primary motor cortex improves word-retrieval in older adults. Front Aging Neurosci, 6, 2014, 253.
Butler, A.J., Shuster, M., O'Hara, E., Hurley, K., Middlebrooks, D., Guilkey, K., A meta-analysis of the efficacy of anodal transcranial direct current stimulation for upper limb motor recovery in stroke survivors. J Hand Ther 26 (2013), 162–171.
Thair, H., Holloway, A.L., Newport, R., Smith, A.D., Transcranial direct current stimulation (tDCS): a Beginner's guide for design and implementation. Front Neurosci, 11, 2017.
López-Alonso, V., Fernández-Del-Olmo, M., Costantini, A., Gonzalez-Henriquez, J.J., Cheeran, B., Intra-individual variability in the response to anodal transcranial direct current stimulation. Clin Neurophysiol 126 (2015), 2342–2347.
Leach, RC, McCurdy, MP, Trumbo, MC, Matzen, LE, Leshikar, ED, Differential age effects of transcranial direct current stimulation on associative memory. J Gerontol Ser B 74:7 (October 2019), 1163–1173.
Heise, K.-F., Niehoff, M., Feldheim, J.-F., Liuzzi, G., Gerloff, C., Hummel, F.C., Differential behavioral and physiological effects of anodal transcranial direct current stimulation in healthy adults of younger and older age. Front Aging Neurosci, 6, 2014, 146.
Lefebvre, S., Laloux, P., Peeters, A., Desfontaines, P., Jamart, J., Vandermeeren, Y., Dual-tDCS enhances online motor skill learning and long-term retention in chronic stroke patients. Front Hum Neurosci, 6, 2013, 343.
Elsner, B., Kugler, J., Pohl, M., Mehrholz, J., Transcranial direct current stimulation (tDCS) for improving function and activities of daily living in patients after stroke. Cochrane Database Syst Rev, 2013, CD009645.