Therapeutic Science for Rehabilitation (재활치료과학)

Korean Society of Neurological Occupational Therapy (대한신경계작업치료학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of tDCS on Cognitive Function of Patients With Stroke: A Systematic Review and Meta-Analysis

뇌졸중 후 인지장애에 대한 경두개 직류 자극: 체계적 고찰 및 메타분석

  • Yang, Min Ah (Osan Dementia Center) ;
  • Won, Kyung-A (Incheon Metropolitan Dementia Center) ;
  • Park, Hae Yean (Dept. of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University) ;
  • Park, Ji-Hyuk (Dept. of Occupational Therapy, College of Software and Digital Healthcare Convergence, Yonsei University)
  • 양민아 (오산시 치매안심센터) ;
  • 원경아 (인천광역시 광역치매센터) ;
  • 박혜연 (연세대학교 소프트웨어디지털헬스케어융합대학 작업치료학과) ;
  • 박지혁 (연세대학교 소프트웨어디지털헬스케어융합대학 작업치료학과)
  • Received : 2020.07.28
  • Accepted : 2021.03.16
  • Published : 2021.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : This study aimed to analyze the effect of transcranial direct current stimulation (tDCS) on cognitive function recovery in patients with stroke. Methods : Data published in Korean and foreign academic journals from 2009 to 2019 were searched using the NDSL, RISS, PubMed, and CINAHL databases. A total of 11 experimental research articles were selected based on the inclusion and exclusion criteria. A qualitative assessment was conducted, and a meta-analysis of nine results from seven of the stuides was performed using the Comprehensive Meta-Analysis 3.0 program. Results : Based on the results of the meta-analysis, the attention and memory effect sizes were 0.725 and 0.796, respectively, which were both considered a "medium effect size". Statistically significant changes were observed in both the areas (p<0.05). Conclusion : The results of this study confirmed that tDCS can be useful in the rehabilitation of patients with stroke with limited cognitive function. In addition, the application methods differed, indicating that a formalized tDCS protocol is required.

목적 : 본 연구의 목적은 뇌졸중 환자의 인지기능 회복에 대한 경두개 직류자극(tDCS)의 효과를 살펴본 연구를 분석하기 위함이다. 연구방법 : 2009년부터 2019년까지 국내외 학술지에 게재된 논문들을 NDSL, RISS, PubMed, CINAHL을 통해 검색하였다. 선정기준과 배제기준을 통해 총 11개의 실험연구 논문이 선정되었다. 이를 질적평가를 시행하고, 이 중 7편의 논문에서 9개의 결과값에 대해 메타분석을 실시하였다. 결과 : 메타 분석을 실시한 결과 효과크기는 attention 0.725, memory 0.796으로 모두 '보통 효과크기'를 보였다. 두 영역 모두 통계적으로 유의한 변화가 있던 것으로 분석되었다(p<0.05) 결론 : 본 연구 결과를 통하여 인지기능이 제한된 뇌졸중 환자에게 tDCS는 효과가 있음을 알 수 있었다. 또한, tDCS 적용법이 연구 간 서로 상이함을 알게 되었으며 이에 따라 정형화된 tDCS 프로토콜과 전문가 양성이 필요할 것으로 보인다.

