Effect of tDCS on Motor Functions and Brain Activity in Acute Stroke Patients
Effect of tDCS on Motor Functions and Brain Activity in Acute Stroke Patients
This study aims to investigate the effects of anodal- and cathodal tDCS combined with
 conventional physical therapy for 5 consecutive sessions on motor functions and brain
 activity in acute stroke patients at immediate and 1-month follow-up.
Stroke or cerebrovascular accident is a leading cause of disabilities. Physical therapy is a
 standard treatment to help motor recovery after stroke. However, disabilities remained in
 some stroke patients despite intensive training. After stroke, there are changes of cortical
 excitability and brain activity in both hemispheres. Lesioned hemisphere decreases cortical
 excitability and increases number of low-frequency brain activity, while non-lesioned
 hemisphere increases cortical excitability and increases number of high-frequency brain
 activity. Transcranial direct current stimulation (tDCS) is a technique which delivers weak
 direct current through scalp and can be used as an adjunctive treatment. Anodal tDCS can
 increase cortical excitability and amount of high-frequency brain activity while cathodal
 tDCS can decrease cortical excitability and increase amount of high-frequency brain activity.
 Increase amount of high-frequency brain activity in the lesioned hemisphere can indicate
 better recovery of stroke. Meta-analysis has reported benefits of both anodal and cathodal
 tDCS for motor recovery in stroke patients. However, only few studies have investigated tDCS
 effects in acute phase of stroke which is a crucial time for enhancing motor recovery. This
 study aims to investigate the effects of anodal- and cathodal tDCS combined with conventional
 physical therapy for 5 consecutive sessions on motor functions and brain activity in acute
 stroke patients at immediate and 1-month follow-up. Participants will be randomly assigned
 into 3 groups (sham-, anodal- and cathodal tDCS). Participants in the anodal and cathodal
 groups will receive 1.5 mA tDCS for 20 minutes before physical therapy programs for 5
 consecutive sessions, while sham group will receive sham tDCS with physical therapy. Brain
 activity by electroencephalography and motor performances by Fugl-Meyer Assessment and Wolf
 Motor Function Test will be evaluated at baseline, post-intervention (day 5) and follow-up at
 1 month. We hypothesize that anodal- and cathodal tDCS combined with physical therapy for 5
 consecutive days can immediately increase number of high-frequency brain activity and improve
 motor functions and this effect will last for a month compared to sham group.
Inclusion Criteria:

 1. Age between 18-75 years old

 2. First-ever acute ischemic stroke of anterior circulation system (anterior cerebral
 artery or middle cerebral artery territory)

 3. Stroke onset from 2-10 days

 4. Having a stable medical condition

 5. Alert of consciousness

 6. Able to follow commands

 7. Modified Rankin Scale (mRS) ≤ 4

 Exclusion Criteria:

 1. Hemorrhagic stroke

 2. Recurrent stroke

 3. Presence of other neurological disorders such as unilateral neglect

 4. Presence of metal implantation, intracranial shunt, cochlear implantation or cardiac
 pacemakers

 5. Presence of opened wound or infectious wound around scalp

 6. History of epilepsy or any neurological antecedent or unstable condition which can
 lead to seizure

 7. Body Mass Index (BMI) > 30 kg/m2

 8. Received hormonal treatment

 9. Ischemic heart disease and peripheral vascular ischemia

 10. Last stage of kidney disease and liver disease