The Effects of rTMS and tDCS Copuled With Robotic Therapy In Patients With Stroke

The Effects of rTMS and tDCS Copuled With Robotic Therapy on Upper Extremity Functional Recovery in Patients With Chronic Stroke

The purpose of this study is to assess the effect of rTMS and tDCS coupled with robotic therapy on upper extremity functional recovery

After being informed about study and potential risks, all patient giving written informed consent will undergo screening period determine eligibility for study entry. The patients who meet the eligibility requirements will be randomized into four groups in a 1:1 ratio to active rTMS, sham rTMS, active tDCS and sham tDCS.

Inclusion Criteria:

• ischemic stroke with a disease interval of 6 months to 2 years
• aged based 18 years
• first stroke
• Mini mental test score ≥ 22
• upper extremity (elbow, wrist and finger) spasticity level Modified Ashworth Scale (MAS)≤2
• Shoulder, elbow and wrist muscle strength ≥ 2 according to Medical Research Council- MRC

Exclusion Criteria:

• hemorrhagic stroke
• history of epilepsy
• a cardiac pacemaker
• pregnancy
• Fugl Meyer upper extremity assessment score ≥44
• history of previous stroke or ischemic attack
• neurological diseases other than stroke
• metallic implant in brain or scalp (including cochlear implant)
• previous brain surgery
• orthopedic disease that prevents upper extremity movements
• diagnosis of malignancy
• receiving robotic /TMS/tDCS treatments in the last 6 months