Hybrid Approach to Mirror Therapy and Transcranial Direct Current Stimulation for Stroke Recovery

Hybrid Approach to Mirror Therapy and Transcranial Direct Current Stimulation for Stroke Recovery: A Follow up Study on Brain Reorganization, Motor Performance of Upper Extremity, Daily Function, and Activity Participation

We hypothesize that (1) the hybrid therapy will induce greater improvements on some health-related outcomes compared to other therapies; (2) such benefits will retain at 6-month follow-up; (3) better motor control and brain reorganization will be found in the hybrid therapy than the other therapies; (4) correlations will be found between brain activity and movement kinematics/health-related outcomes.

Chronic stroke participants will be recruited from the Chang Gung Memorial Hospital and then were randomly assigned to 1 of the 4 groups: MT+tDCS, MT+sham tDCS, MT, and CI groups. The participants in each group receive equivalent amounts of treatment.

Analysis of covariance (ANCOVA), controlling for the pretest differences, will be separately performed for each outcome measure to test the effects of different intervention groups.

Inclusion Criteria:

• First episode of stroke in cortical regions
• Time since stroke more than 6 months
• Initial motor part of UE of FMA score ranging from 24 to 52, indicating moderate to mild movement impairment
• No severe spasticity in any joints of the affected arm (Modified Ashworth Scale ≤ 2)
• No serious cognitive impairment (i.e., Mini Mental State Exam score≧ 24)
• Willing to sign the informed consent form.

Exclusion Criteria:

• Aphasia that might interfere with understanding instructions
• Visual/attention impairments that might interfere with the seeing of mirror illusion, including hemineglect/hemianopsia
• Major health problems or poor physical conditions that might limit participation
• Currently participation in any other research
• Previous brain neurosurgery
• Metallic implants within the brain.