Functional impairments derived from the non-use of severely affected upper limb after stroke have been proposed to be mitigated by action observation and imagination-based techniques, whose effectiveness is enhanced when combined with transcranial direct current stimulation (tDCS). Preliminary studies in mildly impaired individuals in the acute phase post-stroke show intensified effects when action is facilitated by tDCS and mediated by virtual reality (VR) but the effectiveness in cases of severe impairment and chronic stroke is unknown. This study investigated the effectiveness of a combined tDCS and VR-based intervention in the sensorimotor function of chronic individuals post-stroke with persistent severe hemiparesis compared to conventional physical therapy. Twenty-nine participants were randomized into an experimental group, who received 30 minutes of the combined tDCS and VR-based therapy and 30 minutes of conventional physical therapy, or a control group, who exclusively received conventional physical therapy focusing on passive and active assistive range of motion exercises. The sensorimotor function of all participants was assessed before and after 25 one-hour sessions, administered three to five times a week, using the upper extremity subscale of the Fugl-Meyer Assessment, the time and ability subscales of the Wolf Motor Function Test, and the Nottingham Sensory Assessment. A clinically meaningful improvement of the upper limb motor function was consistently revealed in all motor measures after the experimental intervention, but not after conventional physical therapy. Similar limited effects were detected in the sensory function in both groups. The combined tDCS and VR-based paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy.

中文翻译：

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联合经颅直流电刺激和基于虚拟现实的干预对慢性卒中后持续严重偏瘫患者上肢功能的有效性：一项随机对照试验

中风后因不使用严重受影响的上肢而导致的功能障碍已被提议通过行动观察和基于想象力的技术来减轻，当与经颅直流电刺激 (tDCS) 结合使用时，其有效性会得到增强。对中风后急性期轻度受损个体的初步研究表明，当 tDCS 促进行动并由虚拟现实 (VR) 介导时，其效果会增强，但在严重受损和慢性中风病例中的有效性尚不清楚。本研究调查了与传统物理治疗相比，基于 tDCS 和 VR 的联合干预对中风后持续严重偏瘫的慢性个体感觉运动功能的有效性。二十九名参与者被随机分为一个实验组，接受 30 分钟基于 tDCS 和 VR 的联合治疗和 30 分钟的常规物理治疗，或仅接受侧重于被动和主动辅助运动范围的常规物理治疗的对照组。使用 Fugl-Meyer 评估的上肢分量表、Wolf 运动功能测试的时间和能力分量表，在 25 次一小时会议之前和之后评估所有参与者的感觉运动功能，每周进行三到五次。诺丁汉感官评估。实验干预后，所有运动测量均一致显示上肢运动功能有临床意义的改善，但在常规物理治疗后则不然。在两组的感觉功能中都检测到类似的有限影响。