Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial
Background: Constraint-induced movement therapy (CIMT) and transcranial direct current stimulation (tDCS) are used to reduce interhemispheric imbalance after stroke, which is why the combination of these therapies has been used for neurological recovery, but not in the acute phase. Objectives: To ev...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | Brain Stimulation |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1935861X2200256X |
| _version_ | 1797904540483190784 |
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| author | Maricel Garrido M Evelyn Álvarez E Fabrizio Acevedo P Álvaro Moyano V Natalia Castillo N Gabriel Cavada Ch |
| author_facet | Maricel Garrido M Evelyn Álvarez E Fabrizio Acevedo P Álvaro Moyano V Natalia Castillo N Gabriel Cavada Ch |
| author_sort | Maricel Garrido M |
| collection | DOAJ |
| description | Background: Constraint-induced movement therapy (CIMT) and transcranial direct current stimulation (tDCS) are used to reduce interhemispheric imbalance after stroke, which is why the combination of these therapies has been used for neurological recovery, but not in the acute phase. Objectives: To evaluate the effectiveness of combining active or sham bihemispheric tDCS with modified CIMT (mCIMT) for the recovery of the Upper Limb (UL) in hospitalized patients with acute and subacute stroke. Methods: This randomized controlled, double-blind, placebo-controlled, parallel group clinical trial was executed between September 2018 to March 2021 recruited 70 patients. The patients were randomized to one of two groups to receive treatment for 7 consecutive days, which included 20 min of active or sham bihemispheric tDCS daily (anodal ipsilesional and cathodal contralesional), with an mCIMT protocol. The primary outcome was the difference in the evolution of motor and functional upper limb recovery with assessment on days 0, 5, 7, 10 and 90. The secondary outcomes were independence in activities of daily living (ADL) and quality of life. Results: The active group presented a statistically significant gap compared to the simulated group throughout the trend in the scores of the FMA (motor function and joint pain) and WMFT (functional ability and weight to box) (p < 0.05) and showed a minimal clinically important difference (FMA: difference between groups of 4.9 points [CI: 0.007- 9.799]; WMFT: difference between groups of 6.54 points [CI: 1.10-14.15]). In the secondary outcomes, there was a significant difference between the groups in ADL independence (Functional Independence Measure: difference of 8.63 [CI: 1.37-18.64]) and perceived recovery of quality of life evaluated at 90 days (p = 0.0176). Conclusions: Combining mCIMT with bihemispheric tDCS in patients hospitalized with acute-subacute stroke allows us to maximize the motor and functional recovery of the paretic upper limb in the early stages and independence in ADL, maintaining the effects over time. |
| first_indexed | 2024-04-10T09:50:32Z |
| format | Article |
| id | doaj.art-0ad1966afd304a38b8e9cd092f4be180 |
| institution | Directory Open Access Journal |
| issn | 1935-861X |
| language | English |
| last_indexed | 2024-04-10T09:50:32Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brain Stimulation |
| spelling | doaj.art-0ad1966afd304a38b8e9cd092f4be1802023-02-17T04:50:44ZengElsevierBrain Stimulation1935-861X2023-01-011614047Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trialMaricel Garrido M0Evelyn Álvarez E1Fabrizio Acevedo P2Álvaro Moyano V3Natalia Castillo N4Gabriel Cavada Ch5Servicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, Chile; Corresponding author. Hospital Clínico Universidad de Chile. Carlos Lorca Tobar #999, Independencia, Santiago, 8380456, Chile.Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile; Departamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Santiago, ChileServicio de Medicina Física y Rehabilitación, Hospital San José, Santiago, ChileServicio de Medicina Física y Rehabilitación, Hospital Clínico Universidad de Chile, Santiago, ChileDepartamento de Terapia Ocupacional y Ciencia de la Ocupación, Universidad de Chile, Santiago, ChileEscuela de Salud Pública, Universidad de Chile, Santiago, ChileBackground: Constraint-induced movement therapy (CIMT) and transcranial direct current stimulation (tDCS) are used to reduce interhemispheric imbalance after stroke, which is why the combination of these therapies has been used for neurological recovery, but not in the acute phase. Objectives: To evaluate the effectiveness of combining active or sham bihemispheric tDCS with modified CIMT (mCIMT) for the recovery of the Upper Limb (UL) in hospitalized patients with acute and subacute stroke. Methods: This randomized controlled, double-blind, placebo-controlled, parallel group clinical trial was executed between September 2018 to March 2021 recruited 70 patients. The patients were randomized to one of two groups to receive treatment for 7 consecutive days, which included 20 min of active or sham bihemispheric tDCS daily (anodal ipsilesional and cathodal contralesional), with an mCIMT protocol. The primary outcome was the difference in the evolution of motor and functional upper limb recovery with assessment on days 0, 5, 7, 10 and 90. The secondary outcomes were independence in activities of daily living (ADL) and quality of life. Results: The active group presented a statistically significant gap compared to the simulated group throughout the trend in the scores of the FMA (motor function and joint pain) and WMFT (functional ability and weight to box) (p < 0.05) and showed a minimal clinically important difference (FMA: difference between groups of 4.9 points [CI: 0.007- 9.799]; WMFT: difference between groups of 6.54 points [CI: 1.10-14.15]). In the secondary outcomes, there was a significant difference between the groups in ADL independence (Functional Independence Measure: difference of 8.63 [CI: 1.37-18.64]) and perceived recovery of quality of life evaluated at 90 days (p = 0.0176). Conclusions: Combining mCIMT with bihemispheric tDCS in patients hospitalized with acute-subacute stroke allows us to maximize the motor and functional recovery of the paretic upper limb in the early stages and independence in ADL, maintaining the effects over time.http://www.sciencedirect.com/science/article/pii/S1935861X2200256XStrokeTranscranial direct current stimulationUpper limbConstraint induced movement therapyOccupational therapyEarly rehabilitation |
| spellingShingle | Maricel Garrido M Evelyn Álvarez E Fabrizio Acevedo P Álvaro Moyano V Natalia Castillo N Gabriel Cavada Ch Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial Brain Stimulation Stroke Transcranial direct current stimulation Upper limb Constraint induced movement therapy Occupational therapy Early rehabilitation |
| title | Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial |
| title_full | Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial |
| title_fullStr | Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial |
| title_full_unstemmed | Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial |
| title_short | Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial |
| title_sort | early transcranial direct current stimulation with modified constraint induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke a randomized multicentre double blind clinical trial |
| topic | Stroke Transcranial direct current stimulation Upper limb Constraint induced movement therapy Occupational therapy Early rehabilitation |
| url | http://www.sciencedirect.com/science/article/pii/S1935861X2200256X |
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