Combining transcranial Direct Current Stimulation with robot therapy for the impaired upper limb after sub-acute stroke

Introduction: Optimal gain of upper limb (UL) function is pivotal for people with stroke in order to carry out functional activities. However, half of the people surviving stroke remain with some form of UL impairment. Robot Therapy (RT) is one technique that can increase the intensity of rehabilitation and evidence shows that robot-assisted arm training results in improved short- and long-term arm strength and function of people with stroke. RT has also been combined with a non-invasive method of brain stimulation, transcranial Direct Current Stimulation (tDCS). The pilot study by Hesse et al. (2007) suggests that using both RT and tDCS results in short-term UL motor recovery of people with sub-acute stroke however, long-term and neurophysiological measurements were not involved in this study. Main Objective: To develop a protocol exploring the effectiveness and short- and long-term neural changes of tDCS and robot therapy on UL impairment and function of people with sub-acute stroke. Methods: An systematic literature review was carried out investigating different methodologies used for applying tDCS and RT, leading to the finalised protocol. Results: A pilot, double-blinded randomised controlled trial will be carried out involving two groups: 1) Armeo RT and active tDCS, and 2) Armeo RT and sham tDCS with 20 participants with sub-acute stroke in each group. Active or sham tDCS will be delivered before RT. In total, participants will receive 18 hours of RT and tDCS, spread out over 8 weeks. Clinical and neurophysiological measures using Transcranial Magnetic Stimulation will be utilised pre- and post- intervention and at 3 month follow-up. Conclusions: Research into non-invasive brain stimulation and RT seems promising but to translate research findings into clinical stroke practice, further research is needed. In the upcoming months, the aforementioned trial will be initiated which will add to the body of knowledge of neurorehabilitation research