Posts Tagged Stroke

[WEB SITE] Smoking Tied to Worse Outcomes After a Stroke

Smoking Tied to Worse Outcomes After a Stroke


People who smoke or have recently quit have higher odds of being severely impaired after a stroke than their counterparts who never smoked, a new study suggests.

Smoking has long been linked to an increased risk of cardiovascular disease and serious events like heart attacks and strokes. But the new study sheds light on how smoking in the period before a stroke impacts how easily people will be able to navigate daily life afterward.

Compared to nonsmokers, those who were current smokers at the time of their stroke were 29% more likely to have poor functional outcomes afterward, the study found. And while former smokers overall were at no higher risk for poor outcomes than nonsmokers, that wasn’t true for former smokers who had quit within the past two years; this group was 75% more likely to function poorly after the stroke.

The findings were similar for being functionally dependent on others three months after a stroke, the study team notes in the journal Stroke.

“Smoking could be an important and modifiable factor that hinders post-stroke functional recovery,” said study co-author Tetsuro Ago of Kyushu University in Fukuoka, Japan.

“Patients, particularly those harboring stroke risks, should quit smoking as soon as possible,” Ago said by email.

While most stroke patients can recover functionality to some extent after several months, the degree of recovery can vary among individuals, Ago said. Some people can have lasting deficits in physical or mental functioning that make it harder for them to complete daily tasks like dressing, bathing and walking.

Everyone in the current study had an ischemic stroke, the most common kind, which occurs when a clot blocks an artery carrying blood to the brain.

Patients were 70 years old, on average, and roughly one in four were current smokers. Another 32% were former smokers and 43% had no history of smoking.

Among current smokers, the risk of poor functional outcomes increased with the number of cigarettes they smoked each day. Smokers who went through more than a pack a day were 27% to 48% more likely to have poor functional outcomes three months after a stroke than nonsmokers, and they were also 32% to 53% more likely to depend on others to help them get through daily routines.

One limitation of the study is that researchers relied on stroke patients to accurately recall and report any smoking history or current smoking habits. Researchers also lacked data on any secondhand smoke exposure, which might also influence outcomes.

Still, the results suggest that smoking cessation later in life may help minimize disability and disruption to daily life after a stroke, Ago said.

“Smoking cessation may be effective even in elderly patients who have smoked for a long time,” Ago said. “If smokers cannot quit, they should strictly manage other stroke risks, such as hypertension and diabetes, and should exercise and avoid obesity to minimize damage of small blood vessels in the brain.”

[Source: Reuters Health]


via Smoking Tied to Worse Outcomes After a Stroke – Rehab Managment

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[Abstract] Improving Healthcare Access: a Preliminary Design of a Low Cost Arm Rehabilitation Device


A low cost continuous passive motion (CPM) machine, the Gannon Exoskeleton for Arm Rehabilitation (GEAR), was designed. The focus of the machine is on the rehabilitation of primary functional movements of the arm. The device developed integrates two mechanisms consisting of a four-bar linkage and a sliding rod prismatic joint mechanism that can be mounted to a normal chair. When seated, the patient is connected to the device via a padded cuff strapped on the elbow. A set of springs have been used to maintain the system stability and help the lifting of the arm. A preliminary analysis via analytical methods is used to determine the initial value of the springs to be used in the mechanism given the desired gravity compensatory force. Subsequently, a multi-body simulation was performed with the software SimWise 4D by Design Simulation Technologies (DST). The simulation was used to optimize the stiffness of the springs in the mechanism to provide assistance to raising of the patient’s arm. Furthermore, the software can provide a finite element analysis of the stress induced by the springs on the mechanism and the external load of the arm. Finally, a physical prototype of the mechanism was fabricated using PVC pipes and commercial metal springs, and the reaching space was measured using motion capture. We believed that the GEAR has the potential to provide effective passive movement to individuals with no access to post-operative or post-stroke rehabilitation therapy.

via Improving Healthcare Access: a Preliminary Design of a Low Cost Arm Rehabilitation Device | Journal of Medical Devices | ASME Digital Collection

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[Abstract] Upper Limb Movement Modelling for Adaptive and Personalised Physical Rehabilitation in Virtual Reality – Thesis


