O efeito da neuromodulação com High Definition Transcranial Direct Current Stimulation (HD tDCS) na recuperação funcional de pacientes crônicos pós acidente vascular cerebral

Abstract

Stroke is a condition with high incidence and mortality. Their survivors will often exhibit physical, cognitive, or psychological deficits. Functional recovery of the upper limb is almost always limited when compared to that of the lower limb. Interventions based on specific task training, muscle strengthening, and motor learning stimuli are considered to be most effective for upper limb recovery. TDCS is a non-invasive brain stimulation conventional technique capable of modifying the resting potential of the neuronal membrane and the level of spontaneous firing in the stimulated area. It is considered that this technique can optimize the results of motor physical therapy. Simulations using finite element (FEM) computational models indicate that the application of HD-tDCS can be significantly more localized than the conventional technique. More focused and better targeted stimulation has more advantages in terms of efficiency. A prospective, randomized, placebo controlled, blind-valued clinical trial was conducted. Patients were randomly assigned to an experimental group of neuromodulation with HD-tDCS and exercises or to a HD-tDCS placebo group followed by exercise. Safety criteria for a maximum direct current amount have already been established for the tDCS method (28.57 mA / cm2) and researchers have consistently reported success using currents up to 1000 times lower. In the present study, the current density of 40 μA / cm2 was used. The aim of this study was to verify the effect of neuromodulation with HD-tDCS associated with motor physical therapy in the functional recovery of the paretic upper limb in chronic patients after stroke. According to the results found in this study, it is recommended to restrict the use of cathodic tDCS in chronic patients with severe functional impairment and large lesion area.