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In patients with severe motor paralysis, increasing the excitability of the supplementary motor area (SMA) in the non-injured hemisphere contributes to the recovery of lower limb motor function. However, the contribution of transcranial direct current stimulation (tDCS) over the SMA of the non-injured hemisphere in the recovery of lower limb motor function is unclear. This study aimed to examine the effects of tDCS on bilateral hemispheric SMA combined with assisted gait training. A post-stroke patient with severe motor paralysis participated in a retrospective AB design. Assisted gait training was performed only in period A and tDCS to the SMA of the bilateral hemisphere combined with assisted gait training (bi-tDCS) was performed in period B. Additionally, three conditions were performed for 20 min each in the intervals between the two periods: (1) assisted gait training only, (2) assisted gait training combined with tDCS to the SMA of the injured hemisphere, and (3) bi-tDCS. Measurements were muscle activity and beta-band intermuscular coherence (reflecting corticospinal tract excitability) of the vastus medialis muscle. The bi-tDCS immediately and longitudinally increased muscle activity and intermuscular coherence. We consider that bi-tDCS may be effective in recovering lower limb motor function in a patient with severe motor paralysis.

Repetitive transcranial magnetic stimulation (rTMS) with intensive occupational therapy improves upper limb motor paralysis and activities of daily living after stroke; however, the degree of improvement according to paralysis severity remains unverified. Target activities of daily living using upper limb functions can be established by predicting the amount of change after treatment for each paralysis severity level to further aid practice planning. We estimated post-treatment score changes for each severity level of motor paralysis (no, poor, limited, notable, and full), stratified according to Action Research Arm Test (ARAT) scores before combined rTMS and intensive occupational therapy. Motor paralysis severity was the fixed factor for the analysis of covariance; the delta (post-pre) of the scores was the dependent variable. Ordinal logistic regression analysis was used to compare changes in ARAT subscores according to paralysis severity before treatment. We implemented a longitudinal, prospective, interventional, uncontrolled, and multicenter cohort design and analyzed a dataset of 907 patients with stroke hemiplegia. The largest treatment-related changes were observed in the Limited recovery group for upper limb motor paralysis and the Full recovery group for quality-of-life activities using the paralyzed upper limb. These results will help predict treatment effects and determine exercises and goal movements for occupational therapy after rTMS.