Neural Mechanisms and Efficacy of Dual Neurotechnology-Aided Mirror Therapy in Chronic Stroke: Neural and Motor Plasticity, Movement Performance, Daily Function, and Quality of Life

Mirror therapy (MT) has been demonstrated, in terms of neuroplasticity, to improve sensorimotor function of paretic upper extremity (UE) in chronic stroke patients. Central and peripheral electrical stimulation techniques such as transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) can individually enhance effects of MT, combining both of them with MT can be a potentially valuable approach to maximize neural and functional recovery post stroke. To our knowledge, no studies combined central and peripheral neural network reorganization technique with motor behavioral learning approach to investigate its possible benefit after stroke. This project will be the first to design a “dual neurotechnology-aided MT (DNA-MT)”, which combines tDCS and FES with contemporary neurorehabilitation approaches (i.e., MT) to stimulate both central and peripheral nervous systems to maximize neural and functional recovery post stroke. We will determine the efficacy and neurophysiological and motor mechanisms related to this novel DNA-MT approach and identify potential responders to this novel intervention. In this proposed three-year project, we will conduct a double-blinded, randomized controlled trial. 112 chronic stroke patients will be recruited. They will be randomly assigned to one of following 4 intervention groups: (1) active tDCS to the ipsilesional primary motor cortex (M1lesioned) followed by FES to the paretic hand during MT (Dual-aided); (2) sham tDCS to the M1lesioned followed by FES to the paretic hand during MT (FES-alone); (3) active tDCS to the M1lesioned followed by sham FES to the paretic hand during MT (tDCS-alone); and (4) sham tDCS to the M1lesioned followed by sham FES to the paretic hand during MT (Dual-sham). Participants will receive 20 intervention sessions (90 minutes/day, 5 days/week, for 4 consecutive weeks). The outcome measures will be administered before, immediately after, and 3 months after the intervention. Behavioral measures and questionnaires will be used to examine recovery of motor and daily function and quality of life. Electroencephalogram and movement kinematic analysis will be conducted to determine changes of ipsilesional neural networks and spatiotemporal control of movements after interventions. Subsequent analysis will search for the possible characteristics of responders.

Project ID:PC10907-1003
External Project ID:MOST109-2314-B182-027-MY3