Effects of Functional Electrical Stimulation Cycling and Central Neuromodulation on Motor Control in Stroke

In recent years, stroke has been ranked as number two among the top 10 causes of mortality in Taiwan. Most of stroke patients are left with physical impairments deeply affecting the activities of daily living. Weakness and spasticity interfere with proper functional movement and lead to impaired balance, poor posture control and bilaterally asymmetric limb movement. For stroke patients, gait training is one of the important rehabilitation programs. However, it is usually difficult for stroke patients to undertake gait training immediately after stroke. Therefore, therapists have to manually facilitate the patients’ lower extremities to appropriately perform continuous and smooth reciprocal movements for gait training. Both functional electrical stimulation cycling exercise (FESCE) and transcranial direct current stimulation (tDCS) are contemporarily important issues in the advanced motor control and neuromodulation rehabilitation medicine. FESCE is a reciprocal symmetric multiple-joint limb exercise and is suitable for functional limb training. Traditionally, the cycling exercise was only used in subjects with spinal cord injury but rarely used in stroke patients. Transcranial direct current stimulation (tDCS) can change the excitability of regional cortex. According to the polarity of the electrode, inhibitory and excitatory effects can be achieved. tDCS has been applied in clinical conditions such as depression, insomnia, anxiety, stroke and pain disorders and showed some positive effects. Some studies reported the motor re-learning effect of upper extremities in stroke patients by applying tDCS. However, the study regarding the optimal tDCS model for the rehabilitation of lower extremities is still rare. Furthermore, the effects of FESCE combined with tDCS in the rehabilitation of stroke patients’ lower extremities are also unknown. Therefore, the aim of this study is to determine whether traditional rehabilitation (TR) combined with FESCE or/and tDCS can perform a better therapeutic effect than traditional rehabilitation alone. In the project, we plan to recruit 64 stroke patients within 2 years, and will randomly divide them into 4 groups, including A: traditional rehabilitation (TR), B: TR combined with FESCE, C: TR combined with tDCS, D: TR combined with FESCE and tDCS. The kinesiological and kinematical data, balance, limb symmetry, gait analysis, spasticity , and quality of life will be measured before and after the 4-week training. We expect that the results will provide important evidence-based information for promoting patients’ function and health.