Stroke is one of the leading causes of disability with over three-quarters of patients experiencing an upper limb impairment varying in severity. Early, intense, and frequent physical rehabilitation is important for quicker recovery of the upper limbs and the prevention of further deterioration of their upper limb impairment. Rehabilitation begins almost immediately at the hospital. Once released from the hospital it is intended that patients continue their rehabilitation program at home supported by a community stroke team. However, there are two main barriers to rehabilitation continuing effectively at this stage. The first is limited contact with a physiotherapist or occupational therapist to guide and support an intensive rehabilitation programme. The second is that conventional rehabilitation is tough to maintain immediately after stroke due to fatigue, lack of concentration, depression and other effects. Stroke patients can find exercises monotonous and tiring, and a lack of motivation can result in patients failing to engage fully with their treatment. Lack of participation in prescribed rehabilitation exercises may affect recovery or cause deterioration of mobility.

This thesis examines the hypothesis that upper limb stroke rehabilitation can be made more accessible and enjoyable through the use of modern commercial virtual reality (VR) hardware, with personalised models of user hand motion adapted to user capability over time, and VR games with tasks that utilise natural hand gestures as input controls to execute personalised physical rehabilitation exercises. To support the investigation of this hypothesis a novel adaptive, gamebased, virtual reality (VR) rehabilitation system has been designed and developed for self-managed rehabilitation. Hands are tracked using a Leap Motion Controller, with hand movements and gestures used as in input controller for VR tasks. A user-centred design methodology was adopted, and the final version of the system was evolved through several versions and iterative testing and feedback through trials with able-bodied testers, stroke survivor volunteers, and practising clinicians.

A key finding of the research was that an adapted form of Fitts’s law, that models difficulty of reaching and touching objects in 3D interaction spaces, could be used to profile movement capability for able-bodied people and stroke patients vii in upper arm VR stroke rehabilitation. It was also found that even when Fitts’s law was less effective, that the statistics of the regression quality were still informative in profiling users. Fitts law regression statistics along with information on task performance (such as percentage of hits) could be used to adapt task difficulty or advising rest. Further, it was found that multiple regression could provide better movement capability profiles with a modified form of Fitts law to account for varying degrees of difficulty due to the angles of motion in 3D space. In addition, a novel approach was developed which profiled sectors of the 3D VR interaction space separately, rather than treat movement through the whole space as being equally difficult. This approach accounts for some stroke patients having more difficulty moving in some directions than others, e.g. up and left. Results demonstrate that this has potential but may need to be investigated further with stroke patients and with larger numbers of people.

The VR system that utilised the movement capability model was evolved over time with a user-centred design methodology, with input from able-bodied people, stroke patients, and clinicians. A final longitudinal study investigated the suitability of three bespoke games, the usability of the system over a longer time, and the effectiveness of the movement profiler and adaptive system. Throughout this experiment, the system provided informative user movement profile variations that could identify unique movement behaviour traits in individuals. Results showed that user performance varied over time and the adaptive system proved effective in changing the difficulty of the tasks for individuals over multiple sessions. The VR rehabilitation games incorporated enhanced gameplay and feedback, and users expressed enjoyment with the interactive experience. Throughout all of the experiments, users enjoyed wearing a VR headset, preferring it over a standard PC monitor. Most users subjectively felt that they were more effective in completing tasks within VR, and results from experiments provided empirical evidence to support this view. Results within this thesis support the proposal that an appropriately designed, adaptive gamebased VR system can provide an accessible, personalised and enjoyable rehabilitation system that can motivate more regular rehabilitation participation and promote improved motor function.

via Upper Limb Movement Modelling for Adaptive and Personalised Physical Rehabilitation in Virtual Reality — Ulster University

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[ARTICLE] Relationship Between Motor Capacity of the Contralesional and Ipsilesional Hand Depends on the Side of Stroke in Chronic Stroke Survivors With Mild-to-Moderate Impairment – Full Text

