A Meta-Analysis on Dual Protocols for Chronic Stroke Motor Recovery: Robotic Training and tDCS

Abstract

Two popular chronic stroke rehabilitation protocols are robotic-assisted movements and transcranial direct current stimulation (tDCS). Separately, both protocols have produced encouraging motor recovery improvements. An intriguing question remains: what happens to motor recovery when both protocols are administered together? Do the two protocols together produce additive dual effects? This systematic review and meta-analysis investigated the dual effect of combining robotic training and tDCS. We investigated the potential effects of tDCS protocols in addition to robotic-training programs on motor recovery of the upper and lower extremities post-stroke. A systematic literature search identified 20 qualified studies that used robotic training combined with tDCS protocols for upper limb (i.e., 15 studies) and lower limb (i.e., 5 studies) post-stroke rehabilitation. Individuals in the subacute and chronic stages of recovery were investigated. The 20 included studies compared additive effects of the combined protocols with robotic training sham control groups. Further, we estimated short-term and long-term treatment effects of the combined protocols. The random-effects model meta-analyses failed to find any significant short-term and long-term motor improvements in the upper extremities after the combined treatments. However, robotic-assisted movements combined with tDCS protocols revealed significant moderate transient and sustained improvements in functions of the lower limbs post-stroke. These meta-analytic findings suggest clinical implications concerning coupled top-down and bottom-up training protocols (i.e., robotic training and tDCS combined), which will allow us to make progress toward post-stroke motor recovery.