Bihemispheric-tDCS and upper limb rehabilitation improves retention of motor function in chronic stroke

A pilot study

Alicia M. Goodwill, Wei-Peng Teo, Prue Morgan, Robin M. Daly, Dawson J. Kidgell

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)

Abstract

Background: Single sessions of bihemispheric transcranial direct-current stimulation (bihemispheric-tDCS) with concurrent rehabilitation improves motor function in stroke survivors, which outlasts the stimulation period. However few studies have investigated the behavioral and neurophysiological adaptations following a multi-session intervention of bihemispheric-tDCS concurrent with rehabilitation. 

Objective: This pilot study explored the immediate and lasting effects of 3-weeks of bihemispheric-tDCS and upper limb (UL) rehabilitation on motor function and corticospinal plasticity in chronic stroke survivors. 

Methods: Fifteen chronic stroke survivors underwent 3-weeks of UL rehabilitation with sham or real bihemispheric-tDCS. UL motor function was assessed via the Motor Assessment Scale (MAS), Tardieu Scale and grip strength. Corticospinal plasticity was indexed by motor evoked potentials (MEPs), cortical silent period (CSP) and short-interval intracortical inhibition (SICI) recorded from the paretic and non-paretic ULs, using transcranial magnetic stimulation (TMS). Measures were taken at baseline, 48 h post and 3-weeks following (follow-up) the intervention. 

Results: MAS improved following both real-tDCS (62%) and sham-tDCS (43%, P <0.001), however at 3-weeks follow-up, the real-tDCS condition retained these newly regained motor skills to a greater degree than sham-tDCS (real-tDCS 64%, sham-tDCS 21%, P = 0.002). MEP amplitudes from the paretic UL increased for real-tDCS (46%: P <0.001) and were maintained at 3-weeks follow-up (38%: P = 0.03), whereas no changes were observed with sham-tDCS. No changes in MEPs from the non-paretic nor SICI from the paretic UL were observed for either group. SICI from the non-paretic UL was greater at follow-up, for real-tDCS (27%: P = 0.04). CSP from the non-paretic UL increased by 33% following the intervention for real-tDCS compared with sham-tDCS (P = 0.04), which was maintained at 3-weeks follow-up (24%: P = 0.04). 

Conclusion: bihemispheric-tDCS improved retention of gains in motor function, which appears to be modulated through intracortical inhibitory pathways in the contralesional primary motor cortex (M1). The findings provide preliminary evidence for the benefits of bihemispheric-tDCS during rehabilitation. Larger clinical trials are warranted to examine long term benefits of bihemispheric-tDCS in a stroke affected population.

Original languageEnglish
Article number258
Number of pages14
JournalFrontiers in Human Neuroscience
Volume10
DOIs
Publication statusPublished - 9 Jun 2016

Keywords

  • Bihemispheric-tDCS
  • Chronic stroke
  • Corticospinal excitability
  • Intracortical inhibition
  • Motor function
  • Rehabilitation

