Attualmente risulta ancora difficile definire un modello ideale di stimolazione transcranica diretta (tDCS) per la riabilitazione motoria nei pazienti post-ictus, poiché la letteratura prodotta in merito offre ancora pochi lavori e con caratteristiche disomogenee circa le modalità di stimolazione utilizzate, il numero di sedute necessarie, la durata delle stesse, i sistemi di valutazione e le caratteristiche dei pazienti.
Dai risultati ottenuti in questo studio è stato osservato in entrambi i gruppi il miglioramento del punteggio delle scale cliniche con riduzione del livello di menomazione dell’arto superiore, seppur non statisticamente significativo per la specifica sezione del polso.
Attraverso l’analisi cinematica dei movimenti selezionati si sono evidenziati miglioramenti delle prestazioni motorie in entrambi i gruppi, definite dall’aumento del ROM (Range of Motion) articolare, seppur non statisticamente significativi, ed un aumento della velocità di esecuzione dei movimenti con significatività statistica solo per l’abduzione nel gruppo Sham.
Dal confronto fra il miglioramento clinico ottenuto nei valori FM/UE e MI in entrambi i gruppi non è emersa una predominanza nel gruppo tDCS rispetto al gruppo Sham così da ritenere che la tDCS non abbia fornito un valore aggiuntivo al trattamento riabilitativo, fermo restando il campione limitato analizzato.
L’utilizzo del sistema robotico risulta fondamentale per l’analisi qualitativa del movimento e lo studio dei processi di recupero motorio. I risultati preliminari presentati in questo studio dovranno essere confermati mediante (i) l’incremento del numero dei casi studiati e (ii) la rivalutazione degli effetti a lungo termine sui pazienti.
Ulteriori osservazioni che tengono conto di un consenso generale in materia di tDCS riguardano l’applicazione della metodica in associazione alle terapie convenzionali per incentivare gli input afferenti corticali e la ripetizione di più sedute consecutive per rafforzare l’efficacia e la stabilizzazione degli effetti. Una strategia futura utile a nuovi studi potrebbe essere quella di effettuare una maggior selezione delle caratteristiche dei pazienti in termini di etiologia della
lesione (ischemica o emorragica), sede di lesione (emisfero destro o sinistro) ed estensione (corticale o sottocorticale) con rivalutazione a lungo termine degli effetti.
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