Table 2.
Summary of studies applying simultaneous neurorehabilitation therapies.
| Authors | Study design | Stroke phase | One/other intervention | Control | Combined regime | Combination session | Behavioral results |
|---|---|---|---|---|---|---|---|
| Hesse et al., 2007 | Uncontrolled study | Subacute | Anodal tDCS/RT n = 10 |
None | 7 min tDCS over ipsilesional M1 was applied at beginning of 20 min RT | 30 times (6 weeks) |
Three patients showed improved UEFM, but change in UEFM was small in seven patients with cortical lesion |
| Koyama et al., 2014 | Uncontrolled study | Chronic | 1 Hz rTMS/NMES n = 15 |
None | Onset of rTMS over contralesional M1 and NMSE on paretic wrist extensor (0.5 s on and 0.5 s off) were synchronous | 24 times (2 weeks) twice a day |
rTMS/NMSE improved UEFM, WMFT, and BBT |
| Celnik et al., 2009 | Cross-over | Chronic | Anodal tDCS/PNS n = 9 |
Sham tDCS/PNS n = 9 tDCS/sham PNS n = 9 |
20 min tDCS at the end of 2 h PNS of median and ulnar nerve on paretic side | Once | tDCS/PNS improved motor learning more than tDCS or PNS |
| Ochi et al., 2013 | Cross-over | Chronic | Anodal tDCS/RT n = 18 |
Cathodal tDCS/RT n = 18 |
10 min anodal (catodal) tDCS over ipsilesional (contralesional) M1 was applied at beginning of RT | 5 times (1 week) |
Both tDCS/RT improved UEFM, but no difference was observed between anodal and cathodal |
| Geroin et al., 2011 | Single-blind RCT | Chronic | Anodal tDCS/RT gait n = 10 |
sham tDCS/RT gait n = 10 CR (gait) n = 10 |
7 min tDCS over ipsilesional M1 was at the start of 20 min robot-assisted gait training | 10 times (2 weeks) |
tDCS/RT and RT alone improved 6 min and 10 m walking more than CR. However, no difference was observed between tDCS/RT and RT alone |
| Reinkensmeyer et al., 2012 | Single-blind RCT | Chronic | RT/VR n = 13 |
CR n = 13 |
1 h RT in VR environmental | 24 times (2 months) |
RT/VR improved UEFM, BBT, and grip power more than CR |
| Lee and Chun, 2014 | Single-blind RCT | Subacute | Cathodal tDCS/VR n = 19 |
Cathodal tDCS/CR n = 20 VR alone n = 20 |
20 min tDCS during VR | 15 times (3 weeks) |
tDCS/VR improved MFT and UEFM more than tDCS/CR or VR |
| Kim and Lee, 2015 | Single-blind RCT | Chronic | NMES/MT n = 10 |
Non-synchronized NMES/MT n = 10 CR n = 9 |
30 min NMES on paretic wrist extnsor, triggerd by muscle activity of non-paretic side during MT | 20 times (4 weeks) |
NMES/MT improved JTHT and BBT more than non-synchronized NMES/MT or CR |
| Kim et al., 2014b | Single-blind RCT | Subacute | NMES/MT n = 12 |
NMES alone n = 11 |
30 min NMSE on paretic wrist and finger extensors during MT | 20 times (4 weeks) |
NMES/MT improved UEFM more than NMES alone |
| Lin et al., 2014 | Single-blind RCT | Chronic | NMES/MT n = 8 |
MT alone n = 8 |
NMES on paretic hand during 1 h MT | 20 times (4 weeks) |
NMES/MT improved BBT and ARAT more than MT alone |
| Ang et al., 2014a | Single-blind RCT | Chronic | MI/RT feedback n = 11 |
RT alone n = 14 |
MI synchronized with RT feedback of MI using EEG-based BCI | 12 times (4 weeks) |
MI/RT and RT improved UEFM, but no difference was observed between groups |
| Ang et al., 2014b | Single-blind RCT | Chronic | MI/RT feedback n = 6 |
RT alone n = 8 CR alone n = 7 |
MI synchronized with RT feedback of MI using EEG-based BCI | 18 times (6 weeks) |
MI/RT feedback and RT improved UEFM more than CR, but no difference between MI/RT feedback and RT |
| Lindenberg et al., 2010b | Double-blind RCT | Chronic | Bilateral tDCS/CR n = 10 |
Sham tDCS/CR n = 10 |
30 min tDCS was applied at beginning of 60 min CR | 5 times | Bilateral tDCS/CR improved UEFM and WMFT more than sham tDCS/CR |
| Bolognini et al., 2011 | Double-blind RCT | Chronic | Bilateral tDCS/CIMT n = 7 |
Sham tDCS/CIMT n = 7 |
40 min tDCS was applied at beginning of CIMT | 10 times (2 weeks) |
Bilateral tDCS/CIMT improved JTHF and UEFM more than sham tDCS/CIMT |
| Hesse et al., 2011 | Double-blind RCT | Subacute | Aodal tDCS/RT n = 32 |
Sham tDCS/RT n = 32 Cathodal tDCS/RT n = 32 |
20 min tDCS during RT | 30 times (6 weeks) |
All patients showed UEFM improvement, but no difference was observed between groups |
| Mihara et al., 2013 | Double-blind RCT | Chronic | MP/Visual feedback n = 10 |
MP/Irrelevant visual feedback n = 10 |
10 min MP with visual feedback of MI using NIRS-based BCI | 6 times (2 weeks) |
MP/Visual feedback improved UEFM more than MP/irrelevant feedback |
| Ramos-Murguialday et al., 2013 | Double-blind RCT | Chronic | MI/Relevant RT feedback n = 16 |
MI/Irrelevant RT feedback n = 14 |
MI with relevant RT feedback of MI using EEG-based BCI | 20 times (4 weeks) |
MI/rerevant RT feedback improved UEFM more than MI/irrelevant RT feedback |
tDCS, transcranial direct current stimulation; RT, robot training; M1, primary motor cortex; UEFM, upper extremity Fugl-Meyer score; rTMS, repetitive transcranial magnetic stimulation; NMES, neuromuscular electrical stimulation; WMFT, Wolf motor function test; BBT, box and block test; PNS, peripheral nerve stimulation; RCT, randomized controlled trial; CR, conventional rehabilitation; VR, virtual reality; MFT, manual function test; MT, mirror therapy; JTHF, Jebsen Taylor hand function Test; ARAT; action research arm test; MI, motor imagery; EEG, electroencephalography; CIMT, constraint-induced movement therapy; MP, mental practice; NIRS, near-infrared spectroscopy.