Keywords

References

  1. Allen, C. K. (1982). Independence through activity: The practice of occupational therapy (psychiatry). American Journal of Occupational Therapy, 36(11), 731-739. doi:10.5014/ajot.36.11.731
  2. An, T. G., & Kwon, H. C. (2019). The effect of transcranial direct-current stimulation on cognitive function and depression in stroke patient's through a computerized cognitive rehabilitation program. Journal of the Korean Society of Integrative Medicine, 7(3), 33-40. doi:10.15268/ksim.2019.7.3.033
  3. Arbesman, M., Scheer, J., & Lieberman, D. (2008). Using AOTA's critically appraised topic (CAT) and critically appraised paper (CAP) series to link evidence to practice. OT Practice, 13(12), 18-22. Retrieved from http://hsrc.himmelfarb.gwu.edu/sphhs_prv_facpubs/636
  4. Au-Yeung, S. S., Wang, J., Chen, Y., & Chua, E. (2014). Transcranial direct current stimulation to primary motor area improves hand dexterity and selective attention in chronic stroke. American Journal of Physical Medicine & Rehabilitation, 93(12), 1057-1064. doi:10.1097/PHM.0000000000000127
  5. Bae, S. J. (2012). Effect of applying tDCS to computerized cognitive training on working memory after stroke (Master thesis). Dongshin University, Naju.
  6. Bae, S. J., Jeong, W. S., Lee, H. G., & Kim, K. Y. (2012). Effect of tDCS stimulation for improving working memory on stroke patients' EEG variation. Journal of the Korea Contents Association, 12(7), 261-272. doi:10.5392/JKCA.2012.12.07.261
  7. Chae, J. H. (2018). Therapeutic application of transcranial magnetic stimulation and transcranial direct current stimulation in depression. Journal of Korean Neuropsychiatric Association, 57(2), 119-132. doi:10.4306/jknpa.2018.57.2.119
  8. Chi, R. P., Fregni, F., & Snyder, A. W. (2010). Visual memory improved by non-invasive brain stimulation. Brain Research, 1353, 168-175. doi:10.1016/j.brainres.2010.07.062
  9. Chung, J. W., & Kim, J. H. (2015). Factors related to fear of recurrence in stroke patients. Journal of Korean Academy of Fundamentals of Nursing, 22(2), 190-197. doi:10.7739/jkafn.2015.22.2.190
  10. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Lawrence Erlbaum Associates.
  11. D'Agata, F., Peila, E., Cicerale, A., Caglio, M. M., Caroppo, P., Vighetti, S., ... Molo, M. T. (2016). Cognitive and neurophysiological effects of non-invasive brain stimulation in stroke patients after motor rehabilitation. Frontiers in Behavioral Neuroscience, 10, 135-145. doi:10.3389/fnbeh.2016.00135
  12. Diller, L., Abreu, B. C., Allen, C. K., Bruce, M. A., Farber, S. D., Fine, S., ... Zemke, R. (1993). Introduction to cognitive rehabilitation. American Occupational Therapy Association.
  13. Erk, S., Mikschl, A., Stier, S., Ciaramidaro, A., Gapp, V., Weber, B., & Walter, H. (2010). Acute and sustained effects of cognitive emotion regulation in major depression. Journal of Neuroscience, 30(47), 15726-15734. doi:10.1523/JNEUROSCI.1856-10.2010
  14. Hosseinzadeh, S. A., Mazhari, S., Najafi, K., Ahmadi, M., Aghaei, I., & Khaksarian, M. (2018). Anodal transcranial direct current stimulation enhances positive changes in movement functions, visual attention and depression of patients with chronic ischemic stroke: A clinical trial. Biomedical Research and Therapy, 5(11), 2841-2849. https://doi.org/10.15419/bmrat.v5i11.503
  15. Jang, E. J., & Kim, D. H. (2019). Bayesian hierarchical model for publication bias. Journal of the Korean Data & Information Science Society, 30(1), 1-10. doi:10.7465/jkdi.2019.30.1.1
  16. Jo, J. M., Kim, Y. H., Ko, M. H., Ohn, S. H., Joen, B., & Lee, K. H. (2009). Enhancing the working memory of stroke patients using tDCS. American Journal of Physical Medicine & Rehabilitation, 88(5), 404-409. doi:10.1097/PHM.0b013e3181a0e4cb
  17. Kang, E. K., Baek, M. J., Kim, S., & Paik, N. J. (2009). Non-invasive cortical stimulation improves post-stroke attention decline. Restorative Neurology and Neuroscience, 27(6), 647-652. doi:10.3233/RNN-2009-0514
  18. Kang, H. (2015). Statistical considerations in meta-analysis. Hanyang Medical Reviews, 35(1), 23-32. doi:10.7599/hmr.2015.35.1.23
