The effects of combined brain stimulation and mirror therapy on movement, daily living and quality of life in stroke survivors

Stroke is the leading cause of disability in the UK with approximately 70% of survivors experiencing difficulties with arm and hand movements. It is predicted that the number of strokes will increase by 44% within the next 20 years (Stevens et al., 2017) placing enormous strain on health and social services. To ease this burden there is a need to develop affordable medical devices that stroke survivors can use at home. There is also a need to understand beliefs about the potential effectiveness and likelihood of improvement of using devices, as adherence to home-based programmes is often low. The aim of this PhD is to evaluate whether combining brain stimulation with mirror therapy provides additional therapeutic value for stroke survivors. It will also examine how the person's beliefs and expectations impact on engagement and outcome. Mirror therapy (MT) requires the person to perform exercises with the limb least affected by their stroke. Observing the reflection of this limb can lead to a psychological illusion of the affected arm making the movements. This can lead to improvements in the mobility and hand dexterity of the affected arm, sometimes achieving better results than conventional physiotherapy (Deconinck et al., 2015). Transcranial Direct Current Stimulation (tDCS) is a form of non-invasive brain stimulation that can temporarily modulate neuronal excitability. To date only one study has combined tDCS and MT for stroke (with significant shortcomings in design). There are competing hypotheses for which tDCS electrode configuration will be most advantageous when combined with MT and these will be explored, along with qualitative measures of beliefs, attitudes and expectations. The use of a motion capture technology will provide detailed quantitative analyses of movement patterns and the relationships between these and the perceptions that stroke survivors have about their performance/daily life will be investigated.