PTOTRCTJournal of neuroengineering and rehabilitation2020

Effects of transcranial direct current stimulation with virtual reality on upper limb function in patients with ischemic stroke: a randomized controlled trial.

Xiaoling Yao, Lijun Cui, Jixian Wang and 3 others

PMID 32539812

WHAT IT FOUND

Adding real cathodal tDCS to VR and conventional occupational and physical therapy improved upper limb impairment after ischemic stroke more than sham tDCS with the same VR and conventional occupational and physical therapy in this small trial.

Key findings

01The primary upper limb impairment outcome showed a larger improvement with real c-tDCS plus VR than with sham tDCS plus VR (P = 0.003).

02Both groups improved on upper limb and daily living measures after treatment, and change scores were larger in the real c-tDCS group.

03Minor adverse effects were reported in the real c-tDCS group: 4 patients tingling and 1 patient itching.

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

Single-center, relatively small sample, so the findings need replication. The study was single-blind, which may introduce bias. All patients also received conventional occupational and physical therapy, and rehabilitation outside the trial could not be quantified or controlled. Only patients who could induce a motor evoked potential in the contralesional first dorsal interossei muscle were included, and aphasia, unilateral neglect or cognitive deficits were excluded. Most patients were about 60 days after stroke, so the results may not apply equally to very early or very late recovery. Evaluations were done 1 day before and after intervention, so longer-term effects were not measured.

Declared interests

Funding came from Shanghai Jiao Tong University School of Medicine-Institute of Neuroscience, Chinese Academy of Sciences, Leading Startup Project of Brain Diseases Clinical Research Center. No author conflicts of interest are stated in the supplied text.

The easy way to misread this

Do not conclude that tDCS alone caused the improvement. The trial delivered c-tDCS, VR and conventional occupational and physical therapy together, so the contribution of any single component cannot be separated.

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