Browse > Article
http://dx.doi.org/10.15268/ksim.2020.8.2.011

Impact of Dual-Hemisphere Transcranial Direct Current Stimulation Combined with Modified Constraint-Induced Movement Therapy on Upper Limb Function in Chronic Stroke: A Single Blinded Randomized Controlled Trial  

Kim, Sunho (Dept. of Occupational Therapy, Young Kwang Rehabilitation Hospital)
Publication Information
Journal of The Korean Society of Integrative Medicine / v.8, no.2, 2020 , pp. 11-20 More about this Journal
Abstract
Purpose : The purpose of this study was to research the effects of dual-hemisphere transcranial direct current stimulation (dual tDCS) and modified constraint-induced movement therapy (mCIMT) to improve upper extremity motor function after stroke. Methods : The study period was from August 2019 to November 2019, and included 24 patients who met the selection criteria. Participants were divided into 2 groups: dual tDCS and mCIMT, and sham dual tDCS and mCIMT group. Dual tDCS and mCIMT group performed mCIMT immediately after applying dual tDCS for 20 minutes, and sham dual tDCS and mCIMT group performed mCIMT immediately after applying sham tDCS for 20 minutes without turning on the power source. Total interventions were conducted 5 times per week for 4 weeks, and mCIMT was conducted for 30 minutes per session for both experimental and control groups. Fugl-Meyer assessment (FMA) and Motor Activity Log scale (MAL) were analyzed before and after 4 weeks of intervention. Results : Both experimental and control groups showed significant changes in FMA, Amount of Use (AOU), and Quality of Movement (QOM) of MAL. When the differences between groups was compared using ANCOVA, the experimental group showed a greater improvement in FMA and AOU of MAL than the control group. Conclusion : In order to enhance the effect of improving upper limb function of stroke patients, dual tDCS could be applied to provide more effective treatment in the clinical setting. Further studies will be needed in larger groups of stroke patients, including long-term follow-up, and multi-group comparisons through the establishment of anodal tDCS and mCIMT, cathodal tDCS, and mCIMT groups to clarify the effects of dual tDCS. In addition, research is needed to establish a protocol for tDCS, and this evidence-based intervention protocol is expected to be used in the clinical setting as an interventional method for various purposes.
Keywords
chronic stroke; dual-hemisphere transcranial direct current stimulation; modified constraint-induced movement therapy group; upper extremity;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Lin KC, Wu CY, Liu JS, et al(2009). Constraint-induced therapy versus dose-matched control intervention to improve motor ability, basic/extended daily functions, and quality of life in stroke. Neurorehabil Neural Repair, 23(2), 160-165. https://doi.org/10.1177/1545968308320642.   DOI
2 Lindenberg R, Renga V, Zhu LL, et al(2010). Bihemispheric brain stimulation facilitates motor recovery in chronic stroke patients. Neurology, 75(24), 2176-2184. https://doi.org/10.1212/WNL.0b013e318202013a.   DOI
3 Mazzoleni S, Tran VD, Dario P, et al(2019). Effects of transcranial direct current stimulation (tDCS) combined with wrist robot-assisted rehabilitation on motor recovery in subacute stroke patients: a randomized controlled trial. IEEE Trans Neural Syst Rehabil Eng, 27(7), 1458-1466. https://doi.org/10.1109/TNSRE.2019.2920576.   DOI
4 Nitsche MA, Liebetanz D, Antal A, et al(2003). Modulation of cortical excitability by weak direct current stimulation--technical, safety and functional aspects. Suppl Clin Neurophysiol, 56, 255-276. https://doi.org/10.1016/s1567-424x(09)70230-2.   DOI
5 Nitsche MA, Paulus W(2000). Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol, 527(3), 633-639. https://doi.org/10.1111/j.1469-7793.2000.t01-1-00633.x.   DOI
6 Nowak DA, Grefkes C, Ameli M, et al(2009). Interhemispheric competition after stroke: brain stimulation to enhance recovery of function of the affected hand. Neurorehabil Neural Repair, 23(7), 641-656. https://doi.org/10.1177/1545968309336661.   DOI
7 Nudo RJ, Wise BM, SiFuentes F, et al(1996). Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science, 272(5269), 1791-1794. https://doi.org/10.1126/science.272.5269.1791.   DOI
8 O'Shea J, Boudrias MH, Stagg CJ, et al(2014). Predicting behavioural response to TDCS in chronic motor stroke. Neuroimage, 85(3), 924-933. https://doi.org/ 10.1016/j.neuroimage.2013.05.096.   DOI
9 Page SJ, Levine P, Leonard A, et al(2008). Modified constraint induced movement therapy in chronic stroke: results of a single blinded randomized controlled trial. Phys Ther, 88(3), 333-340. https://doi.org/10.2522/ptj.20060029.   DOI
10 Page SJ, Fulk GD, Boyne P(2012). Clinically important differences for the upper-extremity Fugl-Meyer Scale in people with minimal to moderate impairment due to chronic stroke. Phys Ther, 92(6), 791-798. https://doi.org/10.2522/ptj.20110009.   DOI
11 Park JH, Kwon YD(1989). Korean version of mini-mental state examination (MMSE-K) part 1: development of the test for the elderly. J Korean Neuropsychiatr Assoc, 28(1), 125-135.
