Effectiveness of telerehabilitation-based exercises plus transcranial direct current stimulation for stroke rehabilitation among older adults: A scoping review

Abstract

Objective

Physiotherapy rehabilitation of patients with stroke is challenging for the patient, their informal caregivers and the therapist involved. A telerehabilitation programme combined with transcranial direct current stimulation (tDCS) may be the more appealing approach that may save rehabilitation time and improve treatment outcomes. This study performs a scoping review on the effect of telerehabilitation-based exercises plus tDCS among older adults with stroke.

Methods

This scoping adopts the Joana Briggs Institute guidelines for conducting a scoping review. Using Keywords and related MeSH terms to telerehabilitation-based exercises and tDCS among older adults with stroke, the following databases were searched: Cochrane, PubMed, Scopus, and Web of Science. Additional seven other databases (Academic Search Complete; PsycInfo; Health Source-Consumer Edition; Health Source: Nursing/Academic Edition; MEDLINE with Full Text; Academic Search Ultimate) were searched via EBSCOhost. The articles identified were imported to Mendeley for deduplication and then to Rayyan for further deduplication, title and abstract screening.

Results

Out of 216 total articles retrieved, 6 met the study’s inclusion criteria and were extracted for this study. The evidence shows that the telerehabilitation-based exercise intervention with tDCS improves upper limb motor function among older adult patients with stroke.

Discussion & conclusion

Most of the evidence found focused on a combination of virtual reality-based exercises plus tDCS, and none of the telerehabilitation exercise interventions follows the neurorehabilitation techniques such as the Brunnstrom approach and Bobath technique. While it can be concluded that the evidence points towards improving upper limb motor functions with virtual reality and tDCS for stroke rehabilitation among older adults, there is no evidence of its effect on non-motor symptoms such as pain and cognitive functions possibly due to unavailability of relevant studies. There is also a dearth of evidence for t he telerehabilitation programme that uses neurodevelopmental techniques such as Brunnstrom and Bobath approaches with tDCS. This is paramount in providing effective care to older adult patients with stroke.