improvement in the standard of living and changes in diet have led to an increase in the 
 prevalence of hypertension , arteriosclerosis , and diabetes mellitus . moreover , cerebrovascular diseases are 
 the second - highest cause of death , followed by cancer , in korea1 . among the cerebrovascular diseases , the prognosis of stroke after the age of 
 65  years is usually poor , and more than 80% of patients experience neurological damage2 . the rate of disability that affects 
 activities of daily living after a stroke , compared to other chronic diseases , is very high . long - term rehabilitation is necessary because of the loss of function in the upper and lower 
 extremities , speech impairment , and cognitive disorders that accompany a stroke3 , 4 . with regard to the recovery of neurological motor functions after a stroke , patients show 
 80% and 95% recovery of the upper and lower extremity function within 3 months , 
 respectively5 . despite intensive , 
 long - term treatment , most stroke patients fail to show complete recovery of the function of 
 their upper limbs6 , 7 . among the upper extremity functions , various 
 treatments , including drugs and exercise , are available to enhance motor functions after a 
 stroke . other methods include neurological physical therapy focusing on neurodevelopment 
 therapy and proprioceptive neuromuscular facilitation , occupational therapy , ischemic nerve 
 block , functional electrical stimulation , constraint - induced movement therapy9 , 10 , 
 and robot - assisted therapy for upper limb rehabilitation11 . these treatment methods may speed up the recovery of patients 
 upper limb functions but require long - term efforts , and continuous treatment may be 
 difficult for various reasons . recent research suggests that transcranial direct current 
 stimulation ( tdcs ) of the brain can improve physical functions in stroke patients12,13,14,15 . therefore , we investigated the effects of tdcs on the recovery of upper limb functions in 
 stroke patients . the study included 24 patients with stroke diagnosed by a specialist at c hospital located 
 in d metropolitan city who were receiving rehabilitation treatment for functional recovery . in all the participants , hemiplegic patients were composed of at least 6 months after the 
 onset . participants with a history of stroke , with a personal or family history of epileptic 
 seizure , who underwent implantation of an artificial cardiac pacemaker , or who showed severe 
 upper extremity contracture and deformity were excluded , because participation of such 
 patients was difficult . patients with hemiplegia who were diagnosed with a stroke were 
 randomly assigned to either an experimental or a control group . data were collected from 
 patients who agreed to participate after they fully understood the research procedures . all 
 procedures were approved by the institutional review board committee of c national 
 university hospital in the korea . fugl - meyer assessment ( fma ) was performed before the experiment for all the patients to 
 determine the function of their upper limbs16 . the experimental group received tdcs and physical therapy , whereas 
 the control group received only physical therapy . after 4 weeks , the fma was performed 
 again , and the intervention was performed 5 times per week for 4 weeks . kolmogorov - smirnov single - sample test was performed to examine the general characteristics 
 of the participants and the normality of each item . the data were analyzed with spss 18.0 spss 
 inc , chicago , il , usa ) for windows , and the significance was set at p < 0.05 . with regard to shoulder function , the mean  standard deviation ( sd ) fma scores were 22.44 
  5.64 before and 21.00  6.08 after the treatment in the control group , and they were 22.64 
  6.02 before and 26.82  4.92 after the treatment in the experimental group ; the changes 
 were statistically significant ( p < 0.01 ) . the mean  sd fma scores for the elbow joint 
 were 5.00  3.74 before and 5.11  3.72 after the treatment in the control group , whereas 
 they were 7.09  2.34 before and 8.45  1.92 after the treatment in the experimental group ; 
 the changes were statistically significant ( p < 0.05 ) . in the control group , the mean  
 sd fma scores for hand function were 8.44  5.22 before and 8.89  5.16 after the treatment . 
 in the experimental group , the mean  sd fma scores were 10.45  2.62 before and 12.45  
 2.16 after the treatment . the changes in both the groups were statistically significant ( p 
 < 0.05)(table 1table 1.changes score of fma items in a stroke patients of before and after transcranial 
 direct current stimulationgroupprepost(%)shoulderexperiment ( n=12)22.646.0226.824.92control ( n=12)22.445.6421.006.08elbowexperiment ( n=12)7.092.348.451.92control ( n=12)5.003.745.113.72handexperiment ( n=12)10.452.6212.452.16control ( n=12)8.445.228.895.16values are mean  sd , * p<0.05 , * * p<0.01 . in this study , we applied tdcs , which activates the motor areas in the cerebral cortex , in 
 combination with physical therapy for patients with a stroke and who experienced hemiplegia 
 for 6 months . the changes in the fma scores for the shoulder joint , elbow joint , and hand functions were 
 greater in the group that received tdcs than in the group that received only physical 
 therapy . the fma is considered the best tool for the assessment of a patient s motor 
 functions . park and choi17 reported that 
 fma was more effective than other methods for the assessment of the recovery of upper 
 extremity motor functions . in addition , a correlation between the effects of tdcs on upper 
 extremity functions and fma scores was verified , and fma was found to be a valid method for 
 the evaluation of upper limb functions . hummel et al.18 and harvey et al.19 applied tdcs for chronic stroke patients and observed that the 
 extent of improvement in the motor function performance , including fma scores , was greater 
 in the tdcs group than in the non - tdcs group . hummel et al.18 reported that tdcs 
 applied for chronic stroke patients reduced the reaction time of the paretic hand and 
 improved the pinch force . in the present study , the shoulder joint , elbow joint , and hand 
 function scores in the experimental group increased significantly , and these findings 
 support the findings of hummel et al18 . therefore , the results 
 can not be generalized to all female patients with stroke . studies in a larger number of 
 participants would generate results that are more meaningful . the validity of the study 
 would also be improved by clarifying the criteria for the selection of participants . therefore , additional research needs to focus on 
 elucidation of the association between changes in the motor areas in the cerebral cortex and 
 improvement in muscle performance of the upper limbs .