Effects of Combined Transcranial Direct Current Stimulation and Collaborative Robot-Assisted Therapy on Upper Limb Function: A Unilateral Pontine Stroke Case Study

Introduction: Unilateral pontine stroke can impair upper limb motor function due to damage in brainstem motor pathways. An emerging intervention approach proposes the combination of neuroplasticity-inducing techniques such as transcranial direct current stimulation (tDCS) with task-specific training exercises like robot-assisted therapy. Objective: To examine the effects of primary motor cortex dual-tDCS (excitatory ipsilesional and inhibitory contralesional) combined with collaborative robot-assisted therapy on hand/upper limb motor function and fatigue of a patient with unilateral chronic pontine stroke. Methodology: A 10-session protocol combining dual-tDCS with a collaborative robot-assisted upper limb exercises was employed. Outcome measures (assessed pre-intervention, mid-intervention, post-intervention, and 1-month follow-up) included hand/upper limb motor function (manual dexterity, hand grip strength, motor reaction time, shoulder flexion range of motion) and perceived physical and mental fatigue. A structured interview was conducted to capture the participant’s subjective perception of improvement. Results: The patient showed significant post-intervention improvements in manual dexterity, shoulder flexion range of motion, and hand grip strength, while also displaying reduction in physical fatigue. These results were largely retained after the 1-month follow-up period. The structured interview indicated that the patient reported greater participation in daily activities, with less perceived fatigue. Conclusion: The combination of dual-tDCS with robot-assisted therapy in a patient with unilateral chronic pontine stroke demonstrated positive effects on hand/upper limb motor function as well as on physical fatigue. This intervention protocol may be a useful and engaging complementary rehabilitation approach for several stroke subtypes.