Anodal tDCS over left parietal cortex expedites recovery from stroke-induced apraxic imitation deficits: a pilot study
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(2019) 1:38
Neurological Research and Practice
RESEARCH ARTICLE
Open Access
Anodal tDCS over left parietal cortex expedites recovery from stroke-induced apraxic imitation deficits: a pilot study Jana M. Ant1, Eva Niessen2, Elisabeth I. S. Achilles1,2, Jochen Saliger3, Hans Karbe3, Peter H. Weiss1,2 Gereon R. Fink1,2*
and
Abstract Background: To date, specific therapeutic approaches to expedite recovery from apraxic deficits after left hemisphere (LH) stroke remain sparse. Thus, in this pilot study we evaluated the effect of anodal transcranial direct current stimulation (tDCS) in addition to a standardized motor training on apraxic imitation deficits. Methods: In a rehabilitation hospital, we assessed apraxic, aphasic, and motor deficits in 30 LH stroke patients before and after a five-day standard programme of motor training combined with either anodal (10 min, 2 mA; n = 14) or sham (10 min, 0 mA, n = 16) tDCS applied in a double-blind fashion over left posterior parietal cortex (PPC). Where appropriate, data were analyzed with either t-test, Fisher’s exact test, or univariate/ repeated measures ANOVA. Results: Compared to sham tDCS, five sessions of anodal tDCS expedited recovery from apraxic imitation deficits (p < 0.05): Already after 5 days, the anodal tDCS group showed levels of imitation performance that were achieved in the sham tDCS group after 3 months. However, the primary outcome of the study (i.e., anodal tDCS induced improvement of the total apraxia score) failed significance, and there was no significant tDCS effect on apraxia after 3 months. Anodal tDCS improved grip force (of the contra-lesional, i.e., right hand), but had no effect on aphasia. Conclusions: Data from this pilot study show that repetitive, anodal tDCS over left PPC combined with a standardized motor training expedites recovery from imitation deficits in LH stroke patients with apraxia (relative to sham stimulation). Results suggest that in patients suffering from apraxic imitation deficits a randomized controlled trial (RCT) is warranted that investigates the effects of tDCS applied over PPC in addition to a standardized motor training. Keywords: Apraxia, Neuromodulation, Stroke, Neurorehabilitation, Transcranial direct current stimulation (tDCS), Motor cognition
Background Apraxia is a disorder of motor cognition leading to deficits in imitation, pantomiming, and tool use that cannot solely be explained by paresis or sensory deficits [36]. It is most commonly observed after left hemisphere (LH) damage. Despite the facts that i) apraxic upper limb deficits occur in up to 50% of the patients with a LH * Correspondence: [email protected] 1 Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany 2 Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, 52425 Jülich, Germany Full list of author information is available at the end of the article
stroke [5, 41], and, importantly, ii) they constitute a poor prognostic factor f
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