There is growing evidence that after a stroke, sensorimotor deficits in the ipsilesional hand are related to the degree of impairment in the contralesional upper extremity. Here, we asked if the relationship between the motor capacities of the two hands differs based on the side of stroke. Forty-two pre-morbidly right-handed chronic stroke survivors (left hemisphere damage, LHD = 21) with mild-to-moderate paresis performed distal items of the Wolf Motor Function Test (dWMFT). We found that compared to RHD, the relationship between contralesional arm impairment (Upper Extremity Fugl-Meyer, UEFM) and ipsilesional hand motor capacity was stronger (R2LHD=RLHD2= 0.42; R2RHDRRHD2 < 0.01; z = 2.12; p = 0.03) and the slope was steeper (t = −2.03; p = 0.04) in LHD. Similarly, the relationship between contralesional dWMFT and ipsilesional hand motor capacity was stronger (R2LHD=RLHD2= 0.65; R2RHDRRHD2 = 0.09; z = 2.45; p = 0.01) and the slope was steeper (t = 2.03; p = 0.04) in LHD compared to RHD. Multiple regression analysis confirmed the presence of an interaction between contralesional UEFM and side of stroke (β3 = 0.66 ± 0.30; p = 0.024) and between contralesional dWMFT and side of stroke (β3 = −0.51 ± 0.34; p = 0.05). Our findings suggest that the relationship between contra- and ipsi-lesional motor capacity depends on the side of stroke in chronic stroke survivors with mild-to-moderate impairment. When contralesional impairment is more severe, the ipsilesional hand is proportionally slower in those with LHD compared to those with RHD.


It is now well-known that unilateral stroke not only results in weakness of the opposite half of the body, i.e., contralateral to the lesion or contralesional limb, but also significant motor deficits in the same half of the body, i.e., ipsilateral to the lesion or ipsilesional limb (14). Previous work suggests that deficits in the ipsilesional arm and hand varies with the severity of contralesional deficits, especially in the sub-acute and chronic phase after stroke (58). More interestingly, the unilateral motor deficits observed for contralesional and ipsilesional limbs seem to be hemisphere-specific and thus depend on side of stroke lesion (915). For predominantly right-handed cohorts, contralesional deficits appear to be more severe in those with right hemisphere damage (RHD), in whom the contralesional limb is non-dominant. For example, using clinical motor assessments of grip strength and hand dexterity, Harris and Eng (11) showed that contralesional motor impairments were less severe in chronic stroke survivors who suffered damage in the dominant (i.e., left) hemisphere (LHD) compared to those who suffered damage in the non-dominant (right) hemisphere (1115).

In contrast, considering ipsilesional motor deficits, the evidence is mixed concerning hemisphere-specific effects. For instance, some studies reported that individuals with LHD exhibited more severe ipsilesional arm and hand deficits compared to those with RHD (41517) while others have reported no difference in ipsilesional hand motor capacity between LHD and RHD (2). In acute stroke survivors, Nowak et al. demonstrated that deficits in grip force of the ipsilesional hand were significantly associated with clinical measures of function of the contralesional hand only in LHD (12). Contrary to this, de Paiva Silva et al. (14) found that compared to controls and LHD, the ipsilesional hand in chronic stroke survivors was significantly slower and less smooth in RHD especially when contralesional impairment was relatively more severe (UEFM < 34).

Taken together, there is converging evidence regarding the relationship between motor deficits of the contralesional and ipsilesional upper extremity, such that ipsilesional deficits are worse when contralesional impairment is greater (Figure 1A); however, it is uncertain whether the relationship between the two limbs depends on which hemisphere is damaged. In particular, motor deficits of the two limbs are most prominent for tasks that require dexterous motor control (e.g., grip force, tapping, tracking). For predominantly right-handed cohorts (as is the case in most studies), contralesional deficits appear to be more severe in those with RHD, in whom the contralesional limb is non-dominant; whereas ipsilesional deficits are more severe in those with LHD. An exception to this observation for those with RHD seems to be in the case when contralesional impairment is most severe (i.e., UEFM < 34) (14). Thus, one might predict that as contralesional impairment worsens, individuals with LHD would have proportionally worse ipsilesional deficits, but individuals with RHD (especially if say UEFM > 34) would not; see Figures 1B,C for two alternative hypotheses. To our knowledge, this prediction has not before been explicitly tested.

