Page 197 - HA Convention 2015

Service Priorities and Programmes Free Papers

SPP8.6 Young Hospital Authority Investigators Presentations 14:30 Room 221

Effects of Transcranial Direct Current Stimulation for Upper Limb Rehabilitation in Stroke Patients — a Controlled

Clinical Trial
Wong KH 1, Ho LOL1, Chan MMF 1, Poon PYH 1, To RWK1, Chow ESL 2, Chu ACK 2, Mak MKY 3
1Physiotherapy Department, 2Division of Rehabilitation, Department of Medicine and Geriatrics, Tuen Mun Hospital,
3Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong

Introduction

An upper limb rehabilitation programme utilising Transcranial Direct Current Stimulation (tDCS) for stroke patients was
developed in Tuen Mun Hospital (TMH). The previous programme evaluation showed that combined tDCS and physiotherapy
treatment have positive effect on enhancing upper limb functional recovery in stroke patients. The present programme
utilised Upper-Extremity Fugl-Meyer Scale and a control intervention to further review the effects of tDCS on enhancing
upper limb functions of stroke patients.

Objectives
To examine the effects of tDCS on enhancing upper limb functional recovery in stroke patients.

Methodology Tuesday, 19 May

Patients diagnosed with cerebrovascular accident (CVA) were recruited from the Rehabilitation Stroke Unit of TMH. Patients
with wrist and finger control of Oxford Scale Grade two or above were recruited. Patients with unstable medical conditions,
diagnosed with transient ischemic attack or having contraindications to tDCS were excluded. Patients were assigned to an
intervention or a control group. For the intervention group, anodal (excitatory) stimulation by tDCS was conducted to hand
area of primary motor cortex (M1) of the affected hemisphere through the electrode placed over C3/C4, while the cathodal
electrode was placed over the contralateral supraorbital area. Patient received 1mA tDCS for 20 minutes. Five consecutive
sessions of tDCS together with intensive physiotherapy upper limb training were given. For the control group, five consecutive
sessions of intensive physiotherapy upper limb training were given. The upper-extremity section of the Fugl-Meyer Scale (UE-
FM) is easily applicable and is one of the most established and commonly used outcome measures in stroke rehabilitative
trials. Assessments were done before the first session of treatment and after the last session of treatment. Wilcoxon Signed
Ranks Test and Mann-Whitney U Test were used for comparing the differences in UE-FM before and after the intervention.

Results

14 stroke patients (nine female patients and five male patients) were assigned to the intervention (n=9) and control (n=5)
group. The mean age was 68.9 ± 10.1 years old and the mean time between stroke onset and the first UE-FM assessment
was 10.6 ± 5.01 days. For the intervention group, the mean score of UE-FM increased from 32.7 ± 8.94 to 49.8 ± 10.3 (Z=-2.67,
p=0.008). No adverse effects of tDCS were reported. For the control group, the mean score of UE-FM increased from 35.0 ±
8.94 to 46.6 ± 11.5 (Z=-2.03, p=0.042). For between-group comparison, the changes in mean score of UE-FM in intervention
group (17.1 ± 4.93) were significantly larger than that in control group (11.6 ± 3.36) (U = 7, p = 0.037). Findings of the present
study showed that tDCS could augment physiotherapy treatment in enhancing upper limb motor functional recovery in
stroke patients. Since tDCS is safe, non-expensive and easily applicable, it could be an adjuvant therapy for upper limb
rehabilitation in stroke patients in future.

HOSPITAL AUTHORITY CONVENTION 2015

195