Combined transcranial Direct Current Stimulation and robot-assisted arm training in patients with stroke: a systematic review

Cristina Fonte; Valentina Varalta; Arianna Rocco; Daniele Munari; Mirko Filippetti; Elisa Evangelista; Angela Modenese; Nicola Smania; Alessandro Picelli

doi:10.3233/RNN-211218

Combined transcranial Direct Current Stimulation and robot-assisted arm training in patients with stroke: a systematic review

Restor Neurol Neurosci. 2021;39(6):435-446. doi: 10.3233/RNN-211218.

Authors

Cristina Fonte^{1

2}, Valentina Varalta^{1

2}, Arianna Rocco¹, Daniele Munari¹, Mirko Filippetti¹, Elisa Evangelista¹, Angela Modenese², Nicola Smania^{1

2}, Alessandro Picelli^{1

2

3}

Affiliations

¹ Neuromotor and Cognitive Rehabilitation Research Center, Section of Physical and Rehabilitation Medicine, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
² Neurorehabilitation Unit, University Hospital of Verona, Verona, Italy.
³ Canadian Advances in Neuro-Orthopedics for Spasticity Congress (CANOSC), Kingston, ON, Canada.

PMID: 34974446
DOI: 10.3233/RNN-211218

Abstract

Background: Upper limb motor deficits in patients with severe stroke often remain unresolved over time. Combining transcranial Direct Current Stimulation with robotic therapy is an innovative neurorehabilitation approach that holds promise to improve upper limb impairment after stroke.

Objective: To investigate the effects of robotic training in combination with transcranial Direct Current Stimulation for treating poststroke upper limb impairment.

Methods: PubMed, MEDLINE, Cochrane Library, and EMBASE electronic databases were searched using keywords, MeSH terms, and strings: "Stroke"[MeSH] AND ("Upper Extremity"[MeSH] OR "upper limb") AND ("Transcranial Direct Current Stimulation" [MeSH] OR "tDCS") AND ("robotics" OR "robotic therapy"). Full-text articles published in English up to October 2020 were included. Each was rated for quality according to the Physiotherapy Database (PEDro) score: eight out of eleven scored more than 8 points; their results were considered reliable for this review.

Results: Of the total of 171 publications retrieved, 11 met the inclusion criteria. The results of studies that examined the same outcome measures were pooled to draw conclusions on the effectiveness of transcranial Direct Current Stimulation and robot-assisted training in corticomotor excitability, upper limb kinematics, muscle strength and tone, function, disability, and quality of life after stroke.

Conclusions: To date, there is insufficient evidence to support the hypothesis that transcranial Direct Current Stimulation enhances the effects of robot-assisted arm training in poststroke patients. Further studies with more accurate, comparable and standardized methodology are needed in order to better define the effects of robotic training in combination with transcranial Direct Current Stimulation on poststroke upper limb impairment. Therefore, given the scarce resources available to rehabilitation researches, other, more promising approaches should be given attention.

Keywords: Brain stimulation; recovery of function; rehabilitation; robotics.

Publication types

Systematic Review

MeSH terms

Arm
Humans
Quality of Life
Recovery of Function
Robotics*
Stroke Rehabilitation* / methods
Stroke* / complications
Stroke* / therapy
Transcranial Direct Current Stimulation* / methods
Upper Extremity