{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T20:11:10Z","timestamp":1791490270007,"version":"4.3.4"},"reference-count":40,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2019,3,28]],"date-time":"2019-03-28T00:00:00Z","timestamp":1553731200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Restorative Neurology and Neuroscience"],"published-print":{"date-parts":[[2019,4,16]]},"abstract":"<jats:sec specific-use=\"heading-level-1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Intensive robot-assisted arm training in the chronic phase of stroke recovery can lead to clinical improvement. Combinatorial therapeutic approaches are sought to further optimize stroke recovery. Transcranial direct current stimulation (tDCS) is one candidate to combine with robotic training, as transient increases in excitability and improvements in motor behavior have separately been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec specific-use=\"heading-level-2\">\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To determine whether tDCS, delivered prior to robotic training, could augment clinical improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec specific-use=\"heading-level-3\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a dual-site, randomized controlled trial in 82 chronic ischemic stroke patients (inclusion\u200a&gt;\u200a6\u200am post-injury, dominant hemisphere, first stroke; residual hemiparesis) who were split into two groups to receive tDCS (M1-SO montage, anode ipsilesional, 5\u00d77\u200acm electrodes, 2\u200amA, 20\u200amins) or sham tDCS, prior to robotic upper-limb training (12 weeks; 36 sessions; shoulder-elbow robot or wrist robot on alternating sessions). The primary end-point was taken after 12 weeks of training, and assessed with the Upper Extremity Fugl-Meyer impairment scale (FM). Corticomotor conduction was assessed with transcranial magnetic stimulation (TMS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec specific-use=\"heading-level-4\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      For the combined group (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u200a=\u200a82; post-training) robotic training increased the FM by 7.36 points compared to baseline (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u200a&lt;\u200a0.0001). There was no difference in the FM increase between the tDCS and sham groups (6.97 and 7.73 respectively,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u200a=\u200a0.46). In both groups, clinically meaningful improvement (\u22655 points) from baseline was evident in the majority of patients (56\/77), was sustained six months later (54\/72), and could be attained in severe, moderate and mild baseline hemiparesis. Clinical improvement was associated with increased excitability in the affected hemisphere as assessed by resting motor threshold (pre-post\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u200a=\u200a0.029; pre-post 6 months\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u200a=\u200a0.029), but not with threshold-adjusted assessment of MEP amplitude (pre-post\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u200a=\u200a0.09; pre-post 6 months\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u200a=\u200a0.15). Participants with motor evoked potentials were more likely to improve clinically than those without (17\/18, 94%, versus 39\/59, 66%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u200a=\u200a0.018).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec specific-use=\"heading-level-5\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Our study confirms the benefit of intensive robot-assisted training in stroke recovery, and indicates that conventional tDCS does not confer further advantage to robotic training. We also showed that corticospinal integrity, as assessed by TMS, is a predictor of clinically meaningful response to intensive arm therapy in chronic stroke.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3233\/rnn-180869","type":"journal-article","created":{"date-parts":[[2019,3,29]],"date-time":"2019-03-29T12:46:10Z","timestamp":1553863570000},"page":"167-180","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":35,"title":["Clinical improvement with intensive robot-assisted arm training in chronic stroke is unchanged by supplementary tDCS"],"prefix":"10.1177","volume":"37","author":[{"given":"Dylan J.","family":"Edwards","sequence":"first","affiliation":[{"name":"Moss Rehabilitation Research Institute","place":["USA"]},{"name":"Burke Neurological Institute","place":["USA"]},{"name":"Weill Cornell Medicine","place":["USA"]},{"name":"Edith Cowan University","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar","family":"Cortes","sequence":"additional","affiliation":[{"name":"Burke Neurological Institute","place":["USA"]},{"name":"Department of PM&R","place":["USA"]},{"name":"Icahn School of Medicine at Mount Sinai","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avrielle","family":"Rykman-Peltz","sequence":"additional","affiliation":[{"name":"Burke Neurological Institute","place":["USA"]},{"name":"Department of PM&R","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Chang","sequence":"additional","affiliation":[{"name":"Feinstein Institute for Medical Research","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Elder","sequence":"additional","affiliation":[{"name":"Boehringer Ingelheim Pharmaceuticals Inc","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Thickbroom","sequence":"additional","affiliation":[{"name":"Burke Neurological