Effect of Home Based Transcranial Direct Current Stimulation (tDCS) With Exercise on Upper and Lower Limb Motor Functions in Chronic Stroke
Condition: Transcranial Direct Current Stimulation; Chronic Stroke
MeSH terms: Stroke
Study type: Interventional

Summary: 
      The aim of the present study is to investigate the effect of home based dual tDCS combined
      with exercise on upper and lower limb motor functions in chronic ischemic stroke patients.
    

Detailed description: 
      Nowadays, stroke is the third cause of death in developing countries after coronary heart
      disease and cancer. Worldwide, 3 million women and 2.5 million men were killed by the stroke
      every year. In Thailand, stroke is the first leading cause of death. In every 2 minutes, Thai
      population have occurred at least one new stroke case.

      Over six months after stroke onset or chronic phase, long-term disability occurred when
      patients did not continuously receive appropriate intervention. Motor disability is the most
      limiting factor influencing activities in daily life, such as upper and lower limb motor
      functions, and gait disturbance, which could in turn leading to long-term disability.
      Especially, affected arm remains malfunction in half of chronic stroke patients. The
      multidisciplinary rehabilitation has been provided for chronic stroke patients to reduce
      burden of caregivers and to improve patients' well-being. Besides, many patients with chronic
      stroke who live in community could not access the hospital or health care center because of
      inconvenient transportation as well as limited support by the family.

      It past twenty years, transcranial direct current stimulation (tDCS) has been introduced as
      is non-invasive brain stimulation (NIBS) that can use in rehabilitation. There are several
      studies shown that tDCS can change cortical excitability in the brain and consider as an
      additional therapy to improve motor function in stroke patients. Moreover, the tDCS is
      portable, cost effective, safety to use and can be self-administered might benefit for
      patients in residence. In fact, imbalance of interhemispheric inhibition (IHI) occurred after
      stroke by neuronal excitability decreased in the lesioned hemisphere and increased in the
      non-lesioned hemisphere. The tDCS delivered weak direct current via two electrodes as anodal
      and cathodal. The effect of cathodal electrode can decrease excitability and increase
      excitability by anodal electrode. Furthermore, both electrodes were applied on the two
      hemisphere in the same period for expect the results of two electrode called dual tDCS.

      Current evidence indicated that the 4-week anodal tDCS combined transcranial direct current
      stimulation (tDCS) with robotic training could improve motor function in chronic stroke
      patients. Nevertheless, this intervention program is a hospital-based intervention, which
      would limit the generalization to patients who live in community. Previous study showed that
      4-week anodal tDCS combined with exercise could improve upper and lower limb motor functions
      in chronic stroke patients. However, there is no evidence indicate that 4-week home-based
      tDCS combined with exercise have been improved upper and lower limb motor functions in
      chronic stroke patients in residence.
    

Intervention name(s): Transcranial direct current stimulation
Intervention type(s): Device
Intervention description(s): Dual/ Sham tDCS will be applied in 2 mA, 20 mins before the home-based exercise program in 3 times per week for 4 weeks (12 sessions)
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: transcranial direct current stimulation; motor function; exercise; chronic stroke