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22. European Stroke Conference 14 Rehabilitation and reorganisation after stroke B 15:10 - 15:20 Effects of five consecutive daily sessions of anodal tDCS combined with repetitive radial nerve stimulation on motor outcome in acute stroke V. SATTLER1, B. ACKET2, A. GERDELAT3, N. RAPOSO4, J.F. ALBUCHER5, S. CHERI-ET6, C. THALAMAS7, F. CHOLLET8, M. SIMONETTA-MOREAU9 Purpan Hospital - Department of Neurology, TOULOUSE, FRANCE1,Purpan Hospital - Department of Neurology, TOULOUSE, FRANCE2, Purpan Hospital - Department of Neu-rology, TOULOUSE, FRANCE3, Purpan Hospital - Department of Neurology, TOULOUSE, FRANCE4, Purpan Hospital - Department of Neurology, TOULOUSE, FRANCE5, Clinical Investigation Centre - CIC 9302, TOULOUSE, FRANCE6, Clinical Investigation Centre - CIC 9302, TOULOUSE, FRANCE7, Purpan Hospital - Department of Neurology, TOULOUSE, FRANCE8, Purpan Hospital - Department of Neurology, TOULOUSE, FRANCE9, Background: Non-invasive brain stimulation, such as repetitive transcranial magnetic stimula-tion (rTMS) or transcranial direct current stimulation (tDCS) applied over the controlesional or ipsilesional motor cortices (M1) in association with neurorehabilitation, can improve motor re-covery in patients after stroke. Most studies have been performed in the chronic phase and very few in the acute one. The purpose of this study was to assess in the acute phase of post-stroke recovery, the effect of anodal tDCS applied over the ipsilesional M1 combined with repetitive electrical peripheral nerve stimulation (rEPNS), on the motor performances of the paretic hand. Method: In this double blind, sham-controlled pilot study, patients were enrolled as soon as possible after a first cortical or subcortical stroke, and randomized in two parallel groups: the first one received five consecutive daily sessions of anodal tDCS over the ipsilesional M1 in as-sociation with rEPNS of the radial nerve applied on the paretic side, and the other one received the same rEPNS combined with sham tDCS. Motor performances and cortical excitability were assessed at baseline and after the interven-tion, at day 5, 15 and 30. The primary endpoint was the full time to complete the Jebsen and Taylor Hand Function Test (JTHFT) Results:Twenty patients have been included within the five days after stroke (+/-3). No side-ef-fects have been reported during the treatment. Preliminary results show a significant difference between the two groups at day 15 (p=0,006) and day 30 (p=0,002) on the time to complete the JTHFT. Conclusion: These promising results suggest that an early cortical neuromodulation with anodal tDCS in association with rEPNS, could act in the early post-stroke phase as an efficient adju-vant to promote the natural cortical plasticity, involved in the recovery process. 13 Rehabilitation and reorganisation after stroke B 15:00 - 15:10 The optimal dosage of the Rehabilitation Gaming System: The impact of a longer period of virtual reality based and standard occupational training on upper limb recovery in the acute phase of stroke. A. Duff1, J. Nirme2, B. Rubio3, E. Duarte4, A. Cuxart5, S. Rodríguez6, P.F.M.J. Verschure7 SPECS Universitat Pompeu Fabra, Barcelona, SPAIN1,SPECS Universitat Pompeu Fabra, Barcelona, SPAIN2, SPECS Universitat Pompeu Fabra, Barcelona, SPAIN3, Servicio de Me-dicina Física y Rehabilitación, Hospitals Mar-Esperança, Parc de Salut Mar. IMIM, Universitat Autònoma de Barcelona, Barcelona, SPAIN4, Servicio de Rehabilitación, Hospital Univer-sitari Vall d’Hebron., Barcelona, SPAIN5, Servicio de Rehabilitación, Hospital Universitari Vall d’Hebron., Barcelona, SPAIN6, SPECS, ICREA & Universitat Pompeu Fabra, Barcelona, SPAIN7 The Rehabilitation Gaming System (RGS) is a Virtual Reality system giving patients augment-ed multimodal feedback on their goal-directed movements. This paradigm is neurologically grounded and proven effective for motor recovery 1. The RGS allows sustained independent use by automatically adapting training tasks to a patient’s skill level. In the current study we confirm that RGS training is at least as effective as standard occupational therapy (OT) and in-vestigate the effect of dose on recovery: how many weeks of training is optimal? We conducted an experiment on 21 acute patients (<14 days post-stroke) who were divided into 2*2 groups. 11 patients performed the RGS Spheroids 1 task 5 times a week (each session lasting 20 min) besides their usual OT program, 5 patients during 3 weeks and 6 patients during 12 weeks. Two groups of 5 patients received 20 min of additional OT for 3 or 12 weeks each. Evaluations on several clinical scales were done at admittance, at weeks 1, 2, 3 and 12, and at follow-ups month 6 and 12. We compared normalized improvement 1 for each clinical scale. A mixed-design ANOVA with time as within-subject factor and treatment (RGS or OT) and duration (3 or 12 weeks) as between-subject factors showed a significant effect of time*dura-tion for improvement on the CAHAI scale. Mann-Whitney U tests between duration groups re-vealed a significantly stronger improvement at the month 6 follow-up for the patients who had trained for 12 weeks compared to 3 weeks (p<0.05). Within the 12 week group, RGS therapy compared to OT tended to produce a better recovery after week 3. We investigated the effect of dose of RGS and OT rehabilitation and found that a period ex-tending 3 weeks can aid recovery. Despite a small sample we observe a difference on a scale for functional improvement. A larger sample might be needed to see a clear difference on other scales. 1. Cameirão et al, 2011 Restor Neurol Neurosci; 2012 Stroke. 146 © 2013 S. Karger AG, Basel Scientific Programme


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