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

中风是英国残疾的主要原因，大约70%的幸存者在手臂和手部运动方面遇到困难。据预测，中风的数量将在未来20年内增加44%（Stevens等人，2017年，对卫生和社会服务造成巨大压力。为了减轻这一负担，有必要开发负担得起的医疗设备，中风幸存者可以在家里使用。还需要了解对使用设备的潜在有效性和改进可能性的看法，因为对基于家庭的方案的坚持程度往往很低。这个博士学位的目的是评估脑刺激与镜像疗法相结合是否为中风幸存者提供了额外的治疗价值。它还将研究个人的信仰和期望如何影响参与和结果。镜像疗法（MT）要求患者用受中风影响最小的肢体进行锻炼。观察这个肢体的反射可以导致受影响的手臂做出运动的心理错觉。这可以导致受影响手臂的移动性和手灵活性的改善，有时比常规物理疗法获得更好的结果（Deconinck等人，2015年）。经颅直流电刺激（tDCS）是一种非侵入性脑刺激，可以暂时调节神经元的兴奋性。到目前为止，只有一项研究将tDCS和MT结合用于卒中（设计上存在显著缺陷）。对于tDCS电极配置在与MT组合时将是最有利的，存在竞争性假设，并且这些假设将与信念、态度和期望的定性测量一起进行沿着探索。运动捕捉技术的使用将提供运动模式的详细定量分析，并将研究这些模式与卒中幸存者对其表现/日常生活的感知之间的关系。

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.