Article

No rehabilitation intervention has effectively improved functional
use of the arm and hand in patients with severe upper limb paresis after stroke.
Pilot studies suggest the potential for transcranial direct current stimulation
and bilateral robotic training to enhance gains.
OBJECTIVE: In a double-blind,
randomized trial the combination of these interventions was tested. This
study randomized 96 patients with an ischemic supratentorial lesion of 3 to 8
weeks' duration with severe impairment of motor control with a Fugl-Meyer score
(FMS) for the upper limb <18 into 3 groups. For 6 weeks, group A received anodal
stimulation of the lesioned hemisphere, group B received cathodal stimulation of
the nonlesioned side for 20 minutes at 2.0 mA, and group C received sham
stimulation. The electrodes were placed over the hand area and above the
contralateral orbit. Contemporaneously, the subjects practiced 400 repetitions
each of 2 different bilateral movements on a robotic assistive device. RESULTS:
The groups were matched at onset. The FMS improved in all patients at 6 weeks (P
< .001). No between-group differences were found; initial versus finish FMS
scores were 7.8 +/- 3.8 versus 19.1 +/- 14.4 in group A, 7.9 +/- 3.4 versus 18.8
+/- 10.5 in group B, and 8.2 +/- 4.4 versus 19.2 +/- 15.0 in group C. No
significant changes between groups were present at 3 months. CONCLUSIONS: Neither
anodal nor cathodal transcranial direct current stimulation enhanced the effect
of bilateral arm training in this exploratory trial of patients with cortical
involvement and severe weakness. Unilateral hand training and upregulation of the
nonlesioned hemisphere might also be tried in this population.

Langue : ANGLAIS