Novel Brain Neurotechnology for Optimizing Precision Mirror Therapy in Stroke

Project: National Health Research InstitutesNational Health Research Institutes Grants Research

Project Details


Developing effective rehabilitation interventions to maximize functional recovery remains to be a major challenge for stroke rehabilitation. Transcranial random noise stimulation (tRNS) has emerged as a promising brain neurotechnology to enhance neural plasticity to augment treatment effects of stroke neuorehabilitation. Compared to traditional brain neurotechnology such as transcranial direct current stimulation (tDCS), tRNS does not have polarity constraints, thus providing more consistent modulatory effects, less response variability and less adverse effect, which make it a potentially ideal approach to combine with contemporary stroke rehabilitation therapies. Mirror therapy (MT) is effective at improving sensorimotor recovery in stroke patients. Because of its easiness for use in clinical settings, MT has been recommended by American Heart Association as a promising intervention for stroke patients. Combining tRNS with MT could be an appealing approach to further boost brain plasticity to maximize MT benefits in the clinical settings. However, MT can be delivered using unilateral or bilateral approaches, which may induce differential treatment benefits. The optimal combination of MT with tRNS to augment health recovery, motor control, and brain plasticity has not yet been established. It is imperative to examine the effects of the combined protocols to develop evidence-based precision brain neurotechnology-augmented stroke rehabilitation therapies. Therefore, this research project will (1) compare the effects of the tRNS-augmented unilateral and bilateral MT, and their effects relative to the control interventions (sham tRNS with unilateral or bilateral MT) comprehensively on health condition (including motor function, daily function, quality of life and self-efficacy), motor control strategies and brain activities (as measured by the electroencephalography, EEG) in the stroke patients; (2) examine the retention effects and possible delayed response of tRNS-augmented unilateral and bilateral MT at 3-month and 6-month after interventions and (3) identify the predictors of the treatment success of the tRNS-augmented unilateral and bilateral MT to determine good responders. We will conduct a randomized, sham controlled clinical trial with 128 stroke patients in this 5-year project. Patients will be randomly assigned to (1) tRNS-augmented unilateral MT, (2) tRNS-augmented bilateral MT, (3) sham tRNS with unilateral MT, and (4) sham tRNS with bilateral MT. Participants will receive 20 intervention sessions (90 minutes/day, 5 days/week, for 4 consecutive weeks). The outcome measures will include the clinical assessments to evaluate health condition (i.e., motor and daily function as well as quality of life and self-efficacy); kinematic assessments to evaluate motor control strategies; and the EEG to evaluate brain activities (power). The clinical assessments will be performed at pre-test, interim-test, post-test, and 3-month and 6-month follow-up. The kinematic and EEG assessments will be administered at pre-test and post-test. In addition, the EEG assessment will be conducted during the intervention period (8 testing sessions in 4 weeks) to evaluate the dynamical changes of brain activities during the intervention. Two-way repeated measures analysis of variance followed by the Bonferroni post hoc test will be used to assess the treatment effects and the dynamical changes of brain activities among the four treatment groups. The effect size of partial η2 will be calculated to index the magnitude of outcome changes. The multiple linear regression analysis will be conducted to identify the predictors/characteristics of stroke patients that respond to the tRNS-augmented intervention. Procedures including the multicollinearity test will be performed to ensure the appropriateness of the regression analysis. This research project will provide scientific evidence of the treatment effects of innovative brain neurotechnology-augmented stroke rehabilitation therapy. Specifically, the findings will facilitate understanding of health outcome changes associated with the novel tRNS-augmented MT and elucidate the possible biomechanical and brain mechanisms. In addition, the results will reveal the characteristics of good responders to the combined intervention to facilitate clinical translation. The overall results will contribute to formulation of precision hybrid brain neurotechnology with stroke rehabilitation therapies to optimize neural and functional recovery in stroke patients.

Project IDs

Project ID:PG11101-0029
External Project ID:NHRI-EX111-11105PI
Effective start/end date01/01/2231/12/22


  • mirror therapy
  • transcranial random noise stimulation
  • stroke
  • neurorehabilitation
  • upper extrimity


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