  19. Kim, Y. H. (2001). Principle of neurorehabilitation. Journal of the Korean Society of Clinical Neurophysiology, 3(2), 223-228.
  20. Kim, Y. H. (2014). Noninvasive brain stimulation: Repetitive transcranial magnetic stimulation and transcranial direct current stimulation. Journal of the Korean Medical Association/Taehan Uisa Hyophoe Chi, 56(1), 30-37. doi:10.5124/jkma.2013.56.1.30
  21. Lee, J. M., Kim, H. M., & Kim, J. H. (2015). The effects of depression, cognitive function, and activities of caily living on quality of life for patients with stroke. The Journal of Korean Society of Community-Based Occupational Therapy, 5(1), 1-9. doi:10.18598/kcbot.2015.05.01.01
  22. Oh, E. Y., & Jung, M. S. (2017). Effects of a cognitive training program on cognitive function and activities of daily living in patients with acute ischemic stroke. Journal of Korean Academy of Nursing, 47(1), 1-13. doi:10.4040/jkan.2017.47.1.1
  23. Oros, R. I., Popescu, C. A., Iova, C. A., Mihancea, P., & Iova, S. O. (2016). The impact of cognitive impairment after stroke on activities of daily living. Human and Veterinary Medicine, 8(1), 41-44.
  24. Park, S. H., Koh, E. J., Choi, H. Y., & Ko, M. H. (2013). A double-blind, sham-controlled, pilot study to assess the effects of the concomitant use of transcranial direct current stimulation with the computer assisted cognitive rehabilitation to the prefrontal cortex on cognitive functions in patients with stroke. Journal of Korean Neurosurgical Society, 54(6), 484-488. doi:10.3340/jkns.2013.54.6.484
  25. Patel, M. D., Coshall, C., Rudd, A. G., & Wolfe, C. D. (2002). Cognitive impairment after stroke: Clinical determinants and its associations with long-term stroke outcomes. Journal of the American Geriatrics Society, 50(4), 700-706. doi:10.1046/j.1532-5415.2002.50165.x.
  26. Saidmanesh, M., Pouretemad, H. R., Amini, A., Nillipour, R., & Ekhtian, H. (2012). Effects of transcranial direct current stimulation on working memory in patients with non-fluent aphasia disorder. Research Journal Biological Sciences, 7(7), 290-296. https://doi.org/10.3923/rjbsci.2012.290.296
  27. Shaker, H. A., Sawan, S. A. E., Fahmy, E. M., Ismail, R. S., & Elrahman, S. A. E. A. (2018). Effect of transcranial direct current stimulation on cognitive function in stroke patients. The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 54(1), 1-8. doi:10.1186/s41983-018-0037-8
  28. Smith, D. V., & Clithero, J. A. (2009). Manipulating executive function with transcranial direct current stimulation. Frontiers in Integrative Neuroscience, 3(1), 1-3. doi:10.3389/neuro.07.026.2009
  29. Trombly, C. A., Radomski, M. V. (2002). Occupational therapy for physical dysfunction (5th ed.). Philadelphia: Lippincott Williams & Wilkins.
  30. Yi, Y. G., Chun, M. H., Do, K. H., Sung, E. J., Kwon, Y. G., & Kim, D. Y. (2016). The effect of transcranial direct current stimulation on neglect syndrome in stroke patients. Annals of Rehabilitation Medicine, 40(2), 223-229. doi:10.5535/arm.2016.40.2.223
  31. Yoo, E. Y., Chun, S. I., Oh, H. C., & Chun, J. S. (1997). The cognitive perceptual performance in relation to activities of daily living in stroke patients. The Journal of Korean Society of Occupational Therapy, 5(1). 8-19.
  32. Yun, G. J. (2012). The effects of transcrainal direct current stimulation on cognition in stroke patients (Master thesis). Ulsan University, Ulsan.
  33. Yun, G. J., Chun, M. H., & Kim, B. R. (2015). The effects of transcranial direct-current stimulation on cognition in stroke patients. Journal of Stroke, 17(3), 354-358. doi:10.5853/jos.2015.17.3.354
  34. Wheatley, C. J. (2001). Evaluation and treatment of cognitive dysfunction. In L. W. Pedretti, & M. B. Early (Eds.). Occupational therapy practice skills of physical dysfunction (5th ed., pp. 456-464). St. Louis: Mosby Elsevier.
  35. Zaghi, S., Acar, M., Hultgren, B., Boggio, P. S., & Fregni, F. (2010). Noninvasive brain stimulation with low-intensity electrical currents: Putative mechanisms of action for direct and alternating current stimulation. The Neuroscientist, 16(3), 285-307. doi:10.1177/1073858409336227