Figure 1. Hypothesized effects represented in schematic figure. (A) The null hypothesis, wherein the relationship between contralesional (CL) impairment and ipsilesional (IL) motor capacity is not modified by the side of stroke lesion, i.e., β1 ≠ 0 but β3 = 0. (B) Alternative hypothesis 1, wherein ipsilesional deficits are related to contralesional impairment but only in LHD (blue) and not in RHD (red). (C) Alternate hypothesis 2, wherein ipsilesional deficits are related to contralesional impairment but only in LHD and in RHD with severe impairment (represented in the shaded dark-gray area). For both alternate hypotheses, β1 and β3 ≠ 0.


via Frontiers | Relationship Between Motor Capacity of the Contralesional and Ipsilesional Hand Depends on the Side of Stroke in Chronic Stroke Survivors With Mild-to-Moderate Impairment | Neurology

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[Abstract] Pushing the limits of recovery in chronic stroke survivors: User perceptions of the Queen Square Upper Limb Neurorehabilitation Programme – Full Text PDF


Introduction: The Queen Square Upper Limb (QSUL) Neurorehabilitation Programme is a clinical service within the National Health Service in the United Kingdom that provides 90 hours of therapy over three weeks to stroke survivors with persistent upper limb impairment. This study aimed to explore the perceptions of participants of this programme, including clinicians, stroke survivors and carers.

Design: Descriptive qualitative.

Setting: Clinical outpatient neurorehabilitation service.

Participants: Clinicians (physiotherapists, occupational therapists, rehabilitation assistants) involved in the delivery of the QSUL Programme, as well as stroke survivors and carers who had participated in the programme were purposively sampled. Each focus group followed a series of semi-structured, open questions that were tailored to the clinical or stroke group. One independent researcher facilitated all focus groups, which were audio-recorded, transcribed verbatim and analysed by four researchers using a thematic approach to identify main themes.

Results: Four focus groups were completed: three including stroke survivors (n = 16) and carers (n = 2), and one including clinicians (n = 11). The main stroke survivor themes related to psychosocial aspects of the programme (″ you feel valued as an individual ″), as well as the behavioural training provided (″ gruelling, yet rewarding& [Prime]). The main clinician themes also included psychosocial aspects of the programme (″ patient driven ethos − no barriers, no rules ″), and knowledge, skills and resources of clinicians (″ it is more than intensity, it is complex ″).

Conclusions: As an intervention, the QSUL Programme is both comprehensive and complex. The impact of participation in the programme spans psychosocial and behavioural domains from the perspectives of both the stroke survivor and clinician.

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via Pushing the limits of recovery in chronic stroke survivors: User perceptions of the Queen Square Upper Limb Neurorehabilitation Programme. | medRxiv

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[Abstract + References] Game Design Principles Influencing Stroke Survivor Engagement for VR-Based Upper Limb Rehabilitation: A User Experience Case Study – Proceedings


Engagement with one’s rehabilitation is crucial for stroke survivors. Serious games utilising desktop Virtual Reality could be used in rehabilitation to increase stroke survivors’ engagement. This paper discusses the results of a user experience case study that was conducted with six stroke survivors to determine which game design principles are or would be important for engaging them with a desktop VR serious games designed for the upper limb rehabilitation. The results of our study showed the game design principles that warrant further investigation are awareness, feedback, interactivity, flow and challenge; and also important to a great extent are attention, involvement, motivation, effort, clear instructions, usability, interest, psychological absorption, purpose and a first-person view.


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via Game Design Principles Influencing Stroke Survivor Engagement for VR-Based Upper Limb Rehabilitation | Proceedings of the 31st Australian Conference on Human-Computer-Interaction

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[WEB SITE] Neofect Debuts Smart Balance, Designed to Rehab the Lower Body by Playing Games – Rehab Managment

Neofect Debuts Smart Balance, Designed to Rehab the Lower Body by Playing Games

Neofect unveils Neofect Smart Balance, a lower-body rehabilitation device designed to help patients recovering from stroke, ambulatory injuries, and other lower body disabilities regain function in their legs via augmented reality.

Recognized as a 2020 CES Innovation Award honoree, Neofect Smart Balance features 16 rehabilitation games that emphasize core strength, restabilization, and balance, all with the goal of helping patients walk unassisted.

The rehab device features a 2.5-foot by 2.5-foot “Dance Dance Revolution”-esque board designed to evaluate a patient’s posture and gait, then track and analyze motions, providing feedback when it senses an imbalance. Optional handlebars provide additional stability as needed. As patients advance, Neofect Smart Balance games increase speed of movement and coordination as patients step on and off the pad, according to the company, US-based in San Francisco, in a media release.

“For the past decade we’ve focused on hand and upper arm rehabilitation, but we’ve always wanted to create more engaging and measurable therapy for patients who need to recover leg function — whether that’s relearning how to walk or regaining range of motion and confidence,” Scott Kim, co-founder and CEO of Neofect USA, says in the release.

“With Neofect Smart Balance, games like ‘Rock Band’ prompt users to move their feet, in this case to the beat of a song. Patients are physically and cognitively challenged and can also have fun while rehabilitating.”

Neofect Smart Balance is designed for use in healthcare clinics and at home, increasing accessibility of treatment for patients with limited mobility. It securely and remotely shares progress reports with therapists, so they can monitor and adjust patients’ recovery regimen as needed.

Neofect announces it is also showcasing Neofect Connect, a new coaching and companion app, at CES 2020. Designed as an extension of therapy in a clinical setting to support and inspire stroke survivors through recovery at home, Neofect Connect will recommend customized daily exercises and educational materials based on patient ability.

The app, which will be available for any stroke survivor regardless if they use Neofect’s solutions, will include a digital telehealth program where physical and occupational therapists will connect with users remotely to guide their rehabilitation.

Neofect Connect is available on the Apple App Store and on the Google Play Store for homeNeofect users and will be open to any stroke survivor in spring 2020, per the release.

[Source(s): Neofect, Business Wire]


via Neofect Debuts Smart Balance, Designed to Rehab the Lower Body by Playing Games – Rehab Managment

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[Abstract + References] Embodied Imagination: An Approach to Stroke Recovery Combining Participatory Performance and Interactive Technology


Participatory performance provides methods for exploring social identities and situations in ways that can help people to imagine new ways of being. Digital technologies provide tools that can help people envision these possibilities. We explore this combination through a performance workshop process designed to help stroke survivors imagine new physical and social possibilities by enacting fantasies of “things they always wanted to do”. This process uses performance methods combined with specially designed real-time movement visualisations to progressively build fantasy narratives that are enacted with and for other workshop participants. Qualitative evaluations suggest this process successfully stimulates participant’s embodied imagination and generates a diverse range of fantasies. The interactive and communal aspects of the workshop process appear to be especially important in achieving these effects. This work highlights how the combination of performance methods and interactive tools can bring a rich, prospective and political understanding of people’s lived experience to design.

Supplemental Material



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via Embodied Imagination | Proceedings of the 2019 CHI Conference on Human Factors in Computing Systems

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[WEB SITE] New APTA-Supported CPG Looks at Best Ways to Improve Walking Speed, Distance for Individuals After Stroke, Brain Injury, and Incomplete SCI

(Journal of Neurologic Physical Therapy, January, 2020)

The message
A new clinical practice guideline (CPG) supported by APTA and developed by the APTA Academy of Neurologic Physical Therapy concludes that when it comes to working with individuals who experienced an acute-onset central nervous system (CNS) injury 6 months ago or more, aerobic walking training and virtual reality (VR) treadmill training are the interventions most strongly tied to improvements in walking distance and speed. Other interventions such as strength training, circuit training, and cycling training also may be considered, authors write, but providers should avoid robotic-assisted walking training, body-weight supported treadmill training, and sitting/standing balance that doesn’t employ augmented visual inputs.

The study
The final recommendations in the CPG are the result of an extensive process that began with a scan of nearly 4,000 research abstracts and subsequent full-text review of 234 articles, further narrowed to 111 randomized controlled trials (RCTs), all focused on interventions related to CNS injuries, with outcome data that included measures of walking distance and speed. CPG panelists evaluated the data and developed recommendations, which were informed by data on patient preferences and submitted for expert and stakeholder review.

Development of the CPG was supported through an APTA-sponsored program that assists APTA sections — in the case, the Academy of Neurologic Physical Therapy — in the development stages such as drafting, appraisal, planning, and external review (for more detail on the program, visit APTA’s CPG Development webpage).


