Although most people who survive a stroke recover the ability to walk regaining useful arm and hand function is less common and conventional therapy appears to be ineffective. Robot therapy is a promising way to augment conventional treatment and is investigated in two other projects in our research group, however another approach is to increase the excitability of nerve pathways within the motor cortex - to up-regulate activity.
This can be done non-invasively using transcranial direct current stimulation (tDCS) Two electrodes are placed on the head; one over the motor cortex of the affected hemisphere and one over the contralateral orbit. A small direct current (1mA) is passed between them for a period of about 20 minutes during which the patient practices hand and arm exercises – in this study the exercises are performed in a robot. Changes in cortico-spinal excitability can be measured as well as motor function – measured by performance in the robot games. tDCS is painless – it cannot be felt after the first few seconds.
While most patients regain walking ability, a severe upper limb paresis with no voluntary hand and finger activity, affecting a third of people after stroke, has a poor prognosis' Transcranial direct current stimulation (tDCS) is a non-invasive procedure used to polarise brain regions through the application of weak direct currents and has the potential to develop into useful adjuvant strategies in neurorehabilitation. Recent literature into the application of tDCS in people with severe arm impairments after stroke is increasing and has shown promising results.
The aim of this study is to examine the effect of combining transcranial direct current stimulation with robotic hand and arm training for the impaired hand and arm after stroke. Transcranial magnetic stimulation (TMS) will be used to measure short and long-term changes in cortico-motor excitability. Anodal tDCS will be applied to the primary motor cortex of the affected hemisphere. The cathode will be positioned on the contralateral supraorbital region. tDCS (1 mA) will be applied for 20 min in the tDCS session and up to 30 sec in the Sham session. Ramps will be used to increase and decrease current.
Professor Jane Burridge, Dr Geert Verheyden Hochschule für Gesundheit – University of Applied Sciences, Bochum, Germany WEBSITE:
Dr Ann-Marie Hughes (Senior Research Fellow)
Prof John Rothwell Professor (University College London) Professor of Human Neurophysiology, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
Lisa Tedesco Triccas (PhD Studentship)
Wessex Medical Research
Rehabilitation Robot Therapy
Non-Invasive Brain Stimulation (NIBS)
Conferences and events associated with this project:
European Congress on Clinical neurophysiology Rome June 2011: http://www.oic.it/eccn2011/
TMS Summer School Oxford: http://www.magstim.com/support/summerschool2011.html