Neurophysiological and behavioral effects of tDCS combined with constraint-induced movement therapy in poststroke patients

Nadia Bolognini, Giuseppe Vallar, Carlotta Casati, Lydia Abdul Latif, Rasheda El-Nazer, Julie Williams, Elisabetta Banco, Debora Duarte MacEa, Luigi Tesio, Cecilia Chessa, Felipe Fregni

Research output: Contribution to journalArticlepeer-review

225 Scopus citations


Background. Recovery of motor function after stroke may depend on a balance of activity in the neural network involving the affected and the unaffected motor cortices. Objective. To assess whether transcranial direct current stimulation (tDCS) can increase the training-induced recovery of motor functions. Methods. In an exploratory study, 14 patients with chronic stroke and mean Fugl-Meyer Upper Extremity Motor Assessment of 29 (range = 8-50) entered a double-blind sham-controlled study, aimed to investigate neurophysiological and behavioral effects of bihemispheric tDCS (cathodal stimulation of the unaffected motor cortex and anodal stimulation of the affected motor cortex), combined with constraint-induced movement therapy (CIMT). Results. Patients in both groups demonstrated gains on primary outcome measures, that is, Jebsen Taylor Hand Function Test, Handgrip Strength, Motor Activity Log Scale, and Fugl-Meyer Motor Score. Gains were larger in the active tDCS group. Neurophysiological measurements showed a reduction in transcallosal inhibition from the intact to the affected hemisphere and increased corticospinal excitability in the affected hemisphere only in the active tDCS/CIMT group. Such neurophysiological changes correlated with the magnitude of the behavioral gains. Both groups showed a reduction in corticospinal excitability of the unaffected hemisphere. Conclusions. CIMT alone appears effective in modulating local excitability but not in removing the imbalance in transcallosal inhibition. Bihemispheric tDCS may achieve this goal and foster greater functional recovery.

Original languageEnglish (US)
Pages (from-to)819-829
Number of pages11
JournalNeurorehabilitation and Neural Repair
Issue number9
StatePublished - Nov 2011
Externally publishedYes


  • constraint-induced movement therapy
  • motor cortex
  • motor recovery
  • stroke rehabilitation
  • transcranial direct current stimulation

ASJC Scopus subject areas

  • Rehabilitation
  • Neurology
  • Clinical Neurology


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