Combined Effect of tDCS and GRASP for Upper Limb Rehabilitation in Stroke: A Clinical and Accelerometric Pilot Study

Upper limb (UL) impairment after stroke negatively influences stroke survivors' quality of life (QOL). This study aims to evaluate, through clinical assessment and accelerometric measures, the efficacy of anodal Transcranial Direct Current Stimulation (a-tDCS) combined with the Graded Repetitive Arm Supplementary Program (GRASP) in post-acute stroke UL rehabilitation. Subjects were enrolled if they were aged ≥18 years and had a first stroke diagnosis, UL motor impairment and adequate trunk control. The subjects underwent combined administration of intensive a-tDCS and GRASP (15 sessions/30 min each). Before and after treatment, a subgroup of subjects was evaluated through wearable accelerometers. A total of 30 subjects were included in this study (mean age 68.34 ± 14.08 years; 19 males/11 females). Medical Research Council (MRC), Hand Grip Strength (HGS), Nine-Hole Peg Test (9HPT), Box and Block Test (BBT) and Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores significantly improved after treatment. The accelerometric-derived measurements all revealed a significant increase in the affected UL activity as indicated by the Vector Magnitude value. No side effects were reported. In conclusion, an intensive a-tDCS and GRASP application proved to be effective and safe in UL rehabilitation after stroke. The association of accelerometric monitoring might be of paramount importance for the evaluation of UL recovery.