This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Myoung-Hwan Ko
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0566-3677
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Background Cognitive impairment after stroke is an unfavorable factor for long-term functional independence. Transcranial direct current stimulation (tDCS) is a promising tool for improving cognitive function in patients with stroke. Home-based rehabilitation is increasingly required for patients with stroke, with greater benefits expected if supplemented with remotely supervised tDCS (RS-tDCS). We evaluated cognitive improvement and the feasibility of RS-tDCS in patients with chronic stroke.
Methods Thirty chronic stroke patients with cognitive impairment (K-MoCA <26) received a computerized cognitive training package (ComcogTM, Neofact, Seoul, Korea), and were randomized into real RS-tDCS and sham RS-tDCS groups according to the application of tDCS. Participants were treated 5 days/week for 4 weeks. To ensure correct self-application of tDCS (Mindd Stim®, Ybrain Inc., Korea), patients and caregivers received training and were monitored. Several cognitive evaluations were performed. Rate of adherence to the appropriate RS-tDCS session was also investigated.
Results Among the 30 participants, 2 chose to withdraw and 2 were excluded due to noncompliance. In the within-group comparison, unlike the sham group (n= 14), the real group (n=12) showed a significant improvement in K-MoCA (intra-p=0.004 vs. 0.132), particularly in patients with moderate cognitive impairment (K-MoCA: 10–17; intra-p=0.001 vs. 0.835, K-MoCA: 18-25; intra-p=0.060 vs. 0.064). However, in K-DRS2, Stoop and K-BNT, both groups showed significant improvement, but there was no group time interaction. In the Trail Making Test, Go/no Go, and Controlled Oral Word Association Test, both groups did not show statistically significant improvement. A total of 551 of the 560 sessions conducted by 28 people were successfully performed (adherence rate: 98.4%) and no serious adverse effects were detected.
Conclusion RS-tDCS is a safe and feasible rehabilitation modality for post-stroke cognitive dysfunction.
It has the potential to enhance the effect of home-based CT. RS-tDCS seems to be particularly effective in patients with relatively more severe cognitive impairment who are capable of home-based training.
Trial registration: Clinical Research information Service (KCT0003427). Registered 26 June 2018, https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=12363
Keywords
Cognitive dysfunction, Telerehabilitation, Stroke, Transcranial direct current stimulation, tDCS, Non-invasive brain stimulation
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Myoung-Hwan Ko
Corresponding Author
ORCiD: https://orcid.org/0000-0002-0566-3677
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 2
Posted 26 Jan, 2021
No community comments so far
No comments provided
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Neurology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Cognitive impairment after stroke is an unfavorable factor for long-term functional independence. Transcranial direct current stimulation (tDCS) is a promising tool for improving cognitive function in patients with stroke. Home-based rehabilitation is increasingly required for patients with stroke, with greater benefits expected if supplemented with remotely supervised tDCS (RS-tDCS). We evaluated cognitive improvement and the feasibility of RS-tDCS in patients with chronic stroke.
Methods Thirty chronic stroke patients with cognitive impairment (K-MoCA <26) received a computerized cognitive training package (ComcogTM, Neofact, Seoul, Korea), and were randomized into real RS-tDCS and sham RS-tDCS groups according to the application of tDCS. Participants were treated 5 days/week for 4 weeks. To ensure correct self-application of tDCS (Mindd Stim®, Ybrain Inc., Korea), patients and caregivers received training and were monitored. Several cognitive evaluations were performed. Rate of adherence to the appropriate RS-tDCS session was also investigated.
Results Among the 30 participants, 2 chose to withdraw and 2 were excluded due to noncompliance. In the within-group comparison, unlike the sham group (n= 14), the real group (n=12) showed a significant improvement in K-MoCA (intra-p=0.004 vs. 0.132), particularly in patients with moderate cognitive impairment (K-MoCA: 10–17; intra-p=0.001 vs. 0.835, K-MoCA: 18-25; intra-p=0.060 vs. 0.064). However, in K-DRS2, Stoop and K-BNT, both groups showed significant improvement, but there was no group time interaction. In the Trail Making Test, Go/no Go, and Controlled Oral Word Association Test, both groups did not show statistically significant improvement. A total of 551 of the 560 sessions conducted by 28 people were successfully performed (adherence rate: 98.4%) and no serious adverse effects were detected.
Conclusion RS-tDCS is a safe and feasible rehabilitation modality for post-stroke cognitive dysfunction.
It has the potential to enhance the effect of home-based CT. RS-tDCS seems to be particularly effective in patients with relatively more severe cognitive impairment who are capable of home-based training.
Trial registration: Clinical Research information Service (KCT0003427). Registered 26 June 2018, https://cris.nih.go.kr/cris/en/search/search_result_st01.jsp?seq=12363
Figure 1
Figure 2
Figure 3
Figure 4
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