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The effects of concurrent M1 anodal tDCS and physical therapy interventions on function of ankle muscles in patients with stroke: a randomized, double-blinded sham-controlled trial study

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Abstract

One of the most common symptoms in stroke patients is spasticity. The aims were to investigate the effects of anodal trans-cranial direct current stimulation (a-tDCS) over the affected primary motor cortex (M1) on ankle plantar flexor spasticity and dorsiflexor muscle activity in stroke patients. The design of this study was a randomized sham-controlled clinical trial. Thirty-two participants with stroke were randomly assigned to three groups (experimental, sham, control groups). Participants in the experimental and sham groups received 10-session 20-min M1 a-tDCS concurrent with physical therapy (PT), while the control group only received 10-session PT. All groups were instructed to perform home stretching exercises and balance training. Berg Balance Scale (BBS), Modified Ashworth Scale (MAS) of plantar flexors, and EMG activity of lateral gastrocnemius (LG) and tibialis anterior (TA) were recorded during active and passive ankle dorsiflexion immediately and 1 month after interventions. A significant reduction was shown in MAS and EMG activity of LG during dorsiflexion, immediately and 1 month after intervention in the M1 a-tDCS group (p <0.001). BBS also significantly increased only in the M1 a-tDCS group (p <0.001). In addition, EMG activity of TA during active dorsiflexion increased immediately and 1 month after intervention in the M1 a-tDCS group (p <0.001). However, in the sham and control groups, EMG activity of TA increased immediately (p<0.001), while this was not maintained 1 month after intervention (p >0.05). PT concurrent with M1 a-tDCS can significantly prime lasting effects of decreasing LG spasticity, increasing TA muscle activity, and also balance in stroke patients.

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Acknowledgements

We would like to thank the Research Center of Neuromuscular Rehabilitation of Semnan University of Medical Sciences for the cooperation and providing facilities for this work.

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Authors and Affiliations

  1. Neuromuscular Rehabilitation Research Centre, Semnan University of Medical Sciences, Semnan, Iran

    Fatemeh Ehsani, Marzieh Mortezanejad & Mohaddeseh Hafez Yosephi

  2. Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran

    Said Daniali

  3. Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia

    Shapour Jaberzadeh

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  1. Fatemeh Ehsani
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  2. Marzieh Mortezanejad
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  3. Mohaddeseh Hafez Yosephi
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  4. Said Daniali
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  5. Shapour Jaberzadeh
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Correspondence to Fatemeh Ehsani.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Ehsani, F., Mortezanejad, M., Yosephi, M.H. et al. The effects of concurrent M1 anodal tDCS and physical therapy interventions on function of ankle muscles in patients with stroke: a randomized, double-blinded sham-controlled trial study. Neurol Sci 43, 1893–1901 (2022). https://doi.org/10.1007/s10072-021-05503-9

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  • DOI: https://doi.org/10.1007/s10072-021-05503-9

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