Clinical Comparison Between HD-tDCS and TDCS for Improving Upper Limb Motor Function: A Randomized, Double-Blinded, Sham-Controlled Trial

Overview

Journal Neural Plast

Specialty Neurology

Date 2024 Apr 8

PMID 38585306

Authors

Yaqin Zeng

Ruidong Cheng

Li Zhang

Shan Fang

Shaomin Zhang

Minmin Wang

Qian Lv

Yunlan Dai

Xinyi Gong

Feng Liang

Affiliations

Soon will be listed here.

Abstract

Background: Stroke is a common and frequently occurring disease among middle-aged and elderly people, with approximately 55%-75% of patients remaining with upper limb dysfunction. How to promote the recovery of motor function at an early stage is crucial to the life of the patient.

Objectives: This study aimed to investigate whether high-definition transcranial direct current stimulation (HD-tDCS) of the primary motor cortex (M1) functional area in poststroke patients in the subacute phase is more effective in improving upper limb function than conventional tDCS.

Methods: This randomized, sham-controlled clinical trial included 69 patients with subcortical stroke. They were randomly divided into the HD-tDCS, anodal tDCS (a-tDCS), and sham groups. Each group received 20 sessions of stimulation. The patients were assessed using the Action Research Arm Test, Fugl-Meyer score for upper extremities, Motor Function Assessment Scale, and modified Barthel index (MBI) pretreatment and posttreatment.

Results: The intragroup comparison scores improved after 4 weeks of treatment. The HD-tDCS group showed a slightly greater, but nonsignificant improvement as compared to a-tDCS group in terms of mean change observed in function of trained items. The MBI score of the HD-tDCS group was maintained up to 8 weeks of follow-up and was higher than that in the a-tDCS group.

Conclusion: Both HD-tDCS and a-tDCS can improve upper limb motor function and daily activities of poststroke patients in the subacute stage. This trial is registered with ChiCTR2000031314.

References

Geroin C, Picelli A, Munari D, Waldner A, Tomelleri C, Smania N . Combined transcranial direct current stimulation and robot-assisted gait training in patients with chronic stroke: a preliminary comparison. Clin Rehabil. 2011; 25(6):537-48. DOI: 10.1177/0269215510389497. View

Marquez J, van Vliet P, McElduff P, Lagopoulos J, Parsons M . Transcranial direct current stimulation (tDCS): does it have merit in stroke rehabilitation? A systematic review. Int J Stroke. 2013; 10(3):306-16. DOI: 10.1111/ijs.12169. View

Pickering R, Hubbard I, Baker K, Parsons M . Assessment of the upper limb in acute stroke: the validity of hierarchal scoring for the Motor Assessment Scale. Aust Occup Ther J. 2010; 57(3):174-82. DOI: 10.1111/j.1440-1630.2009.00810.x. View

Minhas P, Bansal V, Patel J, Ho J, Diaz J, Datta A . Electrodes for high-definition transcutaneous DC stimulation for applications in drug delivery and electrotherapy, including tDCS. J Neurosci Methods. 2010; 190(2):188-97. PMC: 2920288. DOI: 10.1016/j.jneumeth.2010.05.007. View

Stafford J, Brownlow M, Qualley A, Jankord R . AMPA receptor translocation and phosphorylation are induced by transcranial direct current stimulation in rats. Neurobiol Learn Mem. 2017; 150:36-41. DOI: 10.1016/j.nlm.2017.11.002. View

Lyle R . A performance test for assessment of upper limb function in physical rehabilitation treatment and research. Int J Rehabil Res. 1981; 4(4):483-92. DOI: 10.1097/00004356-198112000-00001. View

Giordano J, Bikson M, Kappenman E, Clark V, Coslett H, Hamblin M . Mechanisms and Effects of Transcranial Direct Current Stimulation. Dose Response. 2017; 15(1):1559325816685467. PMC: 5302097. DOI: 10.1177/1559325816685467. View