  • Moderate- to high-intensity (60%-80% of heart rate reserve or up to 85% of heart rate maximum) walking training was associated with the strongest evidence for improvements in walking speed and distance.
  • Walking training using VR also fared well, due in part to the ability of a VR treadmill system to allow “safe practice of challenging walking activities,” something that’s hard to do in a more traditional hospital or clinic setting.
  • Strength training, while not included among the interventions that should be performed, was designated as an intervention that may be considered. Authors cite inconsistent evidence on the connection between strength training and improved walking speed and distance, but they acknowledge potential benefits.
  • Also among the list of interventions that “may be considered”: circuit training, as well as cycling training. In both cases, authors cite a paucity of evidence related to how the interventions affect walking speed and distance. They note that these interventions may be revisited during a future reevaluation of the CPG.
  • Body-weight supported treadmill training was labeled as an intervention that should not be performed in order to increase walking speed and distance, with authors finding little evidence supporting the approach, which is often associated with a greater cost. However, they write, the individuals included in the studies reviewed for the CPT were able to ambulate over ground without the use of a body-weight support device, and “different results may occur in those who are nonambulatory or unable to ambulate without the use of [body-weight support].”
  • Both static and dynamic (nonwalking) balance training and robotic-assisted walking training were also characterized as interventions that should not be performed. Authors acknowledge the ways that postural stability and balance are associated with fall risk and reduced participation, but they were unable to find sufficient evidence to support these particular interventions as effective in increasing walking speed and distance (although static and dynamic balance training with VR fared a bit better). As for robotic-assisted walking training, CPG authors note that while ineffective for individuals with CNS who were already ambulatory, “this recommendation … may not apply to nonambulatory individuals or those who require robotic assistance to ambulate.”

Why it matters
Authors note that “the implementation of evidence-based interventions in the field of rehabilitation has been a challenge,” and they believe that the new CPG offers a real opportunity for clinicians to “integrate available research into their practice patterns.” Further, they believe that the CPG has arrived at an important moment in the evolution of health care, with its greater emphasis on evidence for the cost-effectiveness and outcomes of various interventions.

More from the study
The CPG also offers tips for clinicians to implement its recommendations, including acquiring equipment to help providers monitor vital signs, implementing “automatic prompts in electronic medical records that will facilitate obtaining orders to attempt higher-intensity training strategies,” providing training sessions for clinicians, establishing organizational policies to promote use and documentation of the recommended interventions, and simply keeping a few copies of the study on hand for easy reference.

Keep in mind …
Authors acknowledged that the CPG has a few limitations. While the review of RCTs only is a strength, they write, some of those studies involved small sample sizes, and many lacked details on intervention dosage. Additionally, the CPG does not fully address the potential costs associated with its recommendations — specifically VR — which could impact a clinic’s ability to implement a particular intervention. Authors also acknowledge that walking speed and distance are not the only important outcomes related to mobility among individuals with CNS injury, and that other factors such as dynamic stability while walking, peak walking capacity, and community mobility may be incorporated in an assessment of walking function.

via New APTA-Supported CPG Looks at Best Ways to Improve Walking Speed, Distance for Individuals After Stroke, Brain Injury, and Incomplete SCI

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[Abstract] Timing-dependent interaction effects of tDCS with mirror therapy on upper extremity motor recovery in patients with chronic stroke: A randomized controlled pilot study


  • The priming effect of dual tDCS was important to facilitate motor recovery in combination with mirror therapy in stroke.


This study was a randomized, controlled pilot trial to investigate the timing-dependent interaction effects of dual transcranial direct current stimulation (tDCS) in mirror therapy (MT) for hemiplegic upper extremity in patients with chronic stroke. Thirty patients with chronic stroke were randomly assigned to three groups: tDCS applied before MT (prior-tDCS group), tDCS applied during MT (concurrent-tDCS group), and sham tDCS applied randomly prior to or concurrent with MT (sham-tDCS group). Dual tDCS at 1 mA was applied bilaterally over the ipsilesional M1 (anodal electrode) and the contralesional M1 (cathodal electrode) for 30 min. The intervention was delivered five days per week for two weeks. Upper extremity motor performance was measured using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE), the Action Research Arm Test (ARAT), and the Box and Block Test (BBT). Assessments were administered at baseline, post-intervention, and two weeks follow-up. The results indicated that concurrent-tDCS group showed significant improvements in the ARAT in relation to the prior-tDCS group and sham-tDCS group at post-intervention. Besides, a trend toward greater improvement was also found in the FMA-UE for the concurrent-tDCS group. However, no statistically significant difference in the FMA-UE and BBT was identified among the three groups at either post-intervention or follow-up. The concurrent-tDCS seems to be more advantageous and time-efficient in the context of clinical trials combining with MT. The timing-dependent interaction factor of tDCS to facilitate motor recovery should be considered in future clinical application.

via Timing-dependent interaction effects of tDCS with mirror therapy on upper extremity motor recovery in patients with chronic stroke: A randomized controlled pilot study – Journal of the Neurological Sciences

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