***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Clinical studies had shown that EEG-based motor imagery Brain-Computer Interface ( MI-BCI ) combined with robotic feedback is effective in upper limb stroke rehabilitation , and transcranial Direct Current Stimulation ( tDCS ) combined with other rehabilitation techniques further enhanced the facilitating effect of tDCS . This motivated the current clinical study to investigate the effects of combining tDCS with MI-BCI and robotic feedback compared to sham-tDCS for upper limb stroke rehabilitation . The stroke patients recruited were r and omized to receive 20 minutes of tDCS or sham-tDCS prior to 10 sessions of 1-hour MI-BCI with robotic feedback for 2 weeks . The online accuracies of detecting motor imagery from idle condition were assessed and offline accuracies of classifying motor imagery from background rest condition were assessed from the EEG of the evaluation and therapy parts of the 10 rehabilitation sessions respectively . The results showed no evident differences between the online accuracies on the evaluation part from both groups , but the offline analysis on the therapy part yielded higher averaged accuracies for subjects who received tDCS ( n=3 ) compared to  sham-tDCS ( n=2 ) . The results suggest towards tDCS effect in modulating motor imagery in stroke , but a more conclusive result can be drawn when more data are collected in the ongoing study PURPOSE Transcranial direct current stimulation ( tDCS ) of the motor cortex seems to be effective in improving motor performance in patients with chronic stroke , while some recent findings have reported conflicting results for the subacute phase . We aim ed to verify whether upper extremity motor rehabilitation could be enhanced by treatment with tDCS administered before a rehabilitative session . METHODS H and dexterity and force in 16 individuals with subacute stroke were assessed before ( T0 ) and after anodal stimulation ( T1 ) and after a successive session of motor rehabilitation ( T2 ) in a double-blind , r and omized , sham-controlled , crossover trial . To confirm the value of the device as a specific effector , behavioral tests were also administered . RESULTS Anodal and sham stimulation plus rehabilitation significantly improved manual dexterity ( repeated-measure Anova : A-tDCS : p = 0.005 ; S-tDCS : p = 0.042 ) . Post hoc analysis revealed a significant stimulation effect only for A-tDCS ( p = 0.013 between T0 and T1 ) and not for S-tDCS , whereas the rehabilitation effect ( between T1 and T2 ) was not significant in either group . H and force and behavioral features were unchanged . CONCLUSIONS Anodal brain stimulation improves h and dexterity but does not increase the effectiveness of the rehabilitation directly . These results suggest the presence of aftereffects , not priming effects , of A-tDCS superimposed onto motor learning phenomena Background . No rehabilitation intervention has effectively improved functional use of the arm and h and in patients with severe upper limb paresis after stroke . Pilot studies suggest the potential for transcranial direct current stimulation and bilateral robotic training to enhance gains . Objective . In a double-blind , r and omized trial the combination of these interventions was tested . Methods . This study r and omized 96 patients with an ischemic supratentorial lesion of 3 to 8 weeks ’ duration with severe impairment of motor control with a Fugl-Meyer score ( FMS ) for the upper limb < 18 into 3 groups . For 6 weeks , group A received anodal stimulation of the lesioned hemisphere , group B received cathodal stimulation of the nonlesioned side for 20 minutes at 2.0 mA , and group C received sham stimulation . The electrodes were placed over the h and area and above the contralateral orbit . Contemporaneously , the subjects practice d 400 repetitions each of 2 different bilateral movements on a robotic assistive device . Results . The groups were matched at onset . The FMS improved in all patients at 6 weeks ( P < .001 ) . No between-group differences were found ; initial versus finish FMS scores were 7.8 ± 3.8 versus 19.1 ± 14.4 in group A , 7.9 ± 3.4 versus 18.8 ± 10.5 in group B , and 8.2 ± 4.4 versus 19.2 ± 15.0 in group C. No significant changes between groups were present at 3 months . Conclusions . Neither anodal nor cathodal transcranial direct current stimulation enhanced the effect of bilateral arm training in this exploratory trial of patients with cortical involvement and severe weakness . Unilateral h and training and upregulation of the nonlesioned hemisphere might also be tried in this population Objective : Motor recovery after stroke depends on the integrity of ipsilesional motor circuits and interactions between the ipsilesional and contralesional hemispheres . In this sham-controlled r and omized trial , we investigated whether noninvasive modulation of regional excitability of bilateral motor cortices in combination with physical and occupational therapy improves motor outcome after stroke . Methods : Twenty chronic stroke patients were r and omly assigned to receive 5 consecutive sessions of either 1 ) bihemispheric transcranial direct current stimulation ( tDCS ) ( anodal tDCS to upregulate excitability of ipsilesional motor cortex and cathodal tDCS to downregulate excitability of contralesional motor cortex ) with simultaneous physical/occupational therapy or 2 ) sham stimulation with simultaneous physical/occupational therapy .  Changes in motor impairment ( Upper Extremity Fugl-Meyer ) and motor activity ( Wolf Motor Function Test ) assessment s were outcome measures while functional imaging parameters were used to identify neural correlates of motor improvement . Results : The improvement of motor function was significantly greater in the real stimulation group ( 20.7 % in Fugl-Meyer and 19.1 % in Wolf Motor Function Test scores ) when compared to the sham group ( 3.2 % in Fugl-Meyer and 6.0 % in Wolf Motor Function Test scores ) . The effects outlasted the stimulation by at least 1 week . In the real-stimulation group , stronger activation of intact ipsilesional motor regions during paced movements of the affected limb were found postintervention whereas no significant activation changes were seen in the control group . Conclusions : The combination of bihemispheric tDCS and peripheral sensorimotor activities improved motor functions in chronic stroke patients that outlasted the intervention period . This novel approach may potentiate cerebral adaptive processes that facilitate motor recovery after stroke . Classification of evidence : This study provides Class I evidence that for adult patients with ischemic stroke treated at least 5 months after their first and only stroke , bihemispheric tDCS and simultaneous physical/occupational therapy given over 5 consecutive sessions significantly improves motor function as measured by the Upper Extremity Fugl-Meyer assessment ( raw change treated 6.1 ± 3.4 , sham 1.2 ± 1.0 ) OBJECTIVE To investigate the effects of combination cathodal transcranial direct current stimulation ( tDCS ) and virtual reality ( VR ) therapy for upper extremity ( UE ) training in patients with subacute stroke . DESIGN Pilot r and omized controlled trial . Patients were r and omly assigned to 1 of 3 groups : group A received cathodal tDCS , group B received VR , and group C received combination therapy ( cathodal tDCS was simultaneously applied during VR therapy ) . SETTING University hospital . PARTICIPANTS Patients ( N=59 ) with impaired unilateral UE motor function after stroke . INTERVENTION Fifteen sessions of treatment over a 3-week period . MAIN OUTCOME MEASURES The Modified Ashworth Scale , manual muscle test ( MMT ) , Manual Function Test ( MFT ) , Fugl-Meyer Scale ( FMS ) , and Box and Block Test were used to assess UE function . To evaluate activities of daily living , the Korean-Modified Barthel Index ( K-MBI ) was used . All outcomes were measured before and immediately after treatment . RESULTS After treatment , all groups demonstrated significant improvements in MMT , MFT , FMS , and K-MBI scores . The change in MFT and FMS scores was different between the 3 groups . Post hoc analysis revealed that the improvement of MFT and FMS scores in group C was significantly higher than those of the other 2 groups . CONCLUSIONS In the present pilot study , the combination of brain stimulation using tDCS and peripheral arm training using VR could facilitate a stronger beneficial effect on UE impairment than using each intervention alone . This combination therapy might be a helpful method to enhance recovery of the paretic UE in patients with stroke [ Purpose ] The purpose of this study was to determine the effect of transcranial direct current stimulation ( tDCS ) on the upper limb of function of patients with post-stroke hemiplegia . [ Subjects ] Twenty subjects were r and omly allocated to either the upper tDCS group or the functional training group , with 10 subjects in each group . [ Methods ] The two groups received