Effect of a tailored upper extremity strength training intervention combined with direct current stimulation in chronic stroke survivors: A Randomized Controlled Trial.
Stephania Palimeris, Yekta Ansari, Anthony Remaud and 4 others
PMID 36189037WHAT IT FOUND
Tailoring strength training intensity to individual brain excitability markers improved arm function and grip in chronic stroke survivors.
Adding anodal tDCS provided no further benefit. The training gains occurred regardless of whether participants received real or sham stimulation.
Key findings
01Strength training tailored to MEP amplitude significantly improved upper limb impairment, dexterity, and grip strength.
02Combining anodal tDCS with the training program did not result in greater gains than training with sham stimulation.
03Participants in all intensity groups showed similar levels of improvement, indicating the tailored approach benefited those with varying degrees of corticospinal integrity.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study excluded individuals with major impairments, significant spasticity, pain, or sensory deficits, so results may not apply to the most severely affected stroke survivors. Many participants had high baseline Fugl-Meyer scores, which may have masked subtle improvements in motor impairment due to ceiling effects. Data collection occurred at three different sites with varying equipment, which could introduce inconsistency. The tDCS protocol used a unihemispheric montage at 2 mA, which may not have been optimal compared to other parameters like bihemispheric montages or higher intensities.
Declared interests
The authors declare no commercial or financial conflicts of interest. Funding was provided by Brain Canada Foundation, Fonds de recherche du Québec-Santé, Fondation Vitae, CRIR, Jewish Rehabilitation Hospital Foundation, Canadian Foundation for Innovation, and McGill University's HBHL initiative.
The easy way to misread this
Do not conclude that tDCS is ineffective for all stroke rehabilitation protocols. This study found no benefit from adding anodal tDCS to a specific tailored strength training program, but this does not rule out benefits from different stimulation montages, intensities, or combinations with other therapies.