tDCS synchronous robotic training on lower-limb with post-stroke hemiplegia: a comparative study between synchronous and sequential group.

BACKGROUND: This study was aimed to compare the effects of tDCS synchronized with robotic training(RT)and tDCS sequential followed by RT on lower-limb with post-stroke hemiplegia, thus to inform clinical decision-making between these delivery schedules. METHODS: 64 patients who met the inclusion and exclusion criteria were allocated into a synchronous group and a sequential group. The synchronous group underwent tDCS synchronous RT, while the sequential group received RT after tDCS ended. Both group received 40 minutes for treatment, five times a week, for a continuous two weeks. Gait Watch three-dimensional gait analysis system was used for both groups before and after treatment. Additionally, the Fugl-Meyer assessment for lower extremities (FMA-LE), functional ambulation category (FAC), and the modified Barthel index(MBI)were used to assess the motor function of lower extremities, walking function, and activities of daily living (ADL) in both groups. RESULTS: Finally, 60 cases finished the study (30 for each group). Before treatment, there was no difference in baseline data between groups (p > 0.05). After treatment, there was no difference in FMA-LE between group (F = 1.751, p = 0.191). The incidence of 95% CI of the hip flexion, knee flexion, FAC, step difference and MBI in synchronous group were more superior than those in the sequential group (all p < 0.001). CONCLUSION: Synchronous tDCS-RT produced superior gait and functional benefits compared with sequential delivery, but did not differentially improve lower-limb motor impairment as measured by the FMA-LE on lower-limb with post-stroke hemiplegia.