TRANSCRANIAL DIRECT-CURRENT STIMULATION IN COMBINATION WITH EXERCISE: A SYSTEMATIC REVIEW

Bi-Anodal Transcranial Direct Current Stimulation Combined With Treadmill Walking Decreases Motor Cortical Activity in Young and Older Adults

Background: Walking in the "real world" involves motor and cognitive processes. In relation to this, declines in both motor function and cognition contribute to age-related gait dysfunction. Transcranial direct current stimulation (tDCS) and treadmill walking (STW) have potential to improve gait, particularly during dual-task walking (DTW); walking whilst performing a cognitive task. Our aims were to analyze effects of combined anodal tDCS + STW intervention on cortical activity and gait during DTW. Methods: Twenty-three young adults (YA) and 21 older adults (OA) were randomly allocated to active or sham tDCS stimulation groups. Participants performed 5-min of mixed treadmill walking (alternating 30 s bouts of STW and DTW) before and after a 20-min intervention of active or sham tDCS + STW. Anodal electrodes were placed over the left prefrontal cortex (PFC) and the vertex (Cz) using 9 cm² electrodes at 0.6 mA. Cortical activity of the PFC, primary motor cortex (M1), premotor cortex (PMC), and supplementary motor area (SMA) bilaterally were recorded using a functional near-infrared spectroscopy (fNIRS) system. Oxygenated hemoglobin (HbO₂) levels were analyzed as indicators of cortical activity. An accelerometer measured gait parameters. We calculated the difference between DTW and STW for HbO₂ and gait parameters. We applied linear mixed effects models which included age group (YA vs. OA), stimulation condition (sham vs. active), and time (pre- vs. post-intervention) as fixed effects. Treadmill belt speed was a covariate. Partial correlation tests were also performed. Results: A main effect of age group was observed. OA displayed higher activity bilaterally in the PFC and M1, unilaterally in the right PMC and higher gait variability than YA. M1 activity decreased in both YA and OA following active tDCS + STW. There was no overall effect of tDCS + STW on PFC activity or gait parameters. However, negative correlations were observed between changes in left PFC and stride length variability following active tDCS + STW intervention. Conclusion: Increased activity in multiple cortical areas during DTW in OA may act as a compensatory mechanism. Reduction in M1 activity following active tDCS + STW with no observed gait changes suggests improved neural efficiency.

Engineering the ABIO-BIO interface of neurostimulation electrodes using polypyrrole and bioactive hydrogels

Following spinal cord injury, the use of electrodes for neurostimulation in animal models has been shown to stimulate muscle movement, however, the efficacy of such treatment is impaired by increased interfacial impedance caused by fibrous encapsulation of the electrode. Sputter-deposited gold-on-polyimide electrodes were modified by potentiostatic electrodeposition of poly(pyrrole-co-3-pyrrolylbutyrate-conj-aminoethylmethacrylate): sulfopropyl methacrylate [P(Py-co-PyBA-conj-AEMA):SPMA] to various charge densities (0–100 mC/cm2) to address interfacial impedance and coated with a phosphoryl choline containing bioactive hydrogel to address biocompatibility at the ABIO-BIO interface. Electrodes were characterized with scanning electron microscopy (surface morphology), multiple-scan rate cyclic voltammetry (peak current and electroactive area), and electrochemical impedance spectroscopy (charge transfer resistance and membrane resistance). SEM analysis and electroactive area calculations identified films fabricated with a charge density of 50 mC/cm2 as well suited for neurostimulation electrodes. Charge transfer resistance demonstrated a strong inverse correlation (−0.83) with charge density of electrodeposition. On average, the addition of polypyrrole and hydrogel to neurostimulation electrodes decreased charge transfer resistance by 82 %. These results support the use of interfacial engineering techniques to mitigate high interfacial impedance and combat the foreign body response towards epidurally implanted neurostimulation electrodes.