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Table 1 Characteristics and design of the included studies

From: Transcranial direct current stimulation combined with robotic therapy for upper and lower limb function after stroke: a systematic review and meta-analysis of randomized control trials

Author (year)

Study design

Intervention

Groups

Treatment

Parameters

Outcomes

n° sessions (s)

Sessions/week (s/w)

Follow-up

Adverse effects

Geroin C. et al. (2011)297

RCT Double-blinded

RAGT + tDCS

G1) RAGT + tDCS

G2) RAGT + sham tDCS

G3) Overground-walking exercises

7 min tDCS online + 20 min RAGT + 30 leg strengthening exercise

35 cm2

Anode M1 affected, cathode contralateral SO

1.5 mA. CD = 0.05 mA/cm2

6MWT, 10MWT, SGP,

Rivermead Mobility Index,

MI leg, MAS

10 s

5 s/w

2 weeks

No adverse events reported

Hesse S. et al. (2011)2830

RCT Double-blinded

Arm robot + anodal tDCS

G1) Arm robot + anodal tDCS

G2) Arm robot + cathodal tDCS

G3) Arm robot + sham tDCS

20 min anodal or cathodal tDCS online + Arm Robot training

35 cm2

G1) Anode M1 affected, cathode contralateral SO

G2) Cathode M1 unaffected, contralateral SO

2 mA. CD = 0.07 mA/cm2

FM/ue, MRC, MAS, BI, B&B

30 s

5 s/w

3 months

Tingling under the electrodes and transient headaches

Danz et al. (2013)2931

RCT Double-blinded

Anodal tDCS + Lokomat

G1) Anodal tDCS + Lokomat

G2) Sham tDCS + Lokomat

20 min anodal tDCS

 + 20–40 min Lokomat (20–50% body support)

25 cm2: Anode M1 affected

35 cm2: Cathode contralateral SO

2 mA. CD = 0.05 mA/cm2

10MWT, TUG, BBS, FAC, SIS-16

12 s

3 s/w

1 months

No adverse events reported

Triccas et al. (2015)3032

RCT Double-blinded

Anodal tDCS + RT

G1) Anodal tDCS + RT

G2) Sham tDCS + RT

20 min Anode tDCS online + 1 h Armeo robotic training

35 cm2

Anode M1 affected

Cathode contralateral SO

1 mA. CD = 0.035 mA/cm2

FM/ue, ARAT, MAL-28, SIS

18 s

2-3 s/w

3 months

tDCS sensation: itching, tingling, warmth, burning, pain, light flashes and headaches

RT: fatigue, shoulder pain and upper trapezius pain on the affected side

Straudi S et al. (2016)3133

RCT Double-blinded

tDCS + upper extremity robot-assisted

G1) tDCS + robot-assisted

G2) Sham tDCS + robot-assisted

30 min tDCS + 30 min

upper extremity robot-assisted

35 cm2

Anode M1 affected, cathode M1 contralateral hemisphere, 1 mA. CD = 0.035 mA/cm2

FM/ue, B&B

MAL-14

10 s, 5 s/w

Immediately Post-intervention

Skin redness, under the site of stimulation (5/1)

Headache (1/1)

Sleepiness (1/0)

Neck pain (0/1)

(tDCS/sham-tDCS)

Seo HG et al

(2017)3234

Pilot RCT, double-blinded

tDCS + RAGT

G1) tDCS + RAGT

G2) Sham + RAGT

20 min de tDCS + 45 min RAGT

35 cm2

Anode: M1 (leg area) affected. Cathode: contralateral SO

2 mA. CD = 0.07 mA/cm2

FAC, 10MWT, 6MWT, BBS, FMA-LE, MRC

EMG activity: MEP

10 s

5 s/w

4 weeks

No mention

Mazzoleni S, et al. (2017)3335

RCT Single blind

tDCS + wrist RT

G1) tDCS + robot-aided

G2) Sham + robot aided

20 min tDCS online + 30 min

RT

35 cm2

Anode: M1 (hand area) affected. Cathode contralateral orbit

2 mA. CD = 0.07 mA/cm2

(FM/ue, FM/w), MAS, MI, B&B

Kinematic data

30 s

5 s/w

Immediately Post-intervention

No adverse events reported

Dehem et al. (2018)3436

RCT Double blind crossover

robot upper limb + real tDCS

G1) robot upper limb + real tDCS

G2) robot upper limb + Sham tDCS

20 min

tDCS/sham online + RT

35 cm2

Anode M1 affected,

Cathode M1 unaffected

1 mA. CD = 0.035 mA/cm2

B&B, PPT

Upper limb kinematics

2 s

1 s/w

Immediately Post-intervention

No adverse events reported

Edwards et al. (2019)3537

RCT Double blind

tDCS + Robot

G1)Sham + Robot

G2) tDCS + Robot

20 min tDCS/sham + 1 h RT

35 cm2

Anode M1 affected (5 cm lateral to the vertex)

Cathode: contralateral SO

2 mA. CD = 0.07 mA/cm2

FM/ue, Wolf Motor Function Test, BI, MRC, SIS, EMG activity: MEP

36 s

3 s/w

6 months

Headache, burning sensation, sleepiness, tingling, redness, trouble concentrating

Mazzoleni et al. (2019)3638

RCT Single blind

tDCS + wrist robot-assisted training

G1) Sham + robot

G2) tDCS + robot

20 min tDCS/sham online + 30 min

wrist robot-assisted training

35 cm2

Anode: M1 affected

Cathode: contralateral orbit bone

2 mA. CD = 0.07 mA/cm2

FM/ue, FM/w MAS/w, MI, B&B. Wrist kinematic parameters

30 s

5 s/w

Immediately

Post-intervention

No adverse event reported

  1. Randomized controlled trial (RCT). Robot-assisted gait training (RAGT). Transcranial direct current stimulation (tDCS). Group (G). Supraorbital (SO). 6-min walk test (6MWT). 10 min walking test (10MWT). Spatiotemporal gait parameters (SGP). Motricity Index (MI). Modified Ashworth scale (MAS). Fugl-Meyer assessment scale for upper extremities (FM/ue). Barthel Index (BI). Box & block test (B&B). Medical Research Council sum score (MRC). Timed up-and-go test (TUG test). Berg balance scale (BBS). Functional ambulation category (FAC). Stroke impact scale 16 (SIS-16). Robot therapy (RT). Motor activity log 14 items (MAL-14). Action research arm test (ARAT). Motor activity log-28 (MAL-28). Milliamps (mA). Fugl-Meyer assessment scale for wrist (FM/w). Purdue pegboard test (PPT). Electromyography (EMG). Motor-Evoked Potentials (MEP). Modified Ashworth scale on the wrist (MAS/w)