Transcranial Direct Current Stimulation in Conjunction with Mirror Therapy for Upper Extremity Rehabilitation in Chronic Stroke Patients

Abstract

Objective: Stroke represents a major cause of upper limb motor impairment among stroke survivors, resulting in functional disability and affecting negatively their quality of life. Thus, it is imperative that stroke rehabilitation be efficient. Up to the present, several intervention methods have been proposed in an attempt to improve recovery potential poststroke, transcranial direct current stimulation (tDCS) and mirror therapy (MT) being among them. The aim of this review is to investigate the utility of tDCS administration in conjunction with MT on chronic stroke population. Methods: A literature research of two databases (MEDLINE and Scopus) was conducted in order to identify all relevant studies published between January 1st 2010 and September 30th 2021 that focused on the efficacy of the combined application of tDCS and MT on upper limb rehabilitation among chronic stroke patients. Results: Three studies fulfilled the selection criteria and were included in the present review. Transcranial direct current stimulation application along with MT exhibited statistically significant increases in Box and block test, grip strength, Action research arm test score and Nottingham extended activities of daily living score within the experimental group compared to controls. The timing-dependent interaction effects seem to be of key importance, as sequentially delivered tDCS prior to MT is considered to be more advantageous and time-efficient compared to the concurrent application of tDCS and MT. Conclusions: Application of tDCS in parallel with MT represents a promising neurorehabilitation tool for post-stroke patients regarding upper limb motor performance, movement efficiency and daily function. Future studies are needed in order to clarify whether sequential or concurrent tDCS and MT application is more beneficial.

FIGURE 1.

Study flow diagram (PRISMA flowchart)

TABLE 1.

Characteristics of the included studies

TABLE 1.

Characteristics of the included studies