Grant: CIHR Fellowship

Around 50% of stroke survivors have difficulties sensing where their arms are in space without looking at them. This sense, called proprioception, is important for controlling movement. Proprioceptive impairments affect people's ability to perform simple daily tasks and reduce independence after stroke. Unfortunately, few evidence-based treatments for proprioception exist. Two promising technologies for stroke rehabilitation have recently emerged: robotic therapy and a form of brain stimulation called transcranial direct current stimulation (tDCS). Robotic therapy allows high therapy dose to be delivered, maximising the number of repetitions that stroke survivors can perform in therapy. This can enhance neuroplastic changes in the brain to promote recovery. tDCS applies weak electrical currents to the brain, through scalp electrodes. With the correct stimulation settings, it can increase the brain's ability to form and strengthen new connections. Combination therapies (e.g. brain stimulation plus rehabilitation) are increasingly being considered as ways to improve post-stroke outcomes. While robotics and tDCS might be beneficial for stroke recovery, combining them to treat post-stroke proprioception has not been tried. This project aims to see if combining both techniques can benefit impaired upper limb proprioception, which is difficult to treat with conventional one-on-one therapy. We expect participants that receive both robotic therapy and tDCS will make significantly greater improvements in proprioception than those who just receive robotic therapy, or no therapy at all. This study has tremendous implications for stroke rehabilitation both globally and in Canada. Around 60,000 new stroke survivors will suffer from proprioceptive impairments in Canada each year, with no effective treatment options. This study would provide evidence for the use of robotics and tDCS to improve proprioception post-stroke and could help many individuals perform daily activities.