Combined Transcranial Direct Current Stimulation with Occupational Therapy Improves Activities of Daily Living in Traumatic Brain Injuries: A Pilot Randomized Clinical Trial
-
Mehrnaz Afsharipor
,
Mahnaz Hejazi-Shirmard
,
Ashkan Irani
,
Minoo Kalantari
,
Alireza Akbarzade Baghban
Abstract
Introduction: Traumatic brain injury (TBI) is one of the leading causes of long-term disability worldwide. Occupational therapy interventions in these patients are mainly focused on improving patients’ ability to perform daily occupations. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique whose potential for motor and cognitive recovery of patients with TBI has been investigated; however, its effect on functional outcomes following TBI is unknown. This study aims to determine the effectiveness of tDCS combined with routine occupational therapy on the activities of daily living in patients with TBI.
Materials and Methods: This was a single-blind, randomized clinical trial. A total of 24 patients with TBI were recruited using the convenience sampling method and were randomly assigned to the experimental (n=12) and control groups (n=12). Both groups underwent routine occupational therapy for 10 sessions (3 days per week), and the experimental group received tDCS (20 min) in addition to routine occupational therapy. Activities of daily living were assessed using the functional independence measure (FIM) at the baseline and the day after the end of the intervention.
Results: After a 10-session intervention, both groups experienced significant improvements in the cognitive subscale and the FIM total score (P<0.001). Additionally, the findings showed that these improvements were significantly higher in the experimental group (P<0.001).
Conclusion: According to the findings, although routine occupational therapy can effectively improve the ability of patients with TBI to perform daily living activities, adding tDCS as a complementary intervention can accelerate recovery in these patients.
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24. Lee SA, Kim MK. Effect of low frequency repetitive transcranial magnetic stimulation on depression and cognition of patients with traumatic brain injury: A randomized controlled trial. Medical science monitor. 2018; 24:8789-94. [DOI:10.12659/MSM.911385] [PMID]
25. Lesniak M, Polanowska K, Seniów J, Czlonkowska A. Effects of repeated anodal tDCS coupled with cognitive training for patients with severe traumatic brain injury: A pilot randomized controlled trial. The Journal of Head Trauma Rehabilitation. 2014; 29(3):E20-9. [DOI:10.1097/HTR.0b013e318292a4c2] [PMID]
2. Cooksley R, Maguire E, Lannin NA, Unsworth CA, Farquhar M, Galea C, et al. Persistent symptoms and activity changes three months after mild traumatic brain injury. Australian Occupational Therapy Journal. 2018; 65(3):168-75. [DOI:10.1111/1440-1630.12457] [PMID]
3. Rabinowitz AR, Levin HS. Cognitive sequelae of traumatic brain injury. The Psychiatric Clinics of North America. 2014; 37(1):1-11. [DOI:10.1016/j.psc.2013.11.004] [PMID]
4. Ponsford JL, Downing MG, Olver J, Ponsford M, Acher R, Carty M, et al. Longitudinal follow-up of patients with traumatic brain injury: Outcome at two, five, and ten years post-injury. Journal of Neurotrauma. 2014; 31(1):64-77. [DOI:10.1089/neu.2013.2997] [PMID]
5. Wilson L, Horton L, Kunzmann K, Sahakian BJ, Newcombe VF, Stamatakis EA, et al. Understanding the relationship between cognitive performance and function in daily life after traumatic brain injury. Journal of Neurology, Neurosurgery & Psychiatry. 2021; 92(4):407-17. [DOI:10.1136/jnnp-2020-324492] [PMID]
6. Kanchan A, Singh AR, Khan NA, Jahan M, Raman R, Sathyanarayana Rao TS. Impact of neuropsychological rehabilitation on activities of daily living and community reintegration of patients with traumatic brain injury. Indian Journal of Psychiatry. 2018; 60(1):38-48. [DOI:10.4103/psychiatry.IndianJPsychiatry_118_17] [PMID]
7. Andelic N, Forslund MV, Perrin PB, Sigurdardottir S, Lu J, Howe EI, et al. Long-term follow-up of use of therapy services for patients with moderate-to-severe traumatic brain injury. Journal of Rehabilitation Medicine. 2020; 52(3):jrm00034. [DOI:10.2340/16501977-2662] [PMID]
8. Ahorsu DK, Adjaottor ES, Lam BYH. Intervention effect of non-invasive brain stimulation on cognitive functions among people with traumatic brain injury: A systematic review and meta-analysis. Brain Sciences. 2021; 11(7):840. [DOI:10.3390/brainsci11070840] [PMID]
9. Zaninotto AL, El-Hagrassy MM, Green JR, Babo M, Paglioni VM, Benute GG, et al. Transcranial direct current stimulation (tDCS) effects on traumatic brain injury (TBI) recovery: A systematic review. Dementia & Neuropsychologia. 2019; 13(2):172-9. [DOI:10.1590/1980-57642018dn13-020005] [PMID]
