Objective：We aimed to examine the effects of a transcranial direct current stimulation (tDCS) performed prior to occupational therapy and combined with an Integrated Volitional control Electrical Stimulation (IVES) therapy on the upper extremity function for patients with chronic stroke. We also aimed to detect the longitudinal changes of hemodynamic responses in the sensorimotor cortex area (SMC) following successive tDCS prior to IVES therapy.Methods：Seven subjects with moderate upper extremity (UE) paresis in chronic stroke were enrolled in this study. The patients received coupled tDCS and IVES therapy five times a week. UE function was estimated by Simple Test for Evaluating Hand Function (STEF). Functional near-infrared spectroscopy (fNIRS) was used to detect the long-term changes of hemodynamic responses in bilateral SMC during opening and closing of the affected fingers, assisted by IVES. Lastly, the SMC responses after the first tDCS were compared with those obtained after the fifth tDCS.Results：Coupled tDCS and IVES therapy was effective for improving the UE paresis. fNIRS demonstrated a significantly increased hemodynamic responses in bilateral SMC, following IVES therapy with the fifth tDCS relative to those with the first tDCS.Conclusion：The findings suggested that tDCS prior to IVES therapy might improve UE function of the patients with chronic stroke, presumably by augmenting hemodynamic responses in bilateral SMC.

Objective：We aimed to examine the effects of a transcranial direct current stimulation (tDCS) performed prior to occupational therapy and combined with an Integrated Volitional control Electrical Stimulation (IVES) therapy on the upper extremity function for patients with chronic stroke. We also aimed to detect the longitudinal changes of hemodynamic responses in the sensorimotor cortex area (SMC) following successive tDCS prior to IVES therapy.Methods：Seven subjects with moderate upper extremity (UE) paresis in chronic stroke were enrolled in this study. The patients received coupled tDCS and IVES therapy five times a week. UE function was estimated by Simple Test for Evaluating Hand Function (STEF). Functional near-infrared spectroscopy (fNIRS) was used to detect the long-term changes of hemodynamic responses in bilateral SMC during opening and closing of the affected fingers, assisted by IVES. Lastly, the SMC responses after the first tDCS were compared with those obtained after the fifth tDCS.Results：Coupled tDCS and IVES therapy was effective for improving the UE paresis. fNIRS demonstrated a significantly increased hemodynamic responses in bilateral SMC, following IVES therapy with the fifth tDCS relative to those with the first tDCS.Conclusion：The findings suggested that tDCS prior to IVES therapy might improve UE function of the patients with chronic stroke, presumably by augmenting hemodynamic responses in bilateral SMC.