Towards a personalized approach to motor recovery after stroke with transcranial direct current stimulation (tDCS)

Abstract

Introduction: Functional incapacity after stroke related to the upper limb function remains in 75% of cases. The application of transcranial direct current stimulation (tDCS) influences neuroplasticity and functional recovery. Its use is still controversial because of the response variability between individuals and the lack of a standardized tDCS protocol. Objective: To investigate how the severity of the stroke and stimulation parameters influence the individual motor responses during the tDCS. Method: Patients with subacute stroke will practice aiming movements during physical therapy. At the same time they will receive three types of tDCS (anodal, catodal and sham), each one applied on a different day, separated by rest periods. The tDCS will be applied in the non-affected motor cortex by injury. The primary outcomes will be obtained by kinematic analysis of the reaching movements of the upper limb performed before and after each session of tDCS + rehabilitation and 24 hrs after. Functional magnetic resonance will be used to quantify the severity of corticospinal tract injury. Expected results: This project aims to elucidate what kind of tDCS will optimize motor learning for each patient. Work plan: The participation in this research project will allow that the expertise in various areas of knowledge be brought to Brazil and implemented in studies and in physiotherapy practice. Specifically, in: application of tDCS and its usage as a physiotherapeutic approach; analysis of magnetic resonance and the degree of the corticospinal tract lesion as a biomarker; kinematic analysis of the reaching movements; and procedures for rehabilitation in individuals post-stroke. (AU)