Cite this

@article{f960fe1c007d440fb6399e808c8d82a4,
title = "Bihemispheric-tDCS and upper limb rehabilitation improves retention of motor function in chronic stroke: A pilot study",
abstract = "Background: Single sessions of bihemispheric transcranial direct-current stimulation (bihemispheric-tDCS) with concurrent rehabilitation improves motor function in stroke survivors, which outlasts the stimulation period. However few studies have investigated the behavioral and neurophysiological adaptations following a multi-session intervention of bihemispheric-tDCS concurrent with rehabilitation. Objective: This pilot study explored the immediate and lasting effects of 3-weeks of bihemispheric-tDCS and upper limb (UL) rehabilitation on motor function and corticospinal plasticity in chronic stroke survivors. Methods: Fifteen chronic stroke survivors underwent 3-weeks of UL rehabilitation with sham or real bihemispheric-tDCS. UL motor function was assessed via the Motor Assessment Scale (MAS), Tardieu Scale and grip strength. Corticospinal plasticity was indexed by motor evoked potentials (MEPs), cortical silent period (CSP) and short-interval intracortical inhibition (SICI) recorded from the paretic and non-paretic ULs, using transcranial magnetic stimulation (TMS). Measures were taken at baseline, 48 h post and 3-weeks following (follow-up) the intervention. Results: MAS improved following both real-tDCS (62{\%}) and sham-tDCS (43{\%}, P <0.001), however at 3-weeks follow-up, the real-tDCS condition retained these newly regained motor skills to a greater degree than sham-tDCS (real-tDCS 64{\%}, sham-tDCS 21{\%}, P = 0.002). MEP amplitudes from the paretic UL increased for real-tDCS (46{\%}: P <0.001) and were maintained at 3-weeks follow-up (38{\%}: P = 0.03), whereas no changes were observed with sham-tDCS. No changes in MEPs from the non-paretic nor SICI from the paretic UL were observed for either group. SICI from the non-paretic UL was greater at follow-up, for real-tDCS (27{\%}: P = 0.04). CSP from the non-paretic UL increased by 33{\%} following the intervention for real-tDCS compared with sham-tDCS (P = 0.04), which was maintained at 3-weeks follow-up (24{\%}: P = 0.04). Conclusion: bihemispheric-tDCS improved retention of gains in motor function, which appears to be modulated through intracortical inhibitory pathways in the contralesional primary motor cortex (M1). The findings provide preliminary evidence for the benefits of bihemispheric-tDCS during rehabilitation. Larger clinical trials are warranted to examine long term benefits of bihemispheric-tDCS in a stroke affected population.",
keywords = "Bihemispheric-tDCS, Chronic stroke, Corticospinal excitability, Intracortical inhibition, Motor function, Rehabilitation",
author = "Goodwill, {Alicia M.} and Wei-Peng Teo and Prue Morgan and Daly, {Robin M.} and Kidgell, {Dawson J.}",
year = "2016",
month = "6",
day = "9",
doi = "10.3389/fnhum.2016.00258",
language = "English",
volume = "10",
journal = "Frontiers in Human Neuroscience",
issn = "1662-5161",
publisher = "Frontiers Research Foundation",

}

Bihemispheric-tDCS and upper limb rehabilitation improves retention of motor function in chronic stroke : A pilot study. / Goodwill, Alicia M.; Teo, Wei-Peng; Morgan, Prue; Daly, Robin M.; Kidgell, Dawson J.

In: Frontiers in Human Neuroscience, Vol. 10, 258, 09.06.2016.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Bihemispheric-tDCS and upper limb rehabilitation improves retention of motor function in chronic stroke

T2 - A pilot study

AU - Goodwill, Alicia M.

AU - Teo, Wei-Peng

AU - Morgan, Prue

AU - Daly, Robin M.

AU - Kidgell, Dawson J.

