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Yang J, Fu R, Hao Z, Lin N, Cheng X, Ma J, Zhang Y, Li Y, Lo WLA, Yu Q, Wang C. The immediate effects of iTBS on the muscle activation pattern under challenging balance conditions in the patients with chronic low back pain: A preliminary study. Front Neurosci 2023; 17:1135689. [PMID: 36998734 PMCID: PMC10045989 DOI: 10.3389/fnins.2023.1135689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
BackgroundThe patients with chronic low back pain (CLBP) showed impaired postural control, especially in challenging postural task. The dorsolateral prefrontal cortex (DLPFC) is reported to involve in the complex balance task, which required considerable attentional control. The effect of intermittent theta burst stimulation (iTBS) over the DLPFC to the capacity of postural control of CLBP patients is still unknown.MethodsParticipants diagnosed with CLBP received a single-session iTBS over the left DLPFC. All the participants completed the postural control tasks of single-leg (left/right) standing before and after iTBS. The activation changes of the DLPFC and M1 before and after iTBS were recorded by functional near-infrared spectroscopy (fNIRS). The activation pattern of the trunk [transversus abdominis (TrA), superficial lumbar multifidus (SLM)] and leg [tibialis anterior (TA), gastrocnemius medialis (GM)] muscles including root mean square (RMS) and co-contraction index (CCI) during single-leg standing were measured by surface electromyography (sEMG) before and after the intervention. The paired t-test was used to test the difference before and after iTBS. Pearson correlation analyses were performed to test the relationship between the oxyhemoglobin concentration and sEMG outcome variables (RMS and CCI).ResultsOverall, 20 participants were recruited. In the right-leg standing condition, compared with before iTBS, the CCI of the right TrA/SLM was significantly decreased (t = −2.172, p = 0.043), and the RMS of the right GM was significantly increased (t = 4.024, p = 0.001) after iTBS. The activation of the left DLPFC (t = 2.783, p = 0.012) and left M1 (t = 2.752, p = 0.013) were significantly decreased and the relationship between the left DLPFC and M1 was significant after iTBS (r = 0.575, p = 0.014). Correlation analysis showed the hemoglobin concentration of M1 was negatively correlated with the RMS of the right GM (r = −0.659, p = 0.03) and positively correlated between CCI of the right TrA/SLM (r = 0.503, p = 0.047) after iTBS. There was no significant difference in the brain or muscle activation change in the left leg-standing condition between before and after iTBS.ConclusionIntermittent theta burst stimulation over the left DLPFC seems to be able to improve the muscle activation pattern during postural control ability in challenging postural task, which would provide a new approach to the treatment of CLBP.
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Affiliation(s)
- Jiajia Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruochen Fu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zengming Hao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nanhe Lin
- Department of Urology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xue Cheng
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinjin Ma
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yushu Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yan Li
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wai Leung Ambrose Lo
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering and Technology Research Center for Rehabilitation Medicine and Translation, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiuhua Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Qiuhua Yu,
| | - Chuhuai Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Chuhuai Wang,
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Bueno MEB, Silva TCOD, de Souza RJ, Volpe RP, Moura FA, Smaili SM. Acute effects of transcranial direct current stimulation combined with physical therapy on the balance and gait in individuals with Parkinson's disease: A randomized controlled trial. Clin Neurol Neurosurg 2023; 226:107604. [PMID: 36739707 DOI: 10.1016/j.clineuro.2023.107604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
Application methods of transcranial direct current stimulation (tDCS) in Parkinson's disease (PD) are quite divergent making it difficult to define the clinical effectiveness of the tDCS on PD. Thus, the aim of this study was to verify the acute effects of tDCS when applied to different targets (Cz or C3-Cz-C4) combined to physical therapy to improve balance and gait in individuals with PD. A randomized controlled trial was conducted, with 50 individuals who were separated into four groups: 1) Real tDCS (Cz) + physical therapy, 2) Real tDCS (C3-Cz-C4) + physical therapy, 3) Sham tDCS + physical therapy and 4) Educational lecture + physical therapy. The current intensity was 2 mA, applied for 20 min. For the instrumental assessment of balance and gait, the 3D motion analysis system was used. For the biomechanical analysis of gait, three different conditions were performed: normal gait, dual task gait and obstacle gait. For balance analysis, the following positions were utilized: Romberg with eyes opened, Romberg with eyes closed, Tandem with eyes opened and Tandem with eyes closed. All evaluations were performed pre-intervention, post-intervention (immediately at the end of the intervention) and were followed-up on (24 h after the end of the intervention). No statistically significant differences were found for all gait and balance outcomes when considering the interaction between time (pre, post and follow-up assessments) versus group (Education, Sham, Cz and C3-Cz-C4). In conclusion, it was found that one session of tDCS, stimulating Cz or C3-Cz-C4 combined with physical therapy, was not effective in improving the balance and gait in people with PD as compared to sham tDCS or educational lecture plus physiotherapy.
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Affiliation(s)
- Maria Eduarda Brandão Bueno
- Neurofunctional Physical Therapy Research Group (GPFIN), Graduate Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
| | - Taís Caroline Oliveira da Silva
- Neurofunctional Physical Therapy Research Group (GPFIN), Graduate Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
| | - Rogério José de Souza
- Neurofunctional Physical Therapy Research Group (GPFIN), Graduate Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
| | - Renata Pasquarelli Volpe
- Neurofunctional Physical Therapy Research Group (GPFIN), Graduate Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
| | - Felipe Arruda Moura
- Laboratory of Applied Biomechanics, Sport Sciences Department - State University of Londrina, Paraná, Brazil.
| | - Suhaila Mahmoud Smaili
- Department of Physiotherapy, Neurofunctional Physical Therapy Research Group (GPFIN), Master's and Doctoral Degree Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
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Stillianesis G, Cavaleri R, Tang CY, Summers SJ. Exploring Patient Perceptions of Noninvasive Brain Stimulation: A Systematic Review. Neuromodulation 2022; 25:487-493. [PMID: 35667767 DOI: 10.1111/ner.13461] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To synthesize and critically appraise literature exploring patient perceptions regarding the therapeutic use of noninvasive brain stimulation. MATERIAL AND METHODS A systematic search of CINHAL, PUBMED, Web of Science, and Medline was performed. Reference lists of relevant articles were also screened. Studies exploring participant perceptions regarding the therapeutic use of noninvasive brain stimulation were eligible for inclusion. Perceptions were divided into three domains: knowledge, experience, and attitudes. Noninvasive brain stimulation was defined as any neuromodulation technique that alters brain activity but does not require invasive methods such as surgery. No restrictions were placed upon study design or participant population. Two reviewers performed data extraction and risk of bias assessment. Data relating to methodological characteristics, participant demographics, type of noninvasive brain stimulation, and nature of perceptions (knowledge, experience, or attitudes) were extracted. RESULTS Four studies comprising data from 163 participants met the inclusion criteria. All studies investigated perceptions of repetitive transcranial magnetic stimulation (rTMS) in psychiatric populations. Most participants perceived rTMS to be safe and beneficial, demonstrated low levels of fear, and were willing to recommend the intervention to others. No studies were found investigating patient perception of transcranial direct current stimulation (tDCS). CONCLUSION The findings from this review suggest that rTMS is well accepted as a therapeutic treatment among psychiatric populations, providing support for its clinical utility. Future work is needed to determine if similar findings exist for other conditions (eg, chronic pain) and for other therapeutic forms of brain stimulation (eg, tDCS).
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Affiliation(s)
- Georgia Stillianesis
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, NSW, Australia
| | - Rocco Cavaleri
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia; Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, NSW, Australia
| | - Clarice Y Tang
- School of Health Sciences, Western Sydney University, Sydney, NSW, Australia; College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Simon J Summers
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, Western Sydney University, Sydney, NSW, Australia; Research School of Biology, Australian National University, Canberra, ACT, Australia; Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
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Ortelli P, Ferrazzoli D, Maestri R, Saltuari L, Kofler M, Alibardi A, Koch G, Spampinato D, Castagna A, Sebastianelli L, Versace V. Experimental Protocol to Test Explicit Motor Learning–Cerebellar Theta Burst Stimulation. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:720184. [PMID: 36188833 PMCID: PMC9397715 DOI: 10.3389/fresc.2021.720184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022]
Abstract
Implicit and explicit motor learning processes work interactively in everyday life to promote the creation of highly automatized motor behaviors. The cerebellum is crucial for motor sequence learning and adaptation, as it contributes to the error correction and to sensorimotor integration of on-going actions. A non-invasive cerebellar stimulation has been demonstrated to modulate implicit motor learning and adaptation. The present study aimed to explore the potential role of cerebellar theta burst stimulation (TBS) in modulating explicit motor learning and adaptation, in healthy subjects. Cerebellar TBS will be applied immediately before the learning phase of a computerized task based on a modified Serial Reaction Time Task (SRTT) paradigm. Here, we present a study protocol aimed at evaluating the behavioral effects of continuous (cTBS), intermittent TBS (iTBS), or sham Theta Burst Stimulation (TBS) on four different conditions: learning, adaptation, delayed recall and re-adaptation of SRTT. We are confident to find modulation of SRTT performance induced by cerebellar TBS, in particular, processing acceleration and reduction of error in all the conditions induced by cerebellar iTBS, as already known for implicit processes. On the other hand, we expect that cerebellar cTBS could induce opposite effects. Results from this protocol are supposed to advance the knowledge about the role of non-invasive cerebellar modulation in neurorehabilitation, providing clinicians with useful data for further exploiting this technique in different clinical conditions.
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Affiliation(s)
- Paola Ortelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
- *Correspondence: Paola Ortelli
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Roberto Maestri
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Markus Kofler
- Department of Neurology, Hochzirl Hospital, Zirl, Austria
| | - Alessia Alibardi
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Giacomo Koch
- Non-invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Danny Spampinato
- Non-invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia Foundation, Rome, Italy
- Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, United Kingdom
| | - Anna Castagna
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy
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Pilloni G, Bikson M, Badran BW, George MS, Kautz SA, Okano AH, Baptista AF, Charvet LE. Update on the Use of Transcranial Electrical Brain Stimulation to Manage Acute and Chronic COVID-19 Symptoms. Front Hum Neurosci 2020; 14:595567. [PMID: 33281589 PMCID: PMC7689057 DOI: 10.3389/fnhum.2020.595567] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022] Open
Abstract
The coronavirus disease 19 (COVID-19) pandemic has resulted in the urgent need to develop and deploy treatment approaches that can minimize mortality and morbidity. As infection, resulting illness, and the often prolonged recovery period continue to be characterized, therapeutic roles for transcranial electrical stimulation (tES) have emerged as promising non-pharmacological interventions. tES techniques have established therapeutic potential for managing a range of conditions relevant to COVID-19 illness and recovery, and may further be relevant for the general management of increased mental health problems during this time. Furthermore, these tES techniques can be inexpensive, portable, and allow for trained self-administration. Here, we summarize the rationale for using tES techniques, specifically transcranial Direct Current Stimulation (tDCS), across the COVID-19 clinical course, and index ongoing efforts to evaluate the inclusion of tES optimal clinical care.
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Affiliation(s)
- Giuseppina Pilloni
- Department of Neurology, NYU Langone Health, New York, NY, United States
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of New York, New York, NY, United States
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Mark S. George
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
- Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States
| | - Steven A. Kautz
- Ralph H Johnson Veterans Affairs Medical Center, Charleston, SC, United States
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, United States
| | - Alexandre Hideki Okano
- Center for Mathematics, Computation and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
- Brazilian Institute of Neuroscience and Neurothechnology 52 (BRAINN/CEPID53 FAPESP), University of Campinas, Campinas, Brazil
| | - Abrahão Fontes Baptista
- Center for Mathematics, Computation and Cognition, Universidade Federal do ABC, São Bernardo do Campo, Brazil
- Brazilian Institute of Neuroscience and Neurothechnology 52 (BRAINN/CEPID53 FAPESP), University of Campinas, Campinas, Brazil
- Laboratory of Medical Investigation 54 (LIM-54), São Paulo University, São Paulo, Brazil
| | - Leigh E. Charvet
- Department of Neurology, NYU Langone Health, New York, NY, United States
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Madrid J, Benninger DH. Non-invasive brain stimulation for Parkinson's disease: Clinical evidence, latest concepts and future goals: A systematic review. J Neurosci Methods 2020; 347:108957. [PMID: 33017643 DOI: 10.1016/j.jneumeth.2020.108957] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
Parkinson's disease (PD) is becoming a major public-health issue in an aging population. Available approaches to treat advanced PD still have limitations; new therapies are needed. The non-invasive brain stimulation (NIBS) may offer a complementary approach to treat advanced PD by personalized stimulation. Although NIBS is not as effective as the gold-standard levodopa, recent randomized controlled trials show promising outcomes in the treatment of PD symptoms. Nevertheless, only a few NIBS-stimulation paradigms have shown to improve PD's symptoms. Current clinical recommendations based on the level of evidence are reported in Table 1 through Table 3. Furthermore, novel technological advances hold promise and may soon enable the non-invasive stimulation of deeper brain structures for longer periods.
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Affiliation(s)
- Julian Madrid
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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Workman CD, Fietsam AC, Rudroff T. Tolerability and Blinding of Transcranial Direct Current Stimulation in People with Parkinson's Disease: A Critical Review. Brain Sci 2020; 10:brainsci10070467. [PMID: 32698528 PMCID: PMC7407758 DOI: 10.3390/brainsci10070467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/08/2020] [Accepted: 07/16/2020] [Indexed: 12/23/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is accompanied by transient sensations (e.g., tingling, itching, burning), which may affect treatment outcomes or break the blinding of the study protocol. Assessing tolerability and blinding is integral to providing ample evidence of a "real effect" from the applied stimulation and dispelling the possibility of placebo effects. People with Parkinson's disease (PwPD) endure many motor and non-motor symptoms that might be amenable to tDCS. However, because the disease also affects sensation capabilities, these subjects might report tolerability and blinding differently than other cohorts. Therefore, the purpose of this review was to aggregate the tolerability and blinding reports of tDCS studies in PwPD and recommend a standard tolerability and blinding reporting practice. A literature search of the PubMed and Scopus databases from 1 January 2020 to 1 April 2020 was performed to identify publications that applied tDCS to PwPD. Seventy studies were potentially reviewable, but only 36 (nine with quantitative tolerability reports, 20 with qualitative tolerability reports, and seven that only reported blinding) provided sufficient information to be included in the review. Quantitative information on tDCS tolerability and blinding maintenance in PwPD is scarce, and future reviews and metanalyses should carefully consider the possibility of placebo effects in their included studies.
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Affiliation(s)
- Craig D. Workman
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (T.R.)
- Correspondence: ; Tel.: +1-319-467-0746
| | - Alexandra C. Fietsam
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (T.R.)
| | - Thorsten Rudroff
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA 52242, USA; (A.C.F.); (T.R.)
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Cerebellar Transcranial Direct Current Stimulation in People with Parkinson's Disease: A Pilot Study. Brain Sci 2020; 10:brainsci10020096. [PMID: 32053889 PMCID: PMC7071613 DOI: 10.3390/brainsci10020096] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/08/2020] [Accepted: 02/09/2020] [Indexed: 12/25/2022] Open
Abstract
People with Parkinson’s disease (PwPD) often experience gait and balance problems that substantially impact their quality of life. Pharmacological, surgical, and rehabilitative treatments have limited effectiveness and many PwPD continue to experience gait and balance impairment. Transcranial direct current stimulation (tDCS) may represent a viable therapeutic adjunct. The effects of lower intensity tDCS (2 mA) over frontal brain areas, in unilateral and bilateral montages, has previously been explored; however, the effects of lower and higher intensity cerebellar tDCS (2 mA and 4 mA, respectively) on gait and balance has not been investigated. Seven PwPD underwent five cerebellar tDCS conditions (sham, unilateral 2 mA, bilateral 2 mA, unilateral 4 mA, and bilateral 4 mA) for 20 min. After a 10 min rest, gait and balance were tested. The results indicated that the bilateral 4 mA cerebellar tDCS condition had a significantly higher Berg Balance Scale score compared to sham. This study provides preliminary evidence that a single session of tDCS over the cerebellum, using a bilateral configuration at a higher intensity (4 mA), significantly improved balance performance. This intensity and cerebellar configuration warrants future investigation in larger samples and over repeated sessions.
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Coppens MJM, Staring WHA, Nonnekes J, Geurts ACH, Weerdesteyn V. Offline effects of transcranial direct current stimulation on reaction times of lower extremity movements in people after stroke: a pilot cross-over study. J Neuroeng Rehabil 2019; 16:136. [PMID: 31699109 PMCID: PMC6839051 DOI: 10.1186/s12984-019-0604-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has shown promise for rehabilitation after stroke. Ipsilesional anodal tDCS (a-tDCS) over the motor cortex increases corticospinal excitability, while contralesional cathodal tDCS (c-tDCS) restores interhemispheric balance, both resulting in offline improved reaction times of delayed voluntary upper-extremity movements. We aimed to investigate whether tDCS would also have a beneficial effect on delayed leg motor responses after stroke. In addition, we identified whether variability in tDCS effects was associated with the level of leg motor function. METHODS In a cross-over design, 13 people with chronic stroke completed three 15-min sessions of anodal, cathodal and sham stimulation over the primary motor cortex on separate days in an order balanced across participants. Directly after stimulation, participants performed a comprehensive set of lower-extremity tasks involving the paretic tibialis anterior (TA): voluntary ankle-dorsiflexion, gait initiation, and backward balance perturbation. For all tasks, TA onset latencies were determined. In addition, leg motor function was determined by the Fugl-Meyer Assessment - leg score (FMA-L). Repeated measures ANOVA was used to reveal tDCS effects on reaction times. Pearson correlation coefficients were used to establish the relation between tDCS effects and leg motor function. RESULTS For all tasks, TA reaction times did not differ across tDCS sessions. For gait initiation and backward balance perturbation, differences between sham and active stimulation (a-tDCS or c-tDCS) did not correlate with leg motor function. Yet, for ankle dorsiflexion, individual reaction time differences between c-tDCS and sham were strongly associated with FMA-L, with more severely impaired patients exhibiting slower paretic reaction times following c-tDCS. CONCLUSION We found no evidence for offline tDCS-induced benefits. Interestingly, we found that c-tDCS may have unfavorable effects on voluntary control of the paretic leg in severely impaired patients with chronic stroke. This finding points at potential vicarious control from the unaffected hemisphere to the paretic leg. The absence of tDCS-induced effects on gait and balance, two functionally relevant tasks, shows that such motor behavior is inadequately stimulated by currently used tDCS applications. TRIAL REGISTRATION The study is registered in the Netherlands Trial Register (NL5684; April 13th, 2016).
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Affiliation(s)
- Milou J M Coppens
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Wouter H A Staring
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
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