Effect of Transcranial Direct Current Stimulation on Severely Affected Arm-Hand Motor Function in Patients After an Acute Ischemic Stroke: A Pilot Randomized Control Trial.
Meheroz H Rabadi, Christopher E Aston
PMID 28837443WHAT IT FOUND
Cathodal tDCS plus occupational therapy did not improve arm-hand function more than sham plus occupational therapy after severe acute stroke.
The tDCS group gained 10 points on the 57-point arm-hand test versus 2 with sham, but 16 patients were too few.
Key findings
01At discharge, the cathodal tDCS group improved 10 points on the Action Research Arm Test, compared with 2 points in the sham group, but the difference did not reach significance.
02No adverse effects were reported except a tingling sensation at the scalp electrode site, which occurred in both active and sham groups.
03Changes in total Functional Independence Measure and FIM-ADL scores were similar in both groups and not significant.
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 was a pilot with 16 randomized patients, and the primary outcome did not reach significance, so it cannot establish an effect. All participants were men, and all had severe arm-hand weakness (MRC grade 2 or less), so results do not extend to women or milder stroke. Four patients were lost to follow-up, and outcomes were assessed only at discharge and 3 months, so longer-term effects are unknown. Cathodal tDCS was always given with an additional hour of occupational therapy, so the separate contribution of tDCS cannot be determined. The electrode placement method may not localize the target as accurately as fMRI or TMS-based placement. The post-hoc subcortical infarct finding is not a planned test of efficacy and should not guide treatment choice. The study was single-center, which limits generalization.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not read the 10-point Action Research Arm Test gain as proof that tDCS works. It did not reach significance (p = 0.18), and it was given with an extra hour of occupational therapy, so the therapy contribution cannot be separated.