Effect Of Non-Invasive Brain Stimulation On Upper Limb Function In Stroke

Effect of Combined Low-frequency Repetitive Transcranial Magnetic Stimulation and Virtual Reality Training on Upper Limb Function in Subacute Stroke:a Double-blind Randomized Controlled TrailObjective The effect of combined low-frequency repetitive transcranial magnetic stimulation (LF rTMS) and virtual reality (VR) training in patients after stroke was assessed. Methods In a double-blind randomized controlled trial,112 patients withhemiplegia after stroke were randomly divided into two groups:experimental and control. In experimental group, the patients received LF rTMS and VR training treatment, and those in control group received sham rTMS and VR training treatment. Participants in both groups received therapy of 5 days per week for 4 weeks. The primary endpoint including the upper limb motor function test of Fugl-meyer assessment (U-FMA) and wolf motor function test (WMFT), and the secondary endpoint including the stage of Brunnstrom, Modified Ashworth Scale (MAS), Hamilton Depression Scale (HAMD), modified Barthel index (MBI) and 36-item Short Form Health Survey Questionnaire (SF-36) were assessed before and 4 weeks after treatment. Results Totally,108 subjects completed the study (55 in experimental group and 53 in control group respectively). After 4-week treatment, the U-FMA scores, WMFT scores, Brunnstrom stages, HAMD scores, MAS scores, MBI scores and SF-36 scores were significantly increased in the experimental group as compared with the control group (P<0.05, P<0.01). Conclusions The results suggested the combined use of LF rTMS with VR training could effectively improve the upper limb function, the living activity, and the quality of life in patients with hemiplegia following subacute stroke, which may provide a better rehabilitation treatment for subacute stroke.Effectiveness of Transcranial Direct Current Stimulation in Stroke Patients with Upper Motor Dysfunction:A Meta-analysisObjective To evaluate the effectiveness of transcranial direct current stimulation (tDCS) in treating stroke patients with upper motor dysfunction in. Methods The Cochrane Library, MEDLINE, EMbase, CBMdisc, CNKI and Wanfang Data were searched from their inception to January 2014. and the references of the included studies were also retrieved to collect the randomized controlled trials (RCTs) on tDCS in treating stroke patients with upper motor dysfunction. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. The meta-analysis was performed using RevMan 5.0 software, and evidence quality and recommendation level were assessed using the GRADE system.Results A total of 9 RCTs were included. The results of meta-analysis (including 7 RCTs, very low quality) showed that, compared with the sham tDCS group, the a-tDCS group which stimulated the area of primary motor cortex did not increase the score of upper limb Fugl-Meyer Assessment (WMD=3.39,95% CI-2.35 to 9.13) and Jebsen-Taylor Hand Function Test (WMD=-2.67,95% CI-5.44 to 0.10) Conclusions It is still uncertain of the effectiveness of a-tDCS in improving upper motor dysfunction of stroke patients, but a-tDCS has broad application prospects in clinic.Effect of Transcranial Direct Current Stimulation on Upper Limb Function in Stroke:a Double-blind Randomized Controlled TrailObjective To evaluate the effect of combined anodal transcranial direct current stimulation (a-tDCS) and conventional rehabilitation training on upper motor function in individuals in stroke.Methods In a double-blind randomized controlled trial,96 patients with hemiplegia after stroke were randomly divided into two groups:experimental and control. In experimental group, the patients received a-tDCS and conventional rehabilitation training treatment, and those in control group received sham tDCS and conventional rehabilitation training treatment. Participants in both groups received therapy of 5 days per week for 4 weeks. The primary endpoint including the upper limb motor function test of Fugl-meyer assessment (U-FMA) and wolf motor function test (WMFT), and the secondary endpoint including the stage of Brunnstrom^ Modified Ashworth Scale (MAS)?modified Barthel index (MBI) and 36-item Short Form Health Survey Questionnaire (SF-36) were assessed before and 4 weeks after treatment. After 3 months of follow-up, the U-FMA scores, WMFT scores, MAS scores, MBI scores and SF-36 scores were assessed.Results Totally,87 subjects completed the study (44 in experimental group and 43 in control group respectively). There were significant differences in the U-FMA scores, WMFT scores, MAS scores, MBI scores and SF-36 scores in each group between prior to and after treatment (P<0.05,P<0.01). Compared with the sham tDCS group after treatment, the a-tDCS group of the U-FMA scores, WMFT scores, MAS scores, MBI scores and SF-36 scores were significantly higher (P<0.05, P< 0.01). After 3 months of follow-up, the U-FMA scores, WMFT scores, MAS scores, MBI scores and SF-36 scores were significantly increased in the a-tDCS group as compared with the sham tDCS group (P<0.05, P<0.01).Conclusions The results suggested the combined use of a-tDCS with conventional rehabilitation training could effectively improve the upper limb function, the living activity, and the quality of life in patients with hemiplegia following stroke, which may provide a better rehabilitation treatment for stroke.