Effects of concurrent transcranial direct current stimulation and robotic lower-limb training on motor recovery after...

To observe the effects of concurrent transcranial direct current stimulation (tDCS) and robotic lower-limb (RT-LL) training on motor recovery after stroke, thereby offering a novel approach for motor rehabilitation of these patients. The total sample size was sixty (n = 60). We enrolled 60 patients with stroke hemiplegia who met the inclusion and exclusion criteria. Using the random envelope method, these patients were allocated into an experimental group (n = 30) and a control group (n = 30). The experimental group underwent concurrent tDCS and RT-LL training, while the control group received concurrent sham tDCS and RT-LL training. Both groups took part in training sessions lasting for 20 min each, five times a week, for a continuous two weeks. Gait Watch three-dimensional gait analysis system was used for both groups before and after treatment. Additionally, in both groups, the Fugl-Meyer assessment for lower extremities (FMA-LE) was used to assess the motor function of lower extremities, the functional ambulation category (FAC) was used to assess walking function, and the modified Barthel index (MBI) was used to assess activities of daily living (ADL). The functional near-infrared spectroscopy (fNIRS) was used to observe the changes in the concentration of oxygenated hemoglobin and deoxyhemoglobin in the subject's brain before and after treatment. There was not any statistically significant difference in baseline data such as gender, age, and stroke stratification between the two groups before treatment (p > 0.05). After treatment, the gait parameters, FAC, and MBI were significantly improved compared to those of the control group (p < 0.05), there was no difference in the improvement of FMA-LL between the two groups (p > 0.05). The brain network connections of the experimental group, including the affected M1- supplementary motor area (SMA), left M1- right M1, and the affected M1- healthy SMA, were significantly enhanced opposed to the control group (p < 0.001). Transcranial direct current stimulation can promote brain functional connectivity in motor related brain regions. Concurrent transcranial direct current stimulation and robotic lower-limb training can promote motor recover after stroke. Hower, this study gets its limitations, including the relatively short intervention duration and the absence of medium or long-term follow-up, the durability and clinical persistence of benefit remain uncertain.