Transcranial direct current stimulation over the motor and premotor cortex with mirror therapy improves motor control, muscle function, and brain activity in chronic stroke: a double-blind randomized sham-controlled trial.

The trial included only 36 participants, and two in the premotor group, two in the motor cortex group, and one in the sham group declined kinematic assessments, so the movement analysis did not include all 36 participants. Participants had mild to moderate chronic stroke impairment, so results may not apply to severe upper limb impairment. Assessments were only one week before and after intervention, with no longer follow-up reported. The trial measured many kinematic, muscle, and brain outcomes, and some active group changes were not mirrored by between-group differences. All groups received tDCS, either active or sham, plus mirror therapy and functional task practice, so improvements cannot be attributed to tDCS alone. The authors note that stimulation of premotor and motor cortex may affect each other because of neural connections. The authors note findings may apply only to chronic stroke patients with moderate-to-mild impairment.

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Do not conclude that tDCS alone caused the improvements. All groups received tDCS, either active or sham, plus mirror therapy and functional task practice, and the sham group also showed trunk kinematic changes and brain activity shifts.