Affiliations: Klinik Berlin, Department of Neurological
Rehabilitation, Charité – University Medicine Berlin,
Germany | Klinikum Ernst von Bergmann, Department of Physical
Medicine and Rehabilitation, Potsdam, Germany | Addenbrooke's Hospital, Cambridge, UK
Abstract: Background and Purpose: Preliminary reports suggest that central
stimulation may enhance the effect of conventional physical therapies after
stroke. This pilot study examines the safety and methodology of using
transcranial direct stimulation (tDCS) with robot-assisted arm training (AT),
to inform planning a larger randomised controlled trial. Subjects: Ten patients, after an ischaemic stroke 4–8 weeks
before study onset, no history of epilepsy, participated. Eight had a cortical
lesion and 2 had subcortical lesions: all had severe arm paresis and,
co-incidentally, 5 had severe aphasia. Methods: Over six weeks, they received thirty 20 min-sessions of AT.
During the first 7 minutes, 1.5mA of tDCS was applied, with the anode over the
lesioned hemisphere and the cathode above the contralateral orbit. Arm and
language impairment were assessed with the Fugl-Meyer motor score (FM, full
range 0–66) and the Aachener Aphasie Test. Results: No major side effects occurred. Arm function of three
patients (two with a subcortical lesion) improved significantly, with FM scores
increasing from 6 to 28, 10 to 49 and 11 to 48. In the remaining seven
patients, all with cortical lesions, arm function changed little, FM scores did
not increase more than 5 points. Unexpectedly, aphasia improved in 4 patients.
Conclusions: These procedures are safe, and easy to use in a
clinical setting. In future studies, patients should be stratified by degree of
arm weakness and lesion site, also the unexpected aphasia improvement warrants
following-up.
Keywords: Stroke, rehabilitation, aphasia, plasticity, brain stimulation, recovery of function
