Chronic motor disability, present in two thirds of stroke survivors pose tremendous personal and social burden. There is no universally accepted treatment for motor disability resulting from stroke. Recent studies demonstrated that rehabilitative training can improve motor function and relearning after stroke. However, these approaches lead only to partial amelioration.
It is crucial to develop novel strategies to enhance functional recovery after stroke. It has been proposed that cortical stimulation can enhance brain plasticity. New understanding of mechanisms of plasticity led to the preliminary finding that transcranial direct current stimulation (tDCS), a form of non-invasive cortical stimulation, can safely enhance motor performance of the paretic hand in patients with chronic subcortical stroke.
These findings suggest that tDCS, in association with motor training and through Hebbian principles, could enhance recovery processes. The two main hypotheses of this proposal are
- that tDCS can improve performance/learning of a finger motor sequence by the paretic hand after both subcortical and cortical stroke relative to sham; and
- that the mechanisms and neural substrates underlying this effect will include reorganisation within ipsilesional primary motor and premotor cortices.
During the outgoing phase, anodal tDCS and sham will be applied in chronic stroke patients over the motor cortex, in synchrony with motor training consisting of performance of finger motor sequences in a double blind, sham control led experimental design.
Endpoint measures of the study will be
- performance of newly learned motor sequences,
- reorganisational changes in motor and premotor cortices identified by functional magnetic resonance imaging and transcranial magnetic stimulation associated with the sequence learning processes.
During the return phase, tDCS will be applied
- to patients in the subacute stroke stage and
- during rehabilitation training.
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