Effects of transcranial direct current stimulation combined with neuromuscular electrical stimulation on upper extremity motor function in patients with stroke.

Objective To investigate the treatment effects of transcranial direct current stimulation (tDCS) combined with neuromuscular electrical stimulation (NMES) on the motor function of upper extremity (UE) in persons with stroke. Design This study was a pilot double-blind randomized controlled trial. Twenty-six patients due to stroke onset of > 6 months were randomly allocated to three groups: tDCS combined with NMES group, tDCS group, or control group. In addition to conventional rehabilitation, all subjects received one of the three protocols in a total of 15 sessions over 3 weeks. Results A significant difference among the three groups was found for the change scores of the Fugl-Meyer assessment UE subscale (FMA-UE) from pre-treatment to one-month follow up (p = 0.02), in favor of the tDCS combined with NMES group. Moreover, the tDCS combined with NMES group showed significant within-group improvement on the FMA-UE (from pre-intervention to post-intervention, p = 0.01) and the Action Research Arm Test (from pre-intervention to post-intervention and to one-month post-intervention, p = 0.03 and p = 0.04, respectively). Conclusion This preliminary study reveals that combining tDCS and NMES with regular rehabilitation programs may enhance better UE functional improvement than regular rehabilitation programs alone in patients with chronic stroke.