Breaking the ice to improve motor outcomes in patients with chronic stroke: a retrospective clinical study on neuromodul
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ORIGINAL ARTICLE
Breaking the ice to improve motor outcomes in patients with chronic stroke: a retrospective clinical study on neuromodulation plus robotics Antonino Naro 1 & Luana Billeri 1 & Alfredo Manuli 1 & Tina Balletta 1 & Antonino Cannavò 1 & Simona Portaro 1 & Paola Lauria 1 & Fabrizio Ciappina 1 & Rocco Salvatore Calabrò 1 Received: 15 April 2020 / Accepted: 1 November 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Stroke is one of the main causes of impairment affecting daily activities and quality of life. There is a growing effort to potentiate the recovery of functional gait and to enable stroke patients to walk independently. Aim To estimate the effects of dual-site transcranial direct current stimulation (dstDCS) on gait recovery in chronic stroke patients provided with robot-aided gait training (RAGT). Methods Thirty-seven patients were included in this retrospective clinical study. Nine patients were provided with dstDCS during the first 10 min of RAGT by using Lokomat®Pro (on-RAGT), 15 patients immediately after RAGT (post-RAGT), and 13 patients immediately before RAGT (pre-RAGT). Results Each group improved over time concerning disability burden and lower limb strength. on-RAGT and post-RAGT experienced better improvement in balance (p < 0.001) and, moderately, gait endurance (p = 0.04) as compared to pre-RAGT. Furthermore, all treatments decreased the facilitation of the unaffected hemisphere (p < 0.001) and the inhibition of the affected hemisphere (p < 0.001). The duration of such aftereffects was found to be greater for post-RAGT. Discussion and conclusion This is the first trial with dstDCS coupled with RAGT in chronic stroke patients with gait impairment. When timely coupled with RAGT, dstDCS may be considered an effective tool for the recovery of lower limb function in patients with first unilateral stroke in the chronic phase. Moreover, our data suggest the ductility of dstDCS concerning RAGT timing, thus making this intervention suitable in a neurorehabilitation setting and well adaptable to patients’ needs. Keywords Chronic stroke . Dual-site transcranial direct current stimulation . Gait recovery . Robot-aided gait training
Introduction Stroke is one of the main causes of impairment affecting daily activities and quality of life [1]. There is a growing effort to strengthen the recovery of functional gait and to enable patients to walk independently by carrying out intensive, repetitive, and task-oriented rehabilitative exercises by means of robotic devices. Robot-aided gait training (RAGT) has been suggested to be effective after stroke [2–4], as it could increase the plasticity mechanisms of functional recovery [5, 6]. Nevertheless, gait recovery seems to be strongly related to * Rocco Salvatore Calabrò [email protected] 1
IRCCS Centro Neurolesi Bonino Pulejo, via Palermo, SS 113, ctr. Casazza, 98124 Messina, Italy
the time from stroke more than to the type of intervention [7]. Specifically, there is moderate-quality evidence that RAGT plus physiothe
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