functional training for thirty minutes a day , five days a week for four weeks . The tDCS group additionally received tDCS for 20 minutes . The outcome was assessed by the Box and Block test ( BBT ) , grip strength , and the Fugl-Meyer assessment ( FMA ) . [ Results ] There were significant improvements between pre- and post- intervention in both groups , in the BBT , grip strength , and the upper limb and lower lims sub-items of the FMA . The tDCS group showed significantly greater improvements than the control group in the BBT , and upper limb and lower limb sub-items of the FMA . [ Conclusion ] These findings suggest that tDCS may be more beneficial than functional training for improving the upper and lower limb functions of chronic stroke patients Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed BACKGROUND Upper limb ( UL ) impairment is the most common disabling deficit following a stroke . Previous studies have suggested that transcranial direct current stimulation ( tDCS ) enhances the effect of conventional therapies . OBJECTIVE This pilot double-blind r and omized control trial aim ed to determine whether or not tDCS , combined with Wii virtual reality therapy ( VRT ) , would be superior to Wii therapy alone in improving upper limb function and quality of life in chronic stroke individuals . METHODS Twenty participants were r and omly assigned either to an experimental group that received VRT and tDCS , or a control group that received VRT and sham tDCS . The therapy was delivered over 15 sessions with 13 minutes of active or sham anodal tDCS , and one hour of virtual reality therapy . The outcomes included were determined using the Fugl-Meyer scale , the Wolf motor function test , the modified Ashworth scale ( MAS ) , grip strength , and the stroke specific quality of life scale ( SSQOL ) . Minimal clinical ly important differences ( MCID ) were observed when assessing outcome data . RESULTS Both groups demonstrated gains in all evaluated areas , except for the SSQOL-UL domain . Differences between groups were only observed in wrist spasticity levels in the experimental group , where more than 50 % of the participants achieved the MCID . CONCLUSIONS These findings support that tDCS , combined with VRT therapy , should be investigated and clarified further Anodal tDCS applied to the ipsilesional motor cortex of patients with chronic stroke enhances the beneficial effects of motor rehabilitation . Stimulating motor recovery in stroke Rehabilitation of movement after stroke requires repeated practice and involves learning and brain changes . In a new study , Allman et al. tested whether delivering brain stimulation during a 9-day course of h and and arm training improved movement in patients after stroke . The authors found greater improvements in movement in patients who received real compared to sham ( placebo ) brain stimulation . Better scores in patients who received real stimulation were still present 3 months after training ended . These findings suggest that brain stimulation could be added to rehabilitative training to improve outcomes in stroke patients .  Anodal transcranial direct current stimulation ( tDCS ) can boost the effects of motor training and facilitate plasticity in the healthy human brain . Motor rehabilitation depends on learning and plasticity , and motor learning can occur after stroke . We tested whether brain stimulation using anodal tDCS added to motor training could improve rehabilitation outcomes in patients after stroke . We performed a r and omized , controlled trial in 24 patients at least 6 months after a first unilateral stroke not directly involving the primary motor cortex . Patients received either anodal tDCS ( n = 11 ) or sham treatment ( n = 13 ) paired with daily motor training for 9 days . We observed improvements that persisted for at least 3 months post-intervention after anodal tDCS compared to sham treatment on the Action Research Arm Test ( ARAT ) and Wolf Motor Function Test ( WMFT ) but not on the Upper Extremity Fugl-Meyer ( UEFM ) score . Functional magnetic resonance imaging ( 
    Output:
    
tDCS did not improve our secondary outcome , that of arm function , measured by the Fugl-Meyer upper extremity assessment ( FM-UE ) .
There was no difference in safety between tDCS and its control interventions , measured by the number of dropouts and adverse events .
Conclusion Comparing different forms of tDCS shows that cathodal tDCS is the most promising treatment option to improve ADL capacity in people with stroke