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Recovering arm function in chronic stroke patients using combined anodal HD-tDCS and virtual reality therapy (ReArm): a study protocol for a randomised controlled trial

Abstract : Background After a stroke, 80% of the chronic patients have difficulties to use their paretic upper limb (UL) in activities of daily life (ADL) even after rehabilitation. Virtual reality therapy (VRT) and anodal transcranial direct current stimulation (tDCS) are two innovative methods that have shown independently to positively impact functional recovery of the paretic UL when combined with conventional therapy. The objective of the project will be to evaluate the impact of adding anodal high-definition (HD)-tDCS during an intensive 3-weeks UL VRT and conventional therapy program on paretic UL function in chronic stroke. Methods The ReArm project is a quadruple-blinded, randomized, sham-controlled, bi-centre, two-arm parallel, and interventional study design. Fifty-eight chronic (> 3 months) stroke patients will be recruited from the Montpellier and Nimes University Hospitals. Patients will follow a standard 3-weeks in-patient rehabilitation program, which includes 13 days of VRT (Armeo Spring, 1x30min session/day) and conventional therapy (3x30min sessions/day). Twenty-nine patients will receive real stimulation (4x1 anodal HD-tDCS montage, 2mA, 20min) to the ipsilesional primary motor cortex during the VRT session and the other 29 patients will receive active sham stimulation (2mA, 30s). All outcome measures will be assessed at baseline, at the end of rehabilitation and again 3 months later. The primary outcome measure will be the wolf motor function test. Secondary outcomes will include measures of UL function (Box and Block test), impairment (Fugl Meyer Upper Extremity), compensation (Proximal Arm Non-Use), ADL (Actimetry, Barthel Index), pain, fatigue, effort and performance, kinematics and motor cortical region activation during functional motor tasks. Discussion This will be the first trial to determine the impact of adding HD-tDCS during UL VRT and conventional therapy in chronic stroke patients. We hypothesise that improvements in UL function will be greater and longer-lasting with real stimulation than in those receiving sham.
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Preprints, Working Papers, ...
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https://hal.mines-ales.fr/hal-03183978
Contributor : Administrateur Imt - Mines Alès <>
Submitted on : Monday, March 29, 2021 - 10:19:31 AM
Last modification on : Wednesday, March 31, 2021 - 3:07:30 AM

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Camille Muller, Makii Muthalib, Denis Mottet, Stéphane Perrey, Gérard Dray, et al.. Recovering arm function in chronic stroke patients using combined anodal HD-tDCS and virtual reality therapy (ReArm): a study protocol for a randomised controlled trial. 2021. ⟨hal-03183978⟩

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