Feasibility and effectiveness of remotely supervised tDCS combined with computerized cognitive training for patients with stroke: A randomized sham-controlled study
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
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Posted 26 Jan, 2021
On 17 Jan, 2021
On 17 Jan, 2021
On 17 Jan, 2021
On 12 Jan, 2021
On 12 Jan, 2021
On 12 Jan, 2021
On 12 Jan, 2021
On 11 Jan, 2021
Feasibility and effectiveness of remotely supervised tDCS combined with computerized cognitive training for patients with stroke: A randomized sham-controlled study
Posted 26 Jan, 2021
On 17 Jan, 2021
On 17 Jan, 2021
On 17 Jan, 2021
On 12 Jan, 2021
On 12 Jan, 2021
On 12 Jan, 2021
On 12 Jan, 2021
On 11 Jan, 2021
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
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