Combined effects of cerebellar transcranial direct current stimulation and transcutaneous spinal direct current stimulation on robot-assisted gait training in patients with chronic brain stroke: A pilot, single blind, randomized controlled trial

Picelli, Alessandro; Chemello, Elena; Castellazzi, Paola; Filippetti, Mirko; Brugnera, Annalisa; Gandolfi, Marialuisa; Waldner, Andreas; Saltuari, Leopold; Smania, Nicola

doi:10.3233/rnn-170784

Cited by 28 publications

(92 citation statements)

References 51 publications

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“…Consequently, cortical priming strategies may have a limited benefit, and spinal priming strategies may be more effective. Several studies have investigated this possibility by applying trans-cutaneous spinal direct current stimulation (tsDCS) in conjunction with robotic gait training [ 48 , 58 ]. These studies found that combining tsDCS with tDCS or trans-cutaneous cerebellar direct current stimulation is more effective than any type of stimulation in isolation for improving walking endurance.…”

Section: Discussionmentioning

confidence: 99%

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Madhavan

Cleland

Sivaramakrishnan

et al. 2020

J NeuroEngineering Rehabil

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Background: Stroke survivors experience chronic gait impairments, so rehabilitation has focused on restoring ambulatory capacity. High-intensity speed-based treadmill training (HISTT) is one form of walking rehabilitation that can improve walking, but its effectiveness has not been thoroughly investigated. Additionally, cortical priming with transcranial direct current stimulation (tDCS) and movement may enhance HISTT-induced improvements in walking, but there have been no systematic investigations. The objective of this study was to determine if motor priming can augment the effects of HISTT on walking in chronic stroke survivors. Methods: Eighty-one chronic stroke survivors participated in a controlled trial with stratification into four groups: 1) control-15 min of rest (n = 20), 2) tDCS-15 min of stimulation-based priming with transcranial direct current stimulation (n = 21), 3) ankle motor tracking (AMT)-15 min of movement-based priming with targeted movements of the ankle and sham tDCS (n = 20), and 4) tDCS+AMT-15 min of concurrent tDCS and AMT (n = 20). Participants performed 12 sessions of HISTT (40 min/day, 3 days/week, 4 weeks). Primary outcome measure was walking speed. Secondary outcome measures included corticomotor excitability (CME). Outcomes were measured at pre, post, and 3-month follow-up assessments. Results: HISTT improved walking speed for all groups, which was partially maintained 3 months after training. No significant difference in walking speed was seen between groups. The tDCS+AMT group demonstrated greater changes in CME than other groups. Individuals who demonstrated up-regulation of CME after tDCS increased walking speed more than down-regulators. Conclusions: Our results support the effectiveness of HISTT to improve walking; however, motor priming did not lead to additional improvements. Upregulation of CME in the tDCS+AMT group supports a potential role for priming in enhancing neural plasticity. Greater changes in walking were seen in tDCS up-regulators, suggesting that responsiveness to tDCS might play an important role in determining the capacity to respond to priming and HISTT. Trial registration: ClinicalTrials.gov, NCT03492229. Registered 10 April 2018retrospectively registered, https:// clinicaltrials.gov/ct2/show/NCT03492229.

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Section: Discussionmentioning

confidence: 99%

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Madhavan

Cleland

Sivaramakrishnan

et al. 2020

J NeuroEngineering Rehabil

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“…Apart from M1 [153–157], other areas such as the SMA [158], primary somatosensory cortex (S1) [159] and premotor cortex (PMC) [160] and cerebellum [50, 161, 162] have been targeted in tDCS studies for stroke motor rehabilitation. Overall, patients in acute [155, 163], subacute [164] and chronic phase [156, 157, 161] have shown improvement in motor impairment after tDCS. A previous meta-analysis reported that tDCS showed a more significant effect size on motor recovery in chronic stroke when compared to acute stroke [129].…”

Section: Tdcs As a Motor Neurorehabilitation Tool In Neurological Dismentioning

confidence: 99%

Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes

Morya

Monte-Silva

Bikson

et al. 2019

J NeuroEngineering Rehabil

116

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Transcranial Direct Current Stimulation (tDCS) is a non-invasive technique used to modulate neural tissue. Neuromodulation apparently improves cognitive functions in several neurologic diseases treatment and sports performance. In this study, we present a comprehensive, integrative review of tDCS for motor rehabilitation and motor learning in healthy individuals, athletes and multiple neurologic and neuropsychiatric conditions. We also report on neuromodulation mechanisms, main applications, current knowledge including areas such as language, embodied cognition, functional and social aspects, and future directions. We present the use and perspectives of new developments in tDCS technology, namely high-definition tDCS (HD-tDCS) which promises to overcome one of the main tDCS limitation (i.e., low focality) and its application for neurological disease, pain relief, and motor learning/rehabilitation. Finally, we provided information regarding the Transcutaneous Spinal Direct Current Stimulation (tsDCS) in clinical applications, Cerebellar tDCS (ctDCS) and its influence on motor learning, and TMS combined with electroencephalography (EEG) as a tool to evaluate tDCS effects on brain function.

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“…In fact, a recent tDCS study on patients with stroke reported a faster walking when cerebellum was stimulated in addition to the corticospinal system. 27…”

Section: Discussionmentioning

confidence: 99%

The use of brain stimulation in the rehabilitation of walking disability in patients with multiple sclerosis: A randomized double-blind clinical trial study

Oveisgharan

Karimi

Abdi

et al. 2019

CJN

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Background: Transcranial direct current stimulation (tDCS) of the primary motor cortex of the lower limb has been exploited in the treatment of patients with stroke and spastic lower limb paresis. We examined this stimulation efficacy in the treatment of multiple sclerosis (MS)-related walking disability. Methods: In a single-center randomized doubleblind clinical trial study, 13 patients with MS and walking disability and Expanded Disability Status Scale (EDSS) score of 3 to 6 were randomized to the real and sham stimulation groups. In the real tDCS stimulation, 7 patients received anodal 2.5 mA stimulation at 1 cm anterior to the Cz point for 30-minute daily sessions in 7 consecutive days. The other group received sham stimulation with the same protocol. The primary outcome of the trial was change in the Timed 25-Foot Walk (T25-FW) from before to after the stimulation. We also assessed the Multiple Sclerosis Walking Scale-12 (MSWS-12). We employed linear mixed effects model to examine the efficacy of tDCS stimulation on changing the outcomes. Results: On average, patients who received real tDCS stimulation walked faster after 7 sessions of stimulation [Estimate = -2.7, standard error (SE) = 1.3, P = 0.049], while walking speed of sham stimulation recipients did not change. For every session of stimulation, recipients of real tDCS stimulation spent 2.7 seconds less for walking the 25 feet. Real tDCS stimulation was not effective in improving MSWS-12 scores. Conclusion: tDCS stimulation of the lower limb motor cortex speeded up patients with MS in walking, but without improvement in patients’ mobility in daily activities.

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Combined effects of cerebellar transcranial direct current stimulation and transcutaneous spinal direct current stimulation on robot-assisted gait training in patients with chronic brain stroke: A pilot, single blind, randomized controlled trial

Cited by 28 publications

References 51 publications

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Beyond the target area: an integrative view of tDCS-induced motor cortex modulation in patients and athletes

The use of brain stimulation in the rehabilitation of walking disability in patients with multiple sclerosis: A randomized double-blind clinical trial study

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