Borckardt J, Bikson M, Frohman H, Reeves S, Datta A, Bansal V . A pilot study of the tolerability and effects of high-definition transcranial direct current stimulation (HD-tDCS) on pain perception. J Pain. 2011; 13(2):112-20. DOI: 10.1016/j.jpain.2011.07.001. View

Tedesco Triccas L, Burridge J, Hughes A, Verheyden G, Desikan M, Rothwell J . A double-blinded randomised controlled trial exploring the effect of anodal transcranial direct current stimulation and uni-lateral robot therapy for the impaired upper limb in sub-acute and chronic stroke. NeuroRehabilitation. 2015; 37(2):181-91. DOI: 10.3233/NRE-151251. View

10.

Laakso I, Tanaka S, Koyama S, De Santis V, Hirata A . Inter-subject Variability in Electric Fields of Motor Cortical tDCS. Brain Stimul. 2015; 8(5):906-13. DOI: 10.1016/j.brs.2015.05.002. View

11.

Ashizuka A, Mima T, Sawamoto N, Aso T, Oishi N, Sugihara G . Functional relevance of the precuneus in verbal politeness. Neurosci Res. 2014; 91:48-56. DOI: 10.1016/j.neures.2014.10.009. View

12.

Williamson J, James S, He D, Li S, Sidorov E, Yang Y . High-definition transcranial direct current stimulation for upper extremity rehabilitation in moderate-to-severe ischemic stroke: a pilot study. Front Hum Neurosci. 2023; 17():1286238. PMC: 10602806. DOI: 10.3389/fnhum.2023.1286238. View

13.

Hoyer E, Celnik P . Understanding and enhancing motor recovery after stroke using transcranial magnetic stimulation. Restor Neurol Neurosci. 2011; 29(6):395-409. PMC: 3613277. DOI: 10.3233/RNN-2011-0611. View

14.

Tedesco Triccas L, Burridge J, Hughes A, Pickering R, Desikan M, Rothwell J . Multiple sessions of transcranial direct current stimulation and upper extremity rehabilitation in stroke: A review and meta-analysis. Clin Neurophysiol. 2015; 127(1):946-955. DOI: 10.1016/j.clinph.2015.04.067. View

15.

Fertonani A, Miniussi C . Transcranial Electrical Stimulation: What We Know and Do Not Know About Mechanisms. Neuroscientist. 2016; 23(2):109-123. PMC: 5405830. DOI: 10.1177/1073858416631966. View

16.

Shah-Basak P, Sivaratnam G, Teti S, Francois-Nienaber A, Yossofzai M, Armstrong S . High definition transcranial direct current stimulation modulates abnormal neurophysiological activity in post-stroke aphasia. Sci Rep. 2020; 10(1):19625. PMC: 7665190. DOI: 10.1038/s41598-020-76533-0. View

17.

Dmochowski J, Datta A, Bikson M, Su Y, Parra L . Optimized multi-electrode stimulation increases focality and intensity at target. J Neural Eng. 2011; 8(4):046011. DOI: 10.1088/1741-2560/8/4/046011. View

18.

Ahmed I, Mustafaoglu R, Rossi S, Cavdar F, Agyenkwa S, Pang M . Non-invasive Brain Stimulation Techniques for the Improvement of Upper Limb Motor Function and Performance in Activities of Daily Living After Stroke: A Systematic Review and Network Meta-analysis. Arch Phys Med Rehabil. 2023; 104(10):1683-1697. DOI: 10.1016/j.apmr.2023.04.027. View

19.

Bachtiar V, Near J, Johansen-Berg H, Stagg C . Modulation of GABA and resting state functional connectivity by transcranial direct current stimulation. Elife. 2015; 4:e08789. PMC: 4654253. DOI: 10.7554/eLife.08789. View

20.

Morris D, Uswatte G, Crago J, Cook 3rd E, Taub E . The reliability of the wolf motor function test for assessing upper extremity function after stroke. Arch Phys Med Rehabil. 2001; 82(6):750-5. DOI: 10.1053/apmr.2001.23183. View