PY - 2016/6/9

Y1 - 2016/6/9

N2 - Background: Single sessions of bihemispheric transcranial direct-current stimulation (bihemispheric-tDCS) with concurrent rehabilitation improves motor function in stroke survivors, which outlasts the stimulation period. However few studies have investigated the behavioral and neurophysiological adaptations following a multi-session intervention of bihemispheric-tDCS concurrent with rehabilitation. Objective: This pilot study explored the immediate and lasting effects of 3-weeks of bihemispheric-tDCS and upper limb (UL) rehabilitation on motor function and corticospinal plasticity in chronic stroke survivors. Methods: Fifteen chronic stroke survivors underwent 3-weeks of UL rehabilitation with sham or real bihemispheric-tDCS. UL motor function was assessed via the Motor Assessment Scale (MAS), Tardieu Scale and grip strength. Corticospinal plasticity was indexed by motor evoked potentials (MEPs), cortical silent period (CSP) and short-interval intracortical inhibition (SICI) recorded from the paretic and non-paretic ULs, using transcranial magnetic stimulation (TMS). Measures were taken at baseline, 48 h post and 3-weeks following (follow-up) the intervention. Results: MAS improved following both real-tDCS (62%) and sham-tDCS (43%, P <0.001), however at 3-weeks follow-up, the real-tDCS condition retained these newly regained motor skills to a greater degree than sham-tDCS (real-tDCS 64%, sham-tDCS 21%, P = 0.002). MEP amplitudes from the paretic UL increased for real-tDCS (46%: P <0.001) and were maintained at 3-weeks follow-up (38%: P = 0.03), whereas no changes were observed with sham-tDCS. No changes in MEPs from the non-paretic nor SICI from the paretic UL were observed for either group. SICI from the non-paretic UL was greater at follow-up, for real-tDCS (27%: P = 0.04). CSP from the non-paretic UL increased by 33% following the intervention for real-tDCS compared with sham-tDCS (P = 0.04), which was maintained at 3-weeks follow-up (24%: P = 0.04). Conclusion: bihemispheric-tDCS improved retention of gains in motor function, which appears to be modulated through intracortical inhibitory pathways in the contralesional primary motor cortex (M1). The findings provide preliminary evidence for the benefits of bihemispheric-tDCS during rehabilitation. Larger clinical trials are warranted to examine long term benefits of bihemispheric-tDCS in a stroke affected population.

AB - Background: Single sessions of bihemispheric transcranial direct-current stimulation (bihemispheric-tDCS) with concurrent rehabilitation improves motor function in stroke survivors, which outlasts the stimulation period. However few studies have investigated the behavioral and neurophysiological adaptations following a multi-session intervention of bihemispheric-tDCS concurrent with rehabilitation. Objective: This pilot study explored the immediate and lasting effects of 3-weeks of bihemispheric-tDCS and upper limb (UL) rehabilitation on motor function and corticospinal plasticity in chronic stroke survivors. Methods: Fifteen chronic stroke survivors underwent 3-weeks of UL rehabilitation with sham or real bihemispheric-tDCS. UL motor function was assessed via the Motor Assessment Scale (MAS), Tardieu Scale and grip strength. Corticospinal plasticity was indexed by motor evoked potentials (MEPs), cortical silent period (CSP) and short-interval intracortical inhibition (SICI) recorded from the paretic and non-paretic ULs, using transcranial magnetic stimulation (TMS). Measures were taken at baseline, 48 h post and 3-weeks following (follow-up) the intervention. Results: MAS improved following both real-tDCS (62%) and sham-tDCS (43%, P <0.001), however at 3-weeks follow-up, the real-tDCS condition retained these newly regained motor skills to a greater degree than sham-tDCS (real-tDCS 64%, sham-tDCS 21%, P = 0.002). MEP amplitudes from the paretic UL increased for real-tDCS (46%: P <0.001) and were maintained at 3-weeks follow-up (38%: P = 0.03), whereas no changes were observed with sham-tDCS. No changes in MEPs from the non-paretic nor SICI from the paretic UL were observed for either group. SICI from the non-paretic UL was greater at follow-up, for real-tDCS (27%: P = 0.04). CSP from the non-paretic UL increased by 33% following the intervention for real-tDCS compared with sham-tDCS (P = 0.04), which was maintained at 3-weeks follow-up (24%: P = 0.04). Conclusion: bihemispheric-tDCS improved retention of gains in motor function, which appears to be modulated through intracortical inhibitory pathways in the contralesional primary motor cortex (M1). The findings provide preliminary evidence for the benefits of bihemispheric-tDCS during rehabilitation. Larger clinical trials are warranted to examine long term benefits of bihemispheric-tDCS in a stroke affected population.

KW - Bihemispheric-tDCS

KW - Chronic stroke

KW - Corticospinal excitability

KW - Intracortical inhibition

KW - Motor function

KW - Rehabilitation

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U2 - 10.3389/fnhum.2016.00258

DO - 10.3389/fnhum.2016.00258

M3 - Article

VL - 10

JO - Frontiers in Human Neuroscience

JF - Frontiers in Human Neuroscience

SN - 1662-5161

M1 - 258

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