Article

OBJECTIVE: To test whether a multistrategy intervention enhanced recovery
immediately and longitudinally in patients with severe to moderate upper
extremity (UE) paresis. DESIGN: Double-blind, randomized controlled trial with
placebo control. SETTING: Outpatient department of a local medical center.
PARTICIPANTS: People (N=25) with chronic stroke were randomly assigned to 1 of 2
groups: a transcranial direct current stimulation with sensory modulation
(tDCS-SM) group (n=14; mean age +/- SD, 55.3+/-11.4y) or a control group (n=11;
mean age +/- SD, 56.9+/-13.5y). INTERVENTIONS: Eight-week intervention. The
tDCS-SM group received bilateral tDCS, bilateral cutaneous anesthesia, and high
repetitions of passive movements on the paretic hand. The control group received
the same passive movements but with sham tDCS and sham anesthesia. During the
experiment, all participants continued their regular rehabilitation. MAIN OUTCOME
MEASURES: Voluntary UE movement, spasticity, UE function, and basic activities of
daily living. Outcomes were assessed at baseline, at postintervention, and at 3-
and 6-month follow-ups. RESULTS: No significant differences were found between
groups. However, there was a trend that the voluntary UE movement improved more
in the tDCS-SM group than in the control group, with a moderate immediate effect
(partial eta(2) [etap(2)]=.14, P=.07) and moderate long-term effects (3-mo
follow-up: etap(2)=.17, P=.05; 6-mo follow-up: etap(2)=.12, P=.10). Compared with
the control group, the tDCS-SM group had a trend of a small immediate effect
(etap(2)=.02-.04) on reducing spasticity, but no long-term effect. A trend of
small immediate and long-term effects in favor of tDCS-SM was found on UE
function and daily function recovery (etap(2)=.02-.09). CONCLUSIONS: Accompanied
with traditional rehabilitation, tDCS-SM had a nonsignificant trend of having
immediate and longitudinal effects on voluntary UE movement recovery in patients
with severe to moderate UE paresis after stroke, but its effects on spasticity
reduction and functional recovery may be limited.
CI - Copyright (c) 2017 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS