Cathodal transcranial direct current stimulation over the Cz increases joint flexibility

Comparison of the Conjunct Effects of Electrical Stimulation and Whole-Body Vibration Therapy with Transcranial Direct Current Stimulation and Whole-body Vibration Therapy on Balance and Function in Children With Spastic Cerebral Palsy

BACKGROUND AND OBJECTIVES

Cerebral palsy is a neurodevelopmental condition that results in impaired movement and posture, often accompanied by disturbances in balance and functional abilities. Recent advances in neurorehabilitation, including whole-body vibration therapy (WBVT), functional electrical stimulation, and transcranial direct current stimulation, show promise in enhancing traditional interventions and fostering neuroplasticity. However, the efficacy of their conjunct effects remains largely uncharted territory and warrants further exploration. The objective of the study was to compare the conjunct effects of functional electrical stimulation (FES) and WBVT with transcranial direct current stimulation (tDCS) and WBVT on lower extremity range of motion (ROM), dynamic balance, functional mobility, isometric muscle strength and hand grip strength in children with spastic cerebral palsy.

METHODS

A randomized clinical trial was carried out on 42 children of both genders with spastic cerebral palsy, aged 5-15 years. The children were divided at random into three groups (14 in each group). In Group A, there were three (21.42%) males and 11 (78.57%) females, in Group B, eight (57.14%) were males and six (42.85%) were females, and in Group C, six (42.85%) children were males and eight (57.14%) were females. Group A received WBVT only, Group B received WBVT and FES, and Group C received WBVT and tDCS. The intervention was applied four times a week for four consecutive weeks. The data was collected two times before and immediately after four weeks of intervention. Lower extremity ROM was measured by a goniometer, functional mobility or dynamic balance was measured by a Time Up and Go test, isometric muscle strength was measured by a digital force gauge, and hand grip strength was assessed by a digital hand-held dynamometer. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was utilized for statistical analysis.

RESULTS

The mean age of the children in groups A, B, and C was 12.21±2.11 years, 11.71±2.01, and 11.07±2.01 years respectively. Intergroup analysis revealed a statistically significant difference (p<0.05) in the lower extremity range of motion, and functional mobility. Hand grip strength and isometric muscle strength between three groups. Post hoc analysis revealed that WBVT with transcranial direct current stimulation combined showed the most improvement.

CONCLUSION

The study concluded that positive effects were seen in all three groups but tDCS with WBVT was found to be most effective in improving lower extremity ROM, functional mobility or dynamic balance, isometric muscle strength, and hand grip strength in children with spastic CP. The differences between the groups were statistically significant. The effect size was substantial enough to surpass established clinical benchmarks, indicating that the observed improvements are likely to have meaningful and beneficial impacts on patient outcomes.

Effects of high-definition transcranial direct current stimulation on the cortical-muscular functional coupling and muscular activities of ankle dorsi-plantarflexion under running-induced fatigue

Transcranial direct current stimulation (tDCS) can improve motor control performance under fatigue. However, the influences of tDCS on factors contributing to motor control (e.g., cortical-muscular functional coupling, CMFC) are unclear. This double-blinded and randomized study examined the effects of high-definition tDCS (HD-tDCS) on muscular activities of dorsiflexors and plantarflexors and CMFC when performing ankle dorsi-plantarflexion under fatigue. Twenty-four male adults were randomly assigned to receive five sessions of 20-min HD-tDCS targeting primary motor cortex (M1) or sham stimulation. Three days before and 1 day after the intervention, participants completed ankle dorsi-plantarflexion under fatigue induced by prolonged running exercise. During the task, electroencephalography (EEG) of M1 (e.g., C1, Cz) and surface electromyography (sEMG) of several muscles (e.g., tibialis anterior [TA]) were recorded synchronously. The corticomuscular coherence (CMC), root mean square (RMS) of sEMG, blood lactate, and maximal voluntary isometric contraction (MVC) of ankle dorsiflexors and plantarflexors were obtained. Before stimulation, greater beta- and gamma-band CMC between M1 and TA were significantly associated with greater RMS of TA (r = 0.460-0.619, p = 0.001-0.024). The beta- and gamma-band CMC of C1-TA and Cz-TA, and RMS of TA and MVC torque of dorsiflexors were significantly higher after HD-tDCS than those at pre-intervention in the HD-tDCS group and post-intervention in the control group (p = 0.002-0.046). However, the HD-tDCS-induced changes in CMC and muscle activities were not significantly associated (r = 0.050-0.128, p = 0.693-0.878). HD-tDCS applied over M1 can enhance the muscular activities of ankle dorsiflexion under fatigue and related CMFC.

Effects of tDCS on Foot Biomechanics: A Narrative Review and Clinical Applications

In recent years, neuro-biomechanical enhancement techniques, such as transcranial direct current stimulation (tDCS), have been widely used to improve human physical performance, including foot biomechanical characteristics. This review aims to summarize research on the effects of tDCS on foot biomechanics and its clinical applications, and further analyze the underlying ergogenic mechanisms of tDCS. This review was performed for relevant papers until July 2023 in the following databases: Web of Science, PubMed, and EBSCO. The findings demonstrated that tDCS can improve foot biomechanical characteristics in healthy adults, including proprioception, muscle strength, reaction time, and joint range of motion. Additionally, tDCS can be effectively applied in the field of foot sports medicine; in particular, it can be combined with functional training to effectively improve foot biomechanical performance in individuals with chronic ankle instability (CAI). The possible mechanism is that tDCS may excite specific task-related neurons and regulate multiple neurons within the system, ultimately affecting foot biomechanical characteristics. However, the efficacy of tDCS applied to rehabilitate common musculoskeletal injuries (e.g., CAI and plantar fasciitis) still needs to be confirmed using a larger sample size. Future research should use multimodal neuroimaging technology to explore the intrinsic ergogenic mechanism of tDCS.

Effects of patterned electrical sensory nerve stimulation and static stretching on joint range of motion and passive torque

Static stretching and proprioceptive neuromuscular facilitation stretching techniques can modulate specific neural mechanisms to improve the range of motion. However, the effects of modulation of these neural pathways on changes in the range of motion with static stretching remain unclear. Patterned electrical stimulation of the sensory nerve induces plastic changes in reciprocal Ia inhibition. The present study examined the effects of patterned electrical stimulation and static stretching on a range of motion and passive torque in plantarflexion muscles. The subjects were 14 young men (age 20.8 ± 1.3 years). The effects of patterned electrical stimulation (10 pulses at 100 Hz every 1.5 s) or uniform electrical stimulation (one pulse every 150 ms) to the common peroneal nerve for 20 min on reciprocal Ia inhibition of the Hoffman reflex (H-reflex) were examined. Reciprocal Ia inhibition was evaluated as short-latency suppression of the soleus H-reflex by conditioning stimulation of the common peroneal nerve. Then, the effects of transcutaneous electrical nerve stimulation (patterned electrical stimulation or uniform electrical stimulation) or prolonged resting (without electrical stimulation) and static 3-min stretching on the maximal dorsiflexion angle and passive torque were investigated. The passive ankle dorsiflexion test was performed on an isokinetic dynamometer. Stretch tolerance and stiffness of the muscle-tendon unit were evaluated by the peak and slope of passive torques, respectively. Patterned electrical stimulation significantly increased reciprocal Ia inhibition of soleus H-reflex amplitude (9.7 ± 6.1%), but uniform electrical stimulation decreased it significantly (19.5 ± 8.8%). The maximal dorsiflexion angle was significantly changed by patterned electrical stimulation (4.0 ± 1.4°), uniform electrical stimulation (3.8 ± 2.3°), and stretching without electrical stimulation (2.1 ± 3.3°). The increase in stretch tolerance was significantly greater after patterned electrical stimulation and uniform electrical stimulation than after stretching without electrical stimulation. Stiffness of the muscle-tendon unit was significantly decreased by patterned electrical stimulation, uniform electrical stimulation, and stretching without electrical stimulation. Transcutaneous electrical nerve stimulation and static stretching improve stretch tolerance regardless of the degree of reciprocal Ia inhibition.

Effects of cathodal transcranial direct current stimulation on hip range of motion of healthy sedentary women: A crossover study

The improvements in range of motion (ROM) by cathodal transcranial direct current stimulation (c-tDCS) were only found in sedentary men and not in females. Thus, the study investigated the effect of c-tDCS on hip flexion range of motion (HFROM) in sedentary women. Ten healthy (27.2 ± 6.4 years for age, 67.9 ± 17.8 kg for body mass, 159.1 ± 7.1 cm for height, and 87.1 ± 3.3° for HFROM) and right-leg-dominant women performed a counterbalanced crossover design in two experimental sessions, separated a week apart: c-tDCS and placebo stimulus (sham). Before and after experimental conditions (Pre-stimulation, Post-stimulation), participants had their HFROM measured. A significant interaction was demonstrated for conditions × time (F_{(1, 9)} = 10.666; ƞ² = 0.542; p = 0.01), indicating an increase in HFROM in the post-condition (89.0 ± 2.6°) compared to pre-condition (86.5° ± 2.9°) only in the c-tDCS. However, the HFROM improvements varied from 0.3 % to 6.5 % following c-tDCS. This study suggests that c-tDCS applied over the sensorimotor cortex of healthy sedentary women can acutely improve HFROM, but with a low percentage increase.

Systematic Review of the Impact of Transcranial Direct Current Stimulation on the Neuromechanical Management of Foot and Ankle Physical Performance in Healthy Adults

Objective: This study aims to review existing literature regarding the effects of transcranial direct current stimulation (tDCS) on the physical performances of the foot and ankle of healthy adults and discuss the underlying neurophysiological mechanism through which cortical activities influence the neuromechanical management of the physical performances of the foot and ankle.

Methods: This systematic review has followed the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses. A systematic search was performed on PubMed, EBSCO, and Web of Science. Studies were included according to the Participants, Intervention, Comparison, Outcomes, and Setting inclusion strategy. The risk of bias was assessed through the Cochrane Collaboration tool, and the quality of each study was evaluated through the Physiotherapy Evidence Database (PEDro) scale.

Results: The electronic search resulted in 145 studies. Only eight studies were included after screening. The studies performed well in terms of allocation, blinding effectiveness, and selective reporting. Besides, the PEDro scores of all the studies were over six, which indicated that the included studies have high quality. Seven studies reported that tDCS induced remarkable improvements in the physical performances of the foot and ankle, including foot sole vibratory and tactile threshold, toe pinch force, ankle choice reaction time, accuracy index of ankle tracking, and ankle range of motion, compared with sham.

Conclusion: The results in these studies demonstrate that tDCS is promising to help improve the physical performances of the foot and ankle. The possible underlying mechanisms are that tDCS can ultimately influence the neural circuitry responsible for the neuromechanical regulation of the foot and ankle and then improve their physical performances. However, the number of studies included was limited and their sample sizes were small; therefore, more researches are highly needed to confirm the findings of the current studies and explore the underlying neuromechanical effects of tDCS.

Effects of Dynamic Stretching Velocity on Joint Range of Motion, Muscle Strength, and Subjective Fatigue

Mizuno, T. Effects of dynamic stretching velocity on joint range of motion, muscle strength, and subjective fatigue. J Strength Cond Res XX(X): 000-000, 2020-The purpose of this study was to determine the effects of 2 different dynamic stretching (DS) velocities on joint range of motion (ROM), isometric muscle strength, and subjective fatigue during DS. Fifteen healthy male subjects performed DS at 2 different velocities: maximal active ankle plantar flexion-dorsiflexion velocity (DS100) and 50% of maximal velocity (DS50). A passive dorsiflexion test and isometric maximal voluntary contractions (MVCs) of the ankle plantar flexors and dorsiflexors were performed before and after DS. During the passive dorsiflexion test, ankle ROM and passive torque were measured when the ankle was passively dorsiflexed at 1°·s to its maximal ROM. The DS consisted of 4 sets of 10 ankle plantar flexions/dorsiflexions. For DS100, subjects flexed and extended their ankle as quickly as possible, whereas for DS50 the rhythm of the DS was controlled by a metronome. Subjective fatigue during DS was assessed using a visual analog scale. Maximal ankle ROM and passive torque at the maximal dorsiflexion angle were significantly increased after both DS100 and DS50 (p < 0.05), although there was no significant difference between these trials. The passive torque at submaximal angles and the isometric MVC of the ankle plantar flexors and dorsiflexors were not changed in either condition. However, there was a greater difference in subjective fatigue from prestretching to after 4 sets after DS100 than DS50 (p < 0.05). These results indicate that DS velocity did not influence subsequent joint flexibility. However, DS of moderate speed is recommended because faster DS seems to be associated with greater fatigue.

Ergogenic Effects of Bihemispheric Transcranial Direct Current Stimulation on Fitness: a Randomized Cross-over Trial

Several types of routines and methods have been experimented to gain neuromuscular advantages, in terms of exercise performance, in athletes and fitness enthusiasts. The aim of the present study was to evaluate the impact of biemispheric transcranial direct current stimulation on physical fitness indicators of healthy, physically active, men. In a randomized, single-blinded, crossover fashion, seventeen subjects (age: 30.9 ± 6.5 years, BMI: 24.8±3.1 kg/m2) underwent either stimulation or sham, prior to: vertical jump, sit & reach, and endurance running tests. Mixed repeated measures anova revealed a large main effect of stimulation for any of the three physical fitness measures. Stimulation determined increases of lower limb power (+ 5%), sit & reach amplitude (+ 9%) and endurance running capacity (+ 12%) with respect to sham condition (0.16<ηp2 < 0.41; p<0.05). Ratings-of-perceived-exertion, recorded at the end of each test session, did not change across all performances. However, in the stimulated-endurance protocol, an average lower rate-of-perceived-exertion at iso-time was inferred. A portable transcranial direct current stimulation headset could be a valuable ergogenic resource for individuals seeking to improve physical fitness in daily life or in athletic training.

Can transcranial direct current stimulation improve range of motion and modulate pain perception in healthy individuals?

The objective of the present study was to investigate the effects of different electrode assemblies and electric current polarity on the ROM of the hip and pain perception. Ten healthy male, sedentary, right-leg-dominant, and aged between 19 and 30 years (24.0 ± 4.0 years) subjects were recruited. For the experimental conditions, the application of transcranial direct current stimulation (tDCS) was performed with the following montages. In the montage 1, the cathodal electrode was placed over the motor cortex (MC) horizontally, and the anodal electrode was positioned over the left dorsolateral prefrontal cortex (DLPFC). In the montage 2, the anodal electrode was placed over the MC bilaterally, and the cathode electrode was positioned over the left DLPFC. The sham montage was the same as the montage 1. In the montage 1 and 2 stimulation was applied with 2 mA current intensity for 20 min. In the Sham condition, the stimulator was turned off after 30 s of active stimulation and the electrodes remained on the participants for 20 min. Before and after experimental conditions (Pre-stimulation, Post-stimulation), the maximum Hip ROM and pain perception was measured. For the Montage 1, the maximum Hip ROM increased in post-stimulation compared to pre-stimulation, and in the Montage 2, the maximum Hip ROM decreased in post-stimulation compared to pre-stimulation. The pain perception in the Montage 1 decreased in the post-stimulation compared to pre-stimulation. In the post-stimulation, pain perception for the Montage 1 was lower compared to Montage 2 (p = 0.005), and sham (p = 0.004). When the anodic stimulus was applied on the left DLPFC and the cathodic stimulus on the motor cortex, an increase in ROM and a reduction in the pain perception was observed. This montage may to modulate pain perception and joint flexibility.

Bi-hemispheric anodal transcranial direct current stimulation worsens taekwondo-related performance

Transcranial Direct Current Stimulation (tDCS) is a neuromodulatory technique that has been used as an ergogenic aid in exercise/sports performance. However, little is known about its effects on highly-trained subjects, as athletes. The present study aimed to verify the effects of bi-hemispheric anodal tDCS (a-tDCS) on the performance of taekwondo athletes. Additionally, we investigated the persistence of the effects of the a-tDCS one hour after it. Nineteen Taekwondo athletes received active or sham bi-hemispheric a-tDCS over the primary motor cortex (M1). a-tDCS was delivered at 1.5 mA for 15 min. Athletes performed Countermovement Jumps (CMJ) and the Frequency Speed of Kick Test (FSKT) immediately (Mo1) and one hour after stimulation (Mo2). The athletes also reported their session-rating of perceived exertion (session-RPE). The total number of kicks (TK) was higher in sham than in the active a-tDCS condition (p < 0.01). In addition, TK was higher at Mo2 than at Mo1 (p < 0.05). Similarly, the session-RPE was higher in the a-tDCS condition (p < 0.05) and was greater one-hour post-stimulation (p < 0.01). No differences were found for CMJ performance (p > 0.05). Thus, bi-hemispheric a-tDCS worsens performance of taekwondo athletes, and the effect remains present even 1 h after the stimulation.