Institute","place":["USA"]},{"name":"Department of PM&R","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan J.","family":"Mariman","sequence":"additional","affiliation":[{"name":"Metropolitan University of Educational Sciences","place":["Chile"]},{"name":"University of Chile","place":["Chile"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda M.","family":"Gerber","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Oromendia","sequence":"additional","affiliation":[{"name":"Division of Biostatistics and Epidemiology","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hermano I","family":"Krebs","sequence":"additional","affiliation":[{"name":"Massachusetts Institute of Technology","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Fregni","sequence":"additional","affiliation":[{"name":"Harvard Medical School","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce T.","family":"Volpe","sequence":"additional","affiliation":[{"name":"Feinstein Institute for Medical Research","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Pascual-Leone","sequence":"additional","affiliation":[{"name":"and Harvard Medical School","place":["USA"]},{"name":"Universitat Autonoma Barcelona, Barcelona","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2019,3,28]]},"reference":[{"key":"e_1_3_4_2_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.aad5651"},{"key":"e_1_3_4_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2017.12.008"},{"key":"e_1_3_4_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968311411056"},{"key":"e_1_3_4_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-801772-2.00048-5"},{"key":"e_1_3_4_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2007.10.014"},{"key":"e_1_3_4_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ptj\/63.10.1606"},{"key":"e_1_3_4_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2013.01.042"},{"key":"e_1_3_4_9_1","doi-asserted-by":"publisher","DOI":"10.3233\/RNN-2009-0470"},{"key":"e_1_3_4_10_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.29.9.1854"},{"key":"e_1_3_4_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968315625838"},{"key":"e_1_3_4_12_1","doi-asserted-by":"publisher","DOI":"10.3233\/NRE-130927"},{"key":"e_1_3_4_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2012.01.010"},{"key":"e_1_3_4_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.117.020607"},{"key":"e_1_3_4_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-016-4667-8"},{"key":"e_1_3_4_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968308315999"},{"key":"e_1_3_4_17_1","doi-asserted-by":"publisher","DOI":"10.5535\/arm.2016.40.5.806"},{"key":"e_1_3_4_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2015.03.024"},{"key":"e_1_3_4_19_1","doi-asserted-by":"publisher","DOI":"10.1109\/TNSRE.2007.903899"},{"key":"e_1_3_4_20_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e318202013a"},{"key":"e_1_3_4_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968311427568"},{"key":"e_1_3_4_22_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0911341"},{"key":"e_1_3_4_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2017.03.008"},{"key":"e_1_3_4_24_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545968314527351"},{"key":"e_1_3_4_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2007.11.018"},{"key":"e_1_3_4_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7793.2000.t01-1-00633.x"},{"key":"e_1_3_4_27_1","doi-asserted-by":"publisher","DOI":"10.1523\/JNEUROSCI.16-02-00785.1996"},{"key":"e_1_3_4_28_1","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e31829734f2"},{"key":"e_1_3_4_29_1","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20110009"},{"key":"e_1_3_4_30_1","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.2008.166926"},{"key":"e_1_3_4_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001756-199807130-00020"},{"key":"e_1_3_4_32_1","doi-asserted-by":"publisher","DOI":"10.3389\/fncel.2015.00335"},{"key":"e_1_3_4_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(17)30283-1"},{"key":"e_1_3_4_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.488"},{"key":"e_1_3_4_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2015.06.015"},{"key":"e_1_3_4_36_1","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/bhm218"},{"key":"e_1_3_4_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2014.01.034"},{"key":"e_1_3_4_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2006.01.016"},{"key":"e_1_3_4_39_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001828"},{"key":"e_1_3_4_40_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnsys.2016.00082"},{"key":"e_1_3_4_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10548-015-0447-1"}],"container-title":["Restorative Neurology and Neuroscience"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/RNN-180869","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.3233\/RNN-180869","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.3233\/RNN-180869","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T04:48:15Z","timestamp":1777610895000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.3233\/RNN-180869"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,28]]},"references-count":40,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2019,4,16]]}},"alternative-id":["10.3233\/RNN-180869"],"URL":"https:\/\/doi.org\/10.3233\/rnn-180869","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.735458958.793565881","asserted-by":"object"}]},"ISSN":["0922-6028","1878-3627"],"issn-type":[{"value":"0922-6028","type":"print"},{"value":"1878-3627","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,28]]}}}