12 Pascual-Leone A, Amedi A, Fregni F, et al(2005). The plastic human brain cortex. Annu Rev Neurosci, 28(1), 377-401. https://doi.org/10.1146/annurev.neuro.27.070203.144216.   DOI
13 Paulus W(2003). Transcranial direct current stimulation (tDCS). Suppl Clin Neurophysiol, 56, 249-254. https://doi.org/10.1016/S1567-424X(09)70229-6.   DOI
14 Smania N, Gandolfi M, Paolucci S, et al(2012). Reduced-intensity modified constraint-induced movement therapy versus conventional therapy for upper extremity rehabilitation after stroke: a multicenter trial. Neurorehabil Neural Repair, 26(9), 1035-1045. https://doi.org/10.1177/1545968312446003.   DOI
15 Plow EB, Cunningham DA, Beall E, et al(2013). Effectiveness and neural mechanisms associated with tDCS delivered to premotor cortex in stroke rehabilitation: study protocol for a randomized controlled trial. Trials, 14(1), 331-340. https://doi.org/10.1186/1745-6215-14-331.   DOI
16 Schlaug G, Renga V, Nair D(2008). Transcranial direct current stimulation in stroke recovery. Arch Neurol, 65(12), 1571-1576. https://doi.org/10.1001/archneur.65.12.1571.   DOI
17 Sehm B, Kipping J, Schafer A, et al(2013). A comparison between uni- and bilateral tDCS effects on functional connectivity of the human motor cortex. Front Hum Neurosci, 7(183), 1-7. https://doi.org/10.3389/fnhum.2013.00183.
18 Taub E, Miller NE, Novack TA, et al(1993). Technique to improve chronic motor deficit after stroke. Arch Phys Med Rehabil, 74(4), 347-354.
19 Stollberg J(1995). Synapse elimination, the size principle, and Hebbian synapses. J Neurobiol, 26(2), 273-282. https://doi.org/10.1002/neu.480260211.   DOI
20 Takebayashi T, Takahashi K, Moriwaki M, et al(2017). Improvement of upper extremity deficit after constraint-induced movement therapy combined with and without preconditioning stimulation using dual-hemisphere transcranial direct current stimulation and peripheral neuromuscular stimulation in chronic stroke patients: a pilot randomized controlled trial. Front Neurol, 8(568), 1-8. https://doi.org/ 10.3389/fneur.2017.00568.
21 Taub E, Uswatte G, King DK, et al(2006). A placebo-controlled trial of constraint-induced movement therapy for upper extremity after stroke. Stroke, 37(4), 1045-1049. https://doi.org/10.1161/01.STR.0000206463.66461.97.   DOI
22 Uswatte G, Taub E, Morris D, et al(2005). Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use. Stroke, 36(11), 2493-2496. https://doi.org/10.1161/01.STR.0000185928.90848.2e.   DOI
23 Wolf SL, Winstein CJ, Miller JP, et al(2006). Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA, 296(17), 2095-2104. https://doi.org/ 10.1001/jama.296.17.2095.   DOI
24 Folstein MF, Folstein SE, McHugh PR(1975). Mini-mental state: a practice method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12(3), 189-198. https://doi.org/10.1016/0022-3956(75)90026-6.   DOI
25 Ateia A, Talat W, Nawito A, et al(2017). Effect of transcranial direct current stimulation on upper extremity functional recovery in stroke patients. J Adv Pharm Educ Res, 7(4), 486-490.
26 Bolognini N, Vallar G, Casati C, et al(2011). Neurophysiological and behavioral effects of tDCS combined With constraint-induced movement therapy in poststroke patients. Neurorehabil Neural Repair, 25(9), 819-829. https://doi.org/10.1177/1545968311411056.   DOI
27 Brogardh C, Vestling M, Sjalund BH(2009). Shortened constraint-induced movement therapy in subacute stroke - no effect of using a restraint: a randomized controlled study with independent observers. J Rehabil Med, 41(4), 231-236. https://doi.org/10.2340/16501977-0312.   DOI
28 Cohen J(2005). Statistical power analysis for the behavioral science. 2nd ed, New York, Routledge Academic, pp.51-55.
29 Dettmers C, Teske U, Hamzei F, et al(2005). Distributed form of constraint-induced movement therapy improves functional outcome and quality of life after stroke. Arch Phys Med Rehabil, 86(2), 204-209. https://doi.org/10.1016/j.apmr.2004.05.007.   DOI
30 Fregni F, Pascual-Leone A(2007). Technology insight: noninvasive brain stimulation in neurology-perspectives on the therapeutic potential of rTMS and tDCS. Nat Clin Pract Neurol, 3(7), 383-393. https://doi.org/10.1038/ncpneuro0530.   DOI
31 Fugl-Meyer AR, Jaasko L, Leyman I, et al(1975). The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med, 7(1), 13-31.
32 Kim SH, Park JH, Jung MY, et al(2016). Effects of task-oriented training as an added treatment to electromyogram-triggered neuromuscular stimulation on upper extremity function in chronic stroke patients. Occup Ther Int, 23(2), 165-174. https://doi.org/10.1002/oti.1421.   DOI
33 Fuzaro AC, Guerreiro CT, Galetti FC, et al(2012). Modified constraint-induced movement therapy and modified forced-use therapy for stroke patients are both effective to promote balance and gait improvements. Rev Bras Fisioter, 16(2), 157-165. https://doi.org/10.1590/s1413-35552012005000010.   DOI
34 Giacobbe V, Krebs HI, Volpe BT, et al(2013). Transcranial direct current stimulation (tDCS) and robotic practice in chronic stroke: the dimension of timing. NeuroRehabilitation, 33(1), 49-56. https://doi.org/10.3233/NRE-130927.   DOI
35 Gladstone DJ, Danells CJ, Black SE(2002). The Fugl-Meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair, 16(3), 232-240. https://doi.org/10.1177/154596802401105171.   DOI
36 Mercier L, Audet T, Hebert R, et al(2001). Impact of motor, cognitive, and perceptual disorders on ability to perform activities of daily living after stroke. Stroke, 32(11), 2602-2608. https://doi.org/10.1161/hs1101.098154.   DOI
37 Lang CE, Edwards DF, Birkenmeier RL, et al(2008). Estimating minimal clinically important differences of upper-extremity measures early after stroke. Arch Phys Med Rehabil, 89(9), 1693-1700. https://doi.org/10.1016/j.apmr.2008.02.022.   DOI
38 Levine P, Page SJ(2004). Modified constraint- induced therapy: A promising restorative outpatient therapy. Top Stroke Rehabil, 11(4), 1-10. https://doi.org/10.1310/R4HN-51MW-JFYK-2JAN.   DOI
39 Liepert J, Bauder H, Wolfgang HR, et al(2000). Treatment-induced cortical reorganization after stroke in humans. Stroke, 31(6), 1210-1216. https://doi.org/10.1161/01.str.31.6.1210.   DOI