10. Rudroff T, Workman CD. Transcranial direct current stimulation as a treatment tool for mild traumatic brain injury. Brain sciences. 2021; 11(6):806. [DOI:10.3390/brainsci11060806] [PMID]
11. Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke. Cochrane Database of Systematic Reviews. 2020; 11(11):CD009645.[DOI:10.1002/14651858.CD009645.pub4] [PMID]
12. Kim WS, Lee K, Kim S, Cho S, Paik NJ. Transcranial direct current stimulation for the treatment of motor impairment following traumatic brain injury. Journal of Neuroengineering and Rehabilitation. 2019; 16(1):14. [DOI:10.1186/s12984-019-0489-9] [PMID]
13. Naghdi S, Ansari NN, Raji P, Shamili A, Amini M, Hasson S. Cross-cultural validation of the Persian version of the Functional Independence Measure for patients with stroke. Disability and Rehabilitation. 2016; 38(3):289-98. [DOI:10.3109/09638288.2015.1036173] [PMID]
14. Sacco K, Galetto V, Dimitri D, Geda E, Perotti F, Zettin M, et al. Concomitant use of transcranial direct current stimulation and computer-assisted training for the rehabilitation of attention in traumatic brain injured patients: Behavioral and neuroimaging results. Frontiers in Behavioral Neuroscience. 2016; 10:57. [DOI:10.3389/fnbeh.2016.00057] [PMID]
15. Gao F, Foster M, Newcombe P, Geraghty T. Applying bifactor modelling to improve the clinical interpretive values of Functional Independence Measure in adults with acquired brain injury. Disability and Rehabilitation. 2020; 42(12):1753-61. [DOI:10.1080/09638288.2018.1531153] [PMID]
16. Corrigan JD, Smith-Knapp K, Granger CV. Validity of the functional independence measure for persons with traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 1997; 78(8):828-34. [DOI:10.1016/S0003-9993(97)90195-7] [PMID]
17. Fathipour-Azar Z, Akbarfahimi M, Vasaghi-Gharamaleki B, Naderi N. Evaluation of activities of daily living instruments in cardiac patients: Narrative review. Journal of Modern Rehabilitation. 2017; 10(3):139-43. [Link]
18. Sternbach GL. The Glasgow coma scale. The Journal of Emergency Medicine. 2000; 19(1):67-71. [DOI:10.1016/S0736-4679(00)00182-7] [PMID]
19. Begemann MJ, Brand BA, Ćurčić-Blake B, Aleman A, Sommer IE. Efficacy of non-invasive brain stimulation on cognitive functioning in brain disorders: A meta-analysis. Psychological Medicine. 2020; 50(15):2465-86. [DOI:10.1017/S0033291720003670] [PMID]
20. Dodge HH, Kadowaki T, Hayakawa T, Yamakawa M, Sekikawa A, Ueshima H. Cognitive impairment as a strong predictor of incident disability in specific ADL-IADL tasks among community-dwelling elders: The Azuchi study. The Gerontologist. 2005; 45(2):222-30. [DOI:10.1093/geront/45.2.222] [PMID]
21. Rosenthal E, Brennan L, Xie S, Hurtig H, Milber J, Weintraub D, et al. Association between cognition and function in patients with Parkinson disease with and without dementia. Movement Disorders. 2010; 25(9):1170-6. [DOI:10.1002/mds.23073] [PMID]
22. Hoffmann T, Bennett S, Koh CL, McKenna K. A systematic review of cognitive interventions to improve functional ability in people who have cognitive impairment following stroke. Topics in Stroke Rehabilitation. 2010; 17(2):99-107. [DOI:10.1310/tsr1702-99] [PMID]
23. Kalmar JH, Gaudino EA, Moore NB, Halper J, DeLuca J. The relationship between cognitive deficits and everyday functional activities in multiple sclerosis. Neuropsychology. 2008; 22(4):442-9. [DOI:10.1037/0894-4105.22.4.442] [PMID]
24. Lee SA, Kim MK. Effect of low frequency repetitive transcranial magnetic stimulation on depression and cognition of patients with traumatic brain injury: A randomized controlled trial. Medical science monitor. 2018; 24:8789-94. [DOI:10.12659/MSM.911385] [PMID]
25. Lesniak M, Polanowska K, Seniów J, Czlonkowska A. Effects of repeated anodal tDCS coupled with cognitive training for patients with severe traumatic brain injury: A pilot randomized controlled trial. The Journal of Head Trauma Rehabilitation. 2014; 29(3):E20-9. [DOI:10.1097/HTR.0b013e318292a4c2] [PMID]
| Files | ||
| Issue | Vol 18 No 1 (2024) | |
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/jmr.v18i1.14736 | |
| Keywords | ||
| Traumatic brain injuries Transcranial direct current stimulation Occupational therapy Activities of daily living | ||
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How to Cite
1.
Afsharipor M, Hejazi-Shirmard M, Irani A, Kalantari M, Akbarzade Baghban A. Combined Transcranial Direct Current Stimulation with Occupational Therapy Improves Activities of Daily Living in Traumatic Brain Injuries: A Pilot Randomized Clinical Trial. jmr. 2024;18(1):114-120.
