Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial
Abstract Background Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-07-01
|
| Series: | Journal of NeuroEngineering and Rehabilitation |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12984-021-00896-2 |
| _version_ | 1818655311498575872 |
|---|---|
| author | Roberto Llorens María Antonia Fuentes Adrián Borrego Jorge Latorre Mariano Alcañiz Carolina Colomer Enrique Noé |
| author_facet | Roberto Llorens María Antonia Fuentes Adrián Borrego Jorge Latorre Mariano Alcañiz Carolina Colomer Enrique Noé |
| author_sort | Roberto Llorens |
| collection | DOAJ |
| description | Abstract Background Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS). Preliminary studies in mildly impaired individuals in the acute phase post-stroke show intensified effects when action is facilitated by tDCS and mediated by virtual reality (VR) but the effectiveness in cases of severe impairment and chronic stroke is unknown. This study investigated the effectiveness of a combined tDCS and VR-based intervention in the sensorimotor function of chronic individuals post-stroke with persistent severe hemiparesis compared to conventional physical therapy. Methods Twenty-nine participants were randomized into an experimental group, who received 30 minutes of the combined tDCS and VR-based therapy and 30 minutes of conventional physical therapy, or a control group, who exclusively received conventional physical therapy focusing on passive and active assistive range of motion exercises. The sensorimotor function of all participants was assessed before and after 25 one-hour sessions, administered three to five times a week, using the upper extremity subscale of the Fugl-Meyer Assessment, the time and ability subscales of the Wolf Motor Function Test, and the Nottingham Sensory Assessment. Results A clinically meaningful improvement of the upper limb motor function was consistently revealed in all motor measures after the experimental intervention, but not after conventional physical therapy. Similar limited effects were detected in the sensory function in both groups. Conclusion The combined tDCS and VR-based paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy. |
| first_indexed | 2024-12-17T03:07:40Z |
| format | Article |
| id | doaj.art-5b777d8ec87343519e49dc9e67d633ca |
| institution | Directory Open Access Journal |
| issn | 1743-0003 |
| language | English |
| last_indexed | 2024-12-17T03:07:40Z |
| publishDate | 2021-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of NeuroEngineering and Rehabilitation |
| spelling | doaj.art-5b777d8ec87343519e49dc9e67d633ca2022-12-21T22:05:54ZengBMCJournal of NeuroEngineering and Rehabilitation1743-00032021-07-0118111310.1186/s12984-021-00896-2Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trialRoberto Llorens0María Antonia Fuentes1Adrián Borrego2Jorge Latorre3Mariano Alcañiz4Carolina Colomer5Enrique Noé6Neurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de ValènciaNEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales VithasNeurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de ValènciaNeurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de ValènciaNeurorehabilitation and Brain Research Group, Instituto de Investigación e Innovación en Bioingeniería, Universitat Politècnica de ValènciaNEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales VithasNEURORHB. Servicio de Neurorrehabilitación de Hospitales Vithas, Fundación Hospitales VithasAbstract Background Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS). Preliminary studies in mildly impaired individuals in the acute phase post-stroke show intensified effects when action is facilitated by tDCS and mediated by virtual reality (VR) but the effectiveness in cases of severe impairment and chronic stroke is unknown. This study investigated the effectiveness of a combined tDCS and VR-based intervention in the sensorimotor function of chronic individuals post-stroke with persistent severe hemiparesis compared to conventional physical therapy. Methods Twenty-nine participants were randomized into an experimental group, who received 30 minutes of the combined tDCS and VR-based therapy and 30 minutes of conventional physical therapy, or a control group, who exclusively received conventional physical therapy focusing on passive and active assistive range of motion exercises. The sensorimotor function of all participants was assessed before and after 25 one-hour sessions, administered three to five times a week, using the upper extremity subscale of the Fugl-Meyer Assessment, the time and ability subscales of the Wolf Motor Function Test, and the Nottingham Sensory Assessment. Results A clinically meaningful improvement of the upper limb motor function was consistently revealed in all motor measures after the experimental intervention, but not after conventional physical therapy. Similar limited effects were detected in the sensory function in both groups. Conclusion The combined tDCS and VR-based paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy.https://doi.org/10.1186/s12984-021-00896-2Transcranial direct current stimulationVirtual realityEye-trackingSurface electromyographyHemiparesisStroke |
| spellingShingle | Roberto Llorens María Antonia Fuentes Adrián Borrego Jorge Latorre Mariano Alcañiz Carolina Colomer Enrique Noé Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial Journal of NeuroEngineering and Rehabilitation Transcranial direct current stimulation Virtual reality Eye-tracking Surface electromyography Hemiparesis Stroke |
| title | Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial |
| title_full | Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial |
| title_fullStr | Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial |
| title_full_unstemmed | Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial |
| title_short | Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial |
| title_sort | effectiveness of a combined transcranial direct current stimulation and virtual reality based intervention on upper limb function in chronic individuals post stroke with persistent severe hemiparesis a randomized controlled trial |
| topic | Transcranial direct current stimulation Virtual reality Eye-tracking Surface electromyography Hemiparesis Stroke |
| url | https://doi.org/10.1186/s12984-021-00896-2 |
| work_keys_str_mv | AT robertollorens effectivenessofacombinedtranscranialdirectcurrentstimulationandvirtualrealitybasedinterventiononupperlimbfunctioninchronicindividualspoststrokewithpersistentseverehemiparesisarandomizedcontrolledtrial AT mariaantoniafuentes effectivenessofacombinedtranscranialdirectcurrentstimulationandvirtualrealitybasedinterventiononupperlimbfunctioninchronicindividualspoststrokewithpersistentseverehemiparesisarandomizedcontrolledtrial AT adrianborrego effectivenessofacombinedtranscranialdirectcurrentstimulationandvirtualrealitybasedinterventiononupperlimbfunctioninchronicindividualspoststrokewithpersistentseverehemiparesisarandomizedcontrolledtrial AT jorgelatorre effectivenessofacombinedtranscranialdirectcurrentstimulationandvirtualrealitybasedinterventiononupperlimbfunctioninchronicindividualspoststrokewithpersistentseverehemiparesisarandomizedcontrolledtrial AT marianoalcaniz effectivenessofacombinedtranscranialdirectcurrentstimulationandvirtualrealitybasedinterventiononupperlimbfunctioninchronicindividualspoststrokewithpersistentseverehemiparesisarandomizedcontrolledtrial AT carolinacolomer effectivenessofacombinedtranscranialdirectcurrentstimulationandvirtualrealitybasedinterventiononupperlimbfunctioninchronicindividualspoststrokewithpersistentseverehemiparesisarandomizedcontrolledtrial AT enriquenoe effectivenessofacombinedtranscranialdirectcurrentstimulationandvirtualrealitybasedinterventiononupperlimbfunctioninchronicindividualspoststrokewithpersistentseverehemiparesisarandomizedcontrolledtrial |