Effect of Transcranial Direct Current Stimulation Augmented with Motor Imagery and Upper-Limb Functional Training for Upper-Limb Stroke Rehabilitation: A Prospective Randomized Controlled Trial

Faizan Zaffar Kashoo; Raid Saleem Al-Baradie; Msaad Alzahrani; Ahmad Alanazi; Md Dilshad Manzar; Anchit Gugnani; Mohammad Sidiq; Mohammad Abu Shaphe; Mohamed Sherif Sirajudeen; Mehrunnisha Ahmad; Bader Althumayri; Abdullah Aljandal; Ahmed Almansour; Shady Abdullah Alshewaier; Aksh Chahal

doi:10.3390/ijerph192215199

Effect of Transcranial Direct Current Stimulation Augmented with Motor Imagery and Upper-Limb Functional Training for Upper-Limb Stroke Rehabilitation: A Prospective Randomized Controlled Trial

Int J Environ Res Public Health. 2022 Nov 17;19(22):15199. doi: 10.3390/ijerph192215199.

Authors

Affiliations

¹ Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia.
² Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia.
³ Department of Nursing, College of Applied Medical Sciences, Al Majmaah 11952, Saudi Arabia.
⁴ NIMS College of Physiotherapy and Occupational Therapy, NIMS University Jaipur, Jaipur 303121, Rajasthan, India.
⁵ Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia.
⁶ Department of Physical Therapy, Security Forces Hospital, Riyadh 11564, Saudi Arabia.
⁷ Department of Physical Therapy and Rehabilitation, Al Fayha Club, Al Majmmah 11952, Saudi Arabia.
⁸ Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar, Mullana 133207, Haryana, India.

Abstract

Background: Combining transcranial direct current stimulation (tDCS) with other therapies is reported to produce promising results in patients with stroke. The purpose of the study was to determine the effect of combining tDCS with motor imagery (MI) and upper-limb functional training for upper-limb rehabilitation among patients with chronic stroke.

Methods: A single-center, prospective, randomized controlled trial was conducted among 64 patients with chronic stroke. The control group received sham tDCS with MI, while the experimental group received real tDCS with MI. Both groups performed five different upper-limb functional training exercises coupled with tDCS for 30 min, five times per week for two weeks. Fugl-Meyer's scale (FMA) and the Action Research Arm Test (ARAT) were used to measure the outcome measures at baseline and after the completion of the 10th session.

Results: Analysis of covariance showed significant improvements in the post-test mean scores for FMA (F (414.4) = 35.79, p < 0.001; η² = 0.37) and ARAT (F (440.09) = 37.46, p < 0.001; η² = 0.38) in the experimental group compared to the control group while controlling for baseline scores.

Conclusions: Anodal tDCS stimulation over the affected primary motor cortex coupled with MI and upper-limb functional training reduces impairment and disability of the upper limbs among patients with chronic stroke.

Keywords: Fugl-Meyer’s scale; action research arm test; chronic stroke; motor imagery; transcranial direct current stimulation; upper-limb rehabilitation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Humans
Prospective Studies
Stroke Rehabilitation* / methods
Stroke* / therapy
Transcranial Direct Current Stimulation* / methods
Upper Extremity

Grants and funding

The authors would like to thank the Sheikh Abdullah Stroke Chair at Majmaah University, Majmaah, 11952, Saudi Arabia for supporting this work under project 4/2022.