Synergic Effect of Brain Stimulation, Functional Electrical Stimulation and Electrical Stimulation and Mirror Therapy on Stroke Rehabilitation – A Feasibility Study

This study aims to evaluate the feasibility of using a combination of transcranial direct current stimulation, functional electrical stimulation, and mirror therapy to prevent spasticity and maximize re-learning in the brain. The trial was done over 10 days on 10 hemiplegic participants. The participants received 15 minutes of a-tDCS over the ipsi-lesional motor cortex, followed by 10 minutes of combined Functional Electrical Stimulation (FES) and mirror therapy of the wrist flexors and extensors on the affected side. FES was provided with a novel device called the Encoder-controlled FES (EC-FES). Recruitment rates, dropout rates and participant satisfaction were assessed along with preliminary outcomes of the study. The dropout rate was calculated to be 9%, with 1 dropout out of 11 participants. The remaining participants completed 10 days of therapy each. Participants rated the synergic therapy for setting up time (7.3/10), complexity (6.9/10) and willingness to participate in a longer study (7.9/10). Participation satisfaction, as assessed by the Pittsburgh rehabilitation participation scale, yielded an average of 4.81/6, showing that participants were satisfied with the experience. 7 participants reported reduction in muscle tightness after the trial, although there was no change in wrist range of motion (ROM). The results indicate that the trial is safe, with a low dropout rate and good participant satisfaction, paving the way for a more definitive clinical trial.