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Bernal-Jiménez JJ, Polonio-López B, Sanz-García A, Martín-Conty JL, Lerín-Calvo A, Segura-Fragoso A, Martín-Rodríguez F, Cantero-Garlito PA, Corregidor-Sánchez AI, Mordillo-Mateos L. Is the Combination of Robot-Assisted Therapy and Transcranial Direct Current Stimulation Useful for Upper Limb Motor Recovery? A Systematic Review with Meta-Analysis. Healthcare (Basel) 2024; 12:337. [PMID: 38338223 PMCID: PMC10855329 DOI: 10.3390/healthcare12030337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Stroke is the third leading cause of disability in the world, and effective rehabilitation is needed to improve lost functionality post-stroke. In this regard, robot-assisted therapy (RAT) and transcranial direct current stimulation (tDCS) are promising rehabilitative approaches that have been shown to be effective in motor recovery. In the past decade, they have been combined to study whether their combination produces adjuvant and greater effects on stroke recovery. The aim of this study was to estimate the effectiveness of the combined use of RATs and tDCS in the motor recovery of the upper extremities after stroke. After reviewing 227 studies, we included nine randomised clinical trials (RCTs) in this study. We analysed the methodological quality of all nine RCTs in the meta-analysis. The analysed outcomes were deficit severity, hand dexterity, spasticity, and activity. The addition of tDCS to RAT produced a negligible additional benefit on the effects of upper limb function (SMD -0.09, 95% CI -0.31 to 0.12), hand dexterity (SMD 0.12, 95% CI -0.22 to 0.46), spasticity (SMD 0.04, 95% CI -0.24 to 0.32), and activity (SMD 0.66, 95% CI -1.82 to 3.14). There is no evidence of an additional effect when adding tDCS to RAT for upper limb recovery after stroke. Combining tDCS with RAT does not improve upper limb motor function, spasticity, and/or hand dexterity. Future research should focus on the use of RAT protocols in which the patient is given an active role, focusing on the intensity and dosage, and determining how certain variables influence the success of RAT.
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Affiliation(s)
- Juan J. Bernal-Jiménez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - José L. Martín-Conty
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Alfredo Lerín-Calvo
- Neruon Neurobotic S.L., 28015 Madrid, Spain;
- Department of Physiotherapy, Faculty of Health Sciences, University La Salle, 28023 Madrid, Spain
| | - Antonio Segura-Fragoso
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, University of Valladolid, 47005 Valladolid, Spain;
- Advanced Life Support, Emergency Medical Services (SACYL), 47007 Valladolid, Spain
| | - Pablo A. Cantero-Garlito
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Ana-Isabel Corregidor-Sánchez
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Spain; (J.J.B.-J.); (A.S.-G.); (J.L.M.-C.); (A.S.-F.); (P.A.C.-G.); (A.-I.C.-S.); (L.M.-M.)
- Technological Innovation Applied to Health Research Group (ITAS Group), Faculty of Health Sciences, University of de Castilla-La Mancha, 45600 Talavera de la Reina, Spain
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