Journal CME December 2025: Transcranial direct current stimulation combined with isokinetic strength training to improve lower limb motor function in chronic stroke survivors: A randomized controlled study-PM R - 2025 - Chu - Transcranial direct current stimulation combined with isokinetic strength training to improve lower

PM R - 2025 - Chu - Transcranial direct current stimulation combined with isokinetic strength training to improve lower

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This randomized controlled trial investigated the effects of transcranial direct current stimulation (tDCS), isokinetic strength training (IST), and their combination on lower limb motor function, muscle strength, balance, gait, and muscle tone in 56 chronic stroke survivors. Participants (aged 35–77) were assigned to four groups: control (routine rehab), tDCS, IST, and combined tDCS+IST, each receiving 4 weeks of intervention.<br /><br />Primary outcomes measured were peak torque (PT) of knee flexion/extension and the Fugl-Meyer Assessment of Lower Extremity (FMA-LE). Secondary outcomes included Berg Balance Scale (BBS), 10-meter Walk Test (10mWT), and Modified Ashworth Scale (MAS) for muscle tone.<br /><br />Results showed that:<br />- The tDCS group had significant improvements in knee extension PT and FMA-LE scores.<br />- The IST group showed significant gains in knee flexion and extension PT and FMA-LE.<br />- The combined group demonstrated the greatest improvements in knee flexion and extension PT and FMA-LE, significantly outperforming control, tDCS alone, and IST alone.<br /><br />Balance and walking speed (BBS and 10mWT) improved significantly only within the combined group compared to baseline but without significant intergroup differences after treatment. No significant changes in muscle tone (MAS scores) were observed in any group.<br /><br />The study concludes that both tDCS and IST individually enhance lower limb muscle strength and motor function post-stroke, but combining these central (tDCS) and peripheral (IST) interventions yields superior improvements. The combined approach may enhance neural plasticity and peripheral muscle activation better than either alone. However, improvements in balance and gait require longer or more targeted interventions, and muscle tone was not significantly improved by these methods.<br /><br />Limitations include a relatively small sample size, short intervention duration, lack of sham control, and focus only on knee joint training. Future research should explore optimal stimulation parameters, include hip and ankle training, incorporate neurophysiological assessments, and evaluate long-term outcomes.<br /><br />This study supports integrated central and peripheral rehabilitation strategies for improving lower limb function in chronic stroke survivors.

Keywords

transcranial direct current stimulation

isokinetic strength training

chronic stroke rehabilitation

lower limb motor function

knee flexion and extension strength

Fugl-Meyer Assessment Lower Extremity

balance improvement

gait speed

muscle tone